Urologic Conditions in Infants and Children: Toilet Training and Nocturnal Enuresis.

Toilet training is a developmental task that typically can be accomplished without medical intervention. Parent counseling about it can begin approximately at the 18- to 24-month well child visit. Guidelines from the American Academy of Pediatrics recommend beginning toilet training when the child shows signs of readiness, but typically not before age 2 years; praising success using positive terms; avoiding punishment, shaming, or force; and making training positive, nonthreatening, and natural. Nocturnal enuresis is defined as urinary incontinence that occurs at night during sleep in children 5 years or older for 3 consecutive months. It is common, affecting 5%-10% of 7-year-old children in the United States. Nonpharmacologic management includes behavioral interventions (eg, limiting fluid intake before bedtime, waking the child at night to attempt to urinate, lifting the sleeping child onto the toilet and then waking him or her to urinate, bladder training to increase bladder capacity, or instituting a reward system). Bed alarms are the first-line intervention but typically are not reimbursed by health insurance. Pharmacotherapy includes desmopressin, tricyclic antidepressants, and anticholinergics. The combination of a bed alarm with pharmacotherapy can be considered as initial management or after an unsuccessful initial intervention.