1. General information
    1. Involuntary passage of urine after the age of control is expected (about 4 years)
    2. Types
      1. Primary: in children who have never achieved control
      2. Secondary: in children who have developed complete control and lose it
    3. May occur at any time of day but is most frequent at night
    4. More common in boys
    5. No organic cause can be identified; familial tendency
    6. Etiologic possibilities
      1. Sleep disturbances
      2. Delayed neurologic development
      3. Immature development of bladder leading to decreased capacity
      4. Psychologic problems
  2. Medical management
    1. Bladder retention exercises
    2. Behavior modification, e.g., bed alarm devices
    3. Drug therapy: results are temporary; side effects may be unpleasant or even dangerous
      1. Tricyclic antidepressants: imipramine HCI (Tofranil)
      2. Anticholinergics
  3. Assessment findings
    1. Physical exam normal
    2. History of repeated involuntary urination
  4. Nursing interventions
    1. Provide information/counseling to family as needed.
      1. Confirm that this is not conscious behavior and that child is not purposely misbehaving.
      2. Assure parents that they are not responsible and that this is a relatively common problem.
    2. Involve child in care; give praise and support with small accomplishments.
      1. Age 5-6 years; can strip bed of wet sheets.
      2. Age 10-12 years: can do laundry and change bed.
    3. Avoid scolding and belittling child.