“He’s still wetting the bed at 7 — his dad says he’s too old for this”

Nocturnal enuresis at 7 must be managed without shame: it is common (affecting a significant minority of children), not the child’s fault, not laziness or naughtiness, and very treatable — so the first and central task is to say so clearly to both parent and child, stop the counterproductive and harmful responses (telling off, restricting drinks, lifting), protect the child from blame, and engage the embarrassed child kindly and directly. Take a focused history distinguishing primary (never dry) from secondary (dry then wetting again, more likely to have an emotional or medical trigger), and covering daytime symptoms (urgency/frequency/daytime wetting suggesting bladder dysfunction), fluid and caffeine intake/timing, constipation, sleep/snoring, family history (often positive) and psychosocial stressors. Exclude and treat contributors and red flags — constipation (a very common, reversible cause that often resolves the enuresis when treated), UTI (urinalysis only when indicated, not routinely — NICE CG111), diabetes (polyuria, polydipsia, weight loss — same-day glucose if suggestive, never miss new-onset type 1, NICE NG18), daytime bladder dysfunction, neurological/spinal signs, and safeguarding/emotional triggers for secondary enuresis. Manage per NICE CG111: demystify and reassure, address the basics first (adequate drinks spread through the day rather than restricted, avoid caffeine, regular toileting, treat constipation, stop punishment and lifting), then offer an enuresis alarm as first-line for a motivated child/family (best long-term cure rates, needs weeks of commitment), with desmopressin as an option for rapid/short-term results, sleepovers, or where an alarm is unsuitable or has failed (dose per BNFC, with fluid restricted from 1 hour before to 8 hours after the dose because of hyponatraemia risk, and omitted during vomiting or diarrhoea); use reward systems for agreed behaviours (good drinking, toileting, helping with sheets) not for dry nights, which the child cannot control. Engage the child as owner of the plan, set realistic expectations, and — given the loaded dynamic of the father’s frustration, family rows and the child’s shame — lift the blame, educate the family (offering the mother an explanation she can share with the absent father), and protect the child’s wellbeing as much as treating the symptom, watching for emotional impact or secondary causes. Exclude diabetes.