First step in management is to obtain a detailed history and physical examination followed by a routine urine analysis, a random blood sugar and Urine culture (if symptoms of UTI). A 24 hour voiding record helps access the severity of condition and bladder function. Ultrasound or X-rays or exhaustive blood tests are NOT needed.
Next important part in management is the counseling. Caregivers should understand that it is a harmless condition and would remit on its own within 6 weeks to 6 months. Few children may have recurrence of symptoms for 1-2 years. Don’t criticize or punish the child. Don’t force child to hold urine. Increase fluid intake.
Avoid constipation and try identifying any Psychological stressor for the child.
Reassure the child that he/she would be able to hold urine without leaking accidents and try to distract the child by engaging in their favorite activities. But at the same time, also be aware of child’s feelings, and don’t pressurize too much if at all child shows the urge to pass urine and is not attempting to hold. Often ignoring child’s symptoms helps in faster resolution of symptoms. Talk to teachers or other people involved in child’s care privately. They also just need to support and reassure the child.
Further evaluation/referal is needed if there is any change in symptoms like pain during micturition, fever, new onset bed-wetting, excessive thirst etc.
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