A 4-year-old boy wets the bed 4 to 5 nights per week. He has normal daytime continence, no urinary symptoms, and physical examination is unremarkable. What is the most appropriate management?

• A Start desmopressin therapy
• B Urine culture and antibiotics
• C Renal ultrasound
• D Reassurance and behavioral measures ✓

Explanation

Nocturnal enuresis before age 5 is considered normal, especially with normal daytime continence and no other symptoms. Reassurance and behavioral measures such as fluid restriction before bedtime and bladder training are first-line. Desmopressin is reserved for children above 5 to 6 years with persistent enuresis. Urine culture and imaging are not indicated without daytime symptoms.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.