The answer

Leo may have primary nocturnal enuresis without any daytime symptoms – if the latter was not the case, or if he was experiencing bedwetting after several months of being dry at night, he would need referring to the GP – so there are a few things Sarah can try.

The first is to ensure her son is not constipated, as this can cause of urinary incontinence in younger children, and to make sure he is drinking plenty of fluids, as inadequate intake can mask issues such as overactive bladder disorder, and hinder the development of the bladder’s capacity.

Assuming all is well with Leo’s bowels and hydration levels, a sensible next step is to keep a diary of fluid intake, bedwetting and toileting patterns for a couple of weeks. If the issue is twice a week or less, Vicky can reassure Sarah that a wait and see approach is best.

If it is more often than this, Sarah may want to consider using an enuresis alarm in combination with a reward system such as a star chart for helping with changing sheets, drinking enough fluid during the day and using the toilet before going to bed. Desmopressin is an option if there is a need for quick or short-term control, for example, because of a school trip, or if an alarm isn’t suitable, for example because Leo shares a bedroom. Waking the child at night isn’t considered a useful strategy long term.