A 7-Year-Old Girl Comes to the Office with Her Mother

question 438

Multiple Choice

A 7-year-old girl comes to the office with her mother due to "wetting her bed" for the past week.  The patient has been dry at night for the past year but has woken up about once a night for the past week because she urinated in the bed.  She has no fever, dysuria, hematuria, or changes in bowel movements.  There have been no changes in the patient's diet or fluid intake; the family eats dinner at 6:00 PM, with which she has her last glass of milk or juice for the day.  The patient goes to bed at 8:30 PM.  The patient has no medical conditions and takes no daily medications.  Her parents divorced six months ago, and she lives with her mother and older sister.  Temperature is 36.7 C (98.1 F) , blood pressure is 96/57 mm Hg, and pulse is 70/min.  Height and weight are at the 40th percentile.  Cardiopulmonary examination is unremarkable.  The abdomen is soft and nontender.  The external genitalia appear normal with no rashes or excoriations.  Which of the following is the best next step in management of this patient?

• A)Obtain a urinalysis
• B)Reassure that this will resolve in a few weeks
• C)Recommend a voiding diary
• D)Recommend restricting evening fluid intake
• E)Suggest a bed enuresis alarm