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Singapore Nursing Research Conference

March 22-24, 2021 | Singapore

Ruby Parmar

Renowned Speaker for Nursing Conference 2021- Ruby Parmar
Ruby Parmar
Hampshire Hospitals Foundation Trust Winchester, UK
Title : Working together to help children with Enuresis (Nurses play an invaluable role)


Background -  Primary nocturnal enuresis is defined as the involuntary voiding of urine during sleep at least three times a week in children aged five years or older, who do not have any problems with the urinary tract or nervous system
Although not a serious medical condition, Bed wetting is a widespread and distressing condition affecting up to 20% of children at 5 years of age gradually reducing to1% by the time they are 16 years old. It can have a deep impact on a child or young person’s behaviour, emotional wellbeing and social life, and can also be stressful for the parents or carers alike.
It has been established that good support through providing information and education to the child and families can help children achieve dryness and ease the burden of enuresis.
Our Local Enuresis Service
Referral Pathway
This is second tier referral clinic where a doctor works alongside specialist enuresis nurses.  The referrals are received from the GP, from School Nurses, school continence advisors, Psychology and Psychiatry services, and other Paediatricians.
Management Pathway -
General advice promoting good toileting routine is given, but children who do not respond are referred to Second Tier clinic.
Medical assessment is carried out and a treatment plan is initiated using the National Institute of Clinical Excellence (NICE) Guidelines.
The child is then supported and followed up by specialist nurses. This is the most valuable step in the management pathway and requires incredible knowledge, skills, and patience.
Education and Progress
We continually teach and train other school and community nurses, health visitors, school nurses, school continence advisers, junior doctors, and medical students, while updating our own knowledge and practice through attending study days organised by Bowel and Bladder UK, and ERIC, review of difficult cases ,and  audit of our service.
Links with primary and Tertiary Care
We have established a good system where children and families receive general advice through primary care, this helps resolve bedwetting in a large number of children thereby reducing the number of referrals to second tier clinic. Onward Referrals to tertiary clinics like other specialities including Urology, Gastroenterology, Psychiatry, Social Services and other specialist services are made as required.
Current Status
Our service has evolved over time to accommodate large number of referrals, and children with co-morbidities.
An additional Telephone Support Clinic service is run by Nurses, successfully with good feedback
Lessons learnt
Nursing expertise and support is invaluable for children who have Enuresis and their parents.
Training, education, and funding to Health Visitors, School Nurses, Practice Nurses and Staff Nurses as well as other primary care givers, can help provide an excellent service for children with Enuresis.
Timely intervention in Enuresis can prevent children from having low self-esteem, being bullied, and in some cases being abused. Hence nurses and doctors together need to advocate for services for this problem which affects thousands of children in the UK and all over the world. 


Dr Ruby Parmar (MBBS DCH MRCPCH) Working as Associate Specialist In Child health at Hampshire Hospitals Foundation Trust for last 20 years .Lead Roles in Paediatric Continence , Paediatric Audiology, and Professional development of other doctors. Presented Posters at International conferences by Royal college of Paediatrics and Child Health.


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