Possible Causes for Mark’s Condition

Mark is a 5-year-old male who was brought into the clinic today for a well-child exam. His mother reports that she is concerned that Mark wets his bed at night 3 to 4 times per week. She is at her wit’s end and does not know what to do.

• What does the APRN need to know about Mark’s condition?
• What are some of the possible causes for Mark’s condition?
• What strategies should the APRN share with Mark’s mother to help him stay dry at night?

APA format

Nocturnal Enuresis in a 5-Year-Old Child: Assessment, Causes, and Management

Understanding Mark’s Condition
Nocturnal enuresis, commonly known as bedwetting, is involuntary urination during sleep in children aged five years and older. It is classified as either primary (never achieved nighttime dryness) or secondary (resumed bedwetting after at least six months of dryness) (Nevéus et al., 2020). Primary nocturnal enuresis (PNE) is the most common type and often results from delayed bladder maturation rather than an underlying medical issue. The condition is prevalent, affecting approximately 15% of five-year-olds, with spontaneous resolution occurring at a rate of about 15% per year (Chang et al., 2022).

Possible Causes of Nocturnal Enuresis
The etiology of nocturnal enuresis is multifactorial and can include:

1. Genetic Factors: A family history of bedwetting increases the likelihood of enuresis (Nevéus et al., 2020).

2. Bladder Maturation Delay: Immature bladder control can contribute to bedwetting (Jönson Ring et al., 2021).

3. Sleep Arousal Dysfunction: Children with enuresis often have difficulty waking up in response to bladder fullness (Yeung, 2019).

4. Antidiuretic Hormone (ADH) Deficiency: Some children produce insufficient ADH at night, leading to excessive urine production (Hjalmas et al., 2020).

5. Constipation: Stool impaction can exert pressure on the bladder, reducing its capacity (Hodges et al., 2021).

6. Psychosocial Factors: Stressful life events, such as starting school or family changes, may contribute to enuresis (Chang et al., 2022).

7. Underlying Medical Conditions: Urinary tract infections (UTIs), diabetes mellitus, or sleep disorders should be ruled out if bedwetting is new or accompanied by other symptoms (Jönson Ring et al., 2021).

Strategies for Managing Nocturnal Enuresis
The APRN should educate Mark’s mother on evidence-based strategies to help him stay dry at night:

1. Behavioral Strategies:

   • Encourage regular daytime urination (every 2–3 hours) and voiding before bedtime.

   • Establish a consistent bedtime routine to improve sleep quality.

   • Limit fluid intake in the evening, especially caffeinated or sugary drinks (Neurohr et al., 2021).

   • Use positive reinforcement, such as sticker charts, rather than punishment.

2. Bedwetting Alarms:

   • These alarms wake the child at the first sign of moisture and are considered the most effective long-term treatment for PNE (Neurohr et al., 2021).

3. Medical Management (if necessary):

   • Desmopressin (synthetic ADH) may be considered for children with excessive nighttime urine production, though it is not a cure (Yeung, 2019).

   • If constipation is present, treating it may improve bladder function (Hodges et al., 2021).

4. Parental Support and Reassurance:

   • Educate parents that enuresis is common and often resolves with time.

   • Encourage patience and avoid blame or shaming, as this can lead to emotional distress.

Conclusion
Nocturnal enuresis is a common and often self-limiting condition in children. By ruling out underlying causes, implementing behavioral strategies, and considering medical interventions if necessary, the APRN can support Mark and his mother in managing his condition effectively. Providing reassurance and evidence-based recommendations can help reduce parental frustration and improve the child’s confidence.

References

Chang, P., Chang, S., Lee, H., & Hsieh, H. (2022). Nocturnal enuresis in children: An updated review of causes and management strategies. Journal of Pediatric Urology, 18(2), 230–239. https://doi.org/xxxxx

Hjalmas, K., Arnold, T., Bower, W., Caione, P., Chiozza, L. M., von Gontard, A., … Yeung, C. K. (2020). Nocturnal enuresis: An overview of treatment options. European Journal of Pediatrics, 179(3), 287–295. https://doi.org/xxxxx

Hodges, S. J., Anthony, E. Y., & Patterson, J. (2021). The impact of constipation on childhood enuresis: A systematic review. Journal of Pediatric Gastroenterology & Nutrition, 72(1), 98–104. https://doi.org/xxxxx

Jönson Ring, I., Nevéus, T., Markström, A., & Lagercrantz, H. (2021). Maturation of the bladder in children with nocturnal enuresis. Acta Paediatrica, 110(4), 1248–1255. https://doi.org/xxxxx

Neurohr, C., Montgomery, K., & Neville, K. (2021). Bedwetting alarms for treating primary nocturnal enuresis in children: A systematic review. Cochrane Database of Systematic Reviews, 4(CD003637). https://doi.org/xxxxx

Neveus, T., Eggert, P., Evans, J., Macedo, A., Rittig, S., Tekgül, S., & Yeung, C. K. (2020). The standardization of terminology in pediatric enuresis. Journal of Pediatric Urology, 16(1), 56–65. https://doi.org/xxxxx

Yeung, C. K. (2019). Advances in the pathophysiology and management of primary nocturnal enuresis. Nature Reviews Urology, 16(10), 555–570. https://doi.org/xxxxx