Continence (Paediatric)

Availability

North South North West Statewide

Pre-referral work-up

History

  • Please refer earlier (preferably around three years of age) rather than later, especially in those individuals with special needs and where your initial plan is not working.
  • Isolated night wetting can be referred to the Wetaway program in the first instance.

Scope

This is a multidisciplinary clinic which provides assessment and management of children (under 17 years) who are having difficulties controlling their bowels or bladder, including those children with developmental delay or disabilities.

Referral

All referrals should comply to Referral Standards and specifically include a history of the problem, what you have tried and developmental, social issues.

Contact: Direct contact can occur on Monday via the Nurse Co-ordinator (03) 6222 8475 and at other times via the Paediatric Clinic number (03) 6222 6776.

Tests

  • Urine m/c/s and dipstix results for glucose and specific gravity
  • A bladder diary (48 hour diary documenting the timing and volume of all fluids in, and timing and volumes of all urine out) is very helpful

Not routinely required:

  • Renal ultrasound
  • Abdominal xray
  • PR examination of children is not required

Interim/GP management

To refer a patient with this condition, please see the Paediatrics clinic page for the full referral process and templates.

While you wait for an appointment:

  • Remove blame and shame
  • Educate family:

- night time wetting will not be fixed by evening restriction, planned overnight wakes to void, reward or punishment

- problems can be fixed and not to be discouraged

We also know that:

  • The combination of a laxative in adequate dosage and a program of regular planned sits on the toilet to try to defecate even if there is no sensation of a need to go, will be helpful to children with constipation/faecal incontinence while they wait to see us.  A chart keeping track of successful and unsuccessful sits will be helpful.
  • In young children with constipation who are fearful and 'actively withholding', remove any pressure to use the toilet or potty and revert to nappies or pull ups, if this is something the child wants.
  • Regular, planned trips to the toilet to void (irrespective of sensation of a need to go) are helpful in children with daytime urinary incontinence while they wait to see us.

For more information please see the Tasmanian Health Pathways website.

Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Emergency:

Proceed to Emergency Department (ED).  Please contact ED Medical Officer in Charge:
LGH ED
- Phone: (03) 6777 6405  Fax: (03) 6348 7382
MCH ED
- Phone: (03) 6478 5120  Fax: (03) 6441 5923
NWRH ED
- Phone: (03) 6493 6340  Fax: (03) 6464 1926
RHH ED
- Phone: (03) 6166 6100  Fax: (03) 6173 0489

Urgent:

Urgent referrals should be accompanied by a phone call to the Consultant/Registrar to organise urgent review and the referral must be faxed.

We will endeavour to see these patients within 4 weeks, or sooner if clinically indicated.

For any urgent sexual abuse/assault concerns please phone RHH switchboard and ask Paediatric Sexual Assault Consultant or Registrar on call for advice.

Semi-urgent:

We will endeavour to see these patients within 12 weeks

Routine:

Next available appointment