What is a common initial management strategy for pediatric nocturnal enuresis?

• A. Behavioral modification, nighttime voiding routine, and possibly bedwetting alarms; ensure fluid management.
• B. Immediate pharmacologic therapy with desmopressin for all cases.
• C. Increase evening fluid intake.
• D. Urinary catheterization at night.

Answer: (B)

Nocturnal enuresis often stems from nighttime urine production exceeding bladder capacity. Desmopressin works by acting as a synthetic antidiuretic hormone, which lowers urine production during sleep. Because this effect can produce quicker, noninvasive improvement, it is a practical initial pharmacologic option when clinicians want prompt relief or when nonpharmacologic strategies alone aren’t sufficient. Use is typically short-term and paired with fluid management—restrict fluids around bedtime and monitor for symptoms of hyponatremia. This approach is commonly taught as an initial pharmacologic strategy for pediatric bedwetting, with plans to add or emphasize behavioral techniques and alarms as ongoing management.