More than 400 children from 5 to 10 years old are attained in France of primary nocturnal isolated enuresis (ENPI), a problem often crossed under silence while one should take care adapted including a specific treatment allows to speed its disappearance up in the majority of cases. Enuresis remains today another problem too often made commonplace, repercussions of which both on the life of the child and on that of the family are underestimated.

The often misread, family repercussions, are not less important there:

• financial consequences (washing, removal, layers, classical possible treatments or not [consultations, alarms, thermal remedies]);
• consequences to the mobility of the family;
• feeling of educational failure and of guilt of the parents: the inquiry Sofres of 1997 and the inquiry led by the Laboratory Ferring in 1999 reveal that 48 % mothers think that they could be responsible, 57 % think that enuresis started following particular events;
• family dysfunctions were procreated by bad relation between the child and the parents, punishments inflicted on the child (30 % cases), bullying, or even abuses, family secret (the enuresis of the child is for some a taboo subject).

Repercussions on the child are social, but also school and psychological. The social discomfort of enuresis for the children is very real: the child isolates himself, refuses to go to sleep at friends' or to leave in group, and its relations with other children in class or even except the class are damaged.
The ringing of enuresis on the schooling is difficult to appreciate, underlines the Dr Jean-Paul Blanc (liberal pediatrician, Saint- tienne), responsible for the Group of AFPA* on school problems. However, according to the inquiry of Sofres of 1997, 2 % mothers, 15 % school doctors and 26 % teachers think that enuresis blares on school performances.

This negative impact could be linked to the psychological repercussions of enuresis among which some are unquestionable, such as the fall on one and the reduction of the self-esteem is distrustful it.
Anxiety, instability-hyperactivit , aggressiveness, disturbances of mood and sleep troubles: it is difficult to establish with certainty a causal relation between noticed symptoms and enuresis.
The real repercussions of this "taboo" subject in families and in society still are to specify, where from interest of l national inquiry Wee in the bed , thrown by the Laboratory Ferring to assess the ringing of ENPI on the school, family and relational life of the child. This inquiry started the ler October, 2002, she must be led over twenty-four months to 3 000 families, her results will make the object of a publication.

Reassure, justify, search membership
After confirmation of the diagnosis of ENPI, the first stage is based on the quality of maintenance between child, one or several parents and doctor, the objective being to reassure the child on its "normality", to justify him, of entr iner its cooperation and its membership in the treatment.
This first consultation is a chance to give simple advice (to make sure that drinks are regularly divided during the day to be able to restrain them in the evening, to empty his bladder just before falling asleep, abolishing layers) and to make participate the child by the keeping of a mictionnel calendar. Often, this behaviour taking care is enough, of not medicinal specific treatments and/or
medicinal will then be able to be envisaged during following consultations.

A conditioning by sound alarm can give good results (from 70 to 85 %) at a motivated, mature enough child to understand functioning, if living conditions are compatible (individual room), and if the parents are coefficacious. In France, sound alarms are not much used because of their cost and of the absence of taking care by Social security.

Among the medicinal treatments, the desmopressine (Minirin), is pointed out in first intention in ENPI POLYURIQUE. Used in form of nasal spray at the children from 5 years, Minirin is now available in form of tablets in 0,2 mg for the children from 6 years.

Antidepressants tricycliques are not a treatment of first intention in ENPI, explains the Dr Ann Van Egroo (Jeanne-de-Flandre hospital, n phrologie p diatrique, Lille): their therapeutic margin is narrow, their use remains limited to the refractory enuresises of the big children having told the families of the risk of serious undesirable effects linked to excessive dose.
In case of failure of monotherapy, an association between different treatments can be envisaged, as desmopressine sound alarm and.

Dr Small local train FOURCADE
Current conception of the insulated nocturnal nar sie , symposium organised by the Laboratory Ferring. French association of
paediatrics

Dr Micheline Fourcade, The Daily of the doctor, 2/7/2003
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