Nocturnal enuresis (NE), commonly known as bed-wetting, affects millions of school-age children and can have significant psychosocial impacts. An updated expert consensus, published in the World Journal of Pediatrics, now offers a practical framework for clinicians to diagnose and treat this condition more effectively. The new guidance, which includes 18 recommendations, aims to shift practice from symptom-based treatment to a more standardized, individualized, and family-centered approach.
The consensus, led by researchers from the Children's Hospital of Fudan University and the Chinese Cooperative Group for the Management of Pediatric NE, updates the previous 2014 Chinese guidelines. Key changes include lowering the diagnostic threshold to at least one involuntary nighttime void per month for three months in children aged five years or older. This earlier identification allows for timely intervention. The framework also mandates a clear distinction between monosymptomatic NE (MNE), where no daytime lower urinary tract symptoms are present, and non-monosymptomatic NE (NMNE), which includes daytime symptoms such as urgency or incontinence. This classification is crucial for guiding treatment decisions.
A cornerstone of the new approach is the use of voiding diaries. Clinicians are advised to have patients record at least two daytime charts and seven consecutive nights of fluid intake and voids. This helps phenotype children as having nocturnal polyuria (excessive nighttime urine production), reduced bladder capacity, or a combination of both. For MNE, treatment is phenotype-driven: desmopressin for nocturnal polyuria and the enuresis alarm for reduced bladder capacity, with combination therapy for mixed types. For NMNE, the consensus emphasizes managing daytime lower urinary tract symptoms and comorbidities, particularly constipation, which affects 36–80% of these children, before addressing nighttime wetting.
The updated guidance also clarifies referral pathways. Primary care clinicians can manage MNE cases, but non-responders or those with suspected NMNE should be referred for specialist evaluation, which may include urodynamics and lumbosacral magnetic resonance imaging (MRI). For refractory cases, defined as less than 50% improvement after three months, the consensus advises systematic re-evaluation of adherence, diary findings, and potential underlying causes before escalating treatment.
The authors stress that NE should not be treated as a single disorder. By identifying the child's specific pattern and addressing daytime symptoms and comorbidities, care can be more effective. They also highlight that apparent treatment failure should trigger a careful review of adherence and possible missed conditions before adding stronger therapies. This approach aims to reduce trial-and-error treatment and improve response rates.
The full article, with DOI: 10.1007/s12519-026-01051-4, is available in the World Journal of Pediatrics. The journal, with an Impact Factor of 7.3, provides a platform for pediatric research and clinical practice. The consensus represents a significant step toward more systematic and individualized care for children with nocturnal enuresis, potentially improving outcomes and quality of life for affected families.
