Posted by: BMJ | 2010/06/01


What on earth is wrong??

Dear Doc

I have a 3y and3month old son who has been sucsessfully and easily potty trained for several months (almost a year) now. He has also been night time trained for 4 months and we have had less than 3 accidents in total over that time. Of which only 1 was at night - regardless of the amount drunk before bed.

3 weeks ago he started having accidents in the day and also wetting the bed at night (more than once) and this happened everyday for a few days. He did not have a fever and his appetite was poor. My dr arranged for me to do a urine dipstick test at home as she was fully booked. I had a sterile cup and placed the stick in his urine. Immediately afterwards none of the markers changed. I left to answer a call and when I returned to dispose of the dipstick I(40min later) I noticed some of the markers she asked me to look at specifically changed. I called her the next morning and she confirmed a uti. My son absolutely does not take medications orally. He clamps his mouth shut and short of injuring him, it just does not go in (I have 3 sons and have no problem giving meds that must go in) and the bit that you do manage to force in, he vomits up in less than 10 seconds. He does have a major oral tactile issue. Because of this my dr came to give him an antibiotic by injection. I dont remember the name - I just now it was not penicillen as he is allergic. His appetite was better the next day and the day time wetting was much better. However, the night time wetting continues. Before she gave him the injection she took another urine sample to send away for a culture - but it came back clear. He has no fluids after 5pm. He wees before bed. I take him at 10pm again and I set my alarm for 2am again to take him to wee. But he still wakes up wet at 5am. This is now for 3 weeks straight.

I am noticing that he does not seem to like going to the toilet to wee or go outside. I almost have to beg him to go in the day and his undies is always slightly wet. I asked him if it is sore to wee but he says no. He does seem to be holding his penis a lot more than is usual for him. There has been no emotional upsets at all - life is very boring and predictable at the moment. I dont excpect a child as young as he is to never have accidents - but the suddeness, prolonged and seemingly for no reason does worry me. He is not constipated, and otherwise he is healthy and perfectly normal.

Do I just go back to nappies now? Please help me - I am desperate now.

Expert's Reply



Your son has definitely had a recent urinary system infection. In boys this is always of concern and your son must be investigated after having such an infection to make sure that his urinary system is normal.At the very least he will need an ultrasound examination. In the meantime he needs to be back in nappies or pullups.Your paediatrician should arrange for these tests soon so please contact her again. His urinary infection also needs careful treatment as it is essential to clear any possible infection. If the only way this can be done is in hospital then you may need to consider this possibility.Once you are sure that your son's urinary system is entirely normal then you can re-start attempts to deal with his enuresis [bed-wetting] problem starting with using a star chart.

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