Mother of An 8-year-old Bedwetter Requesting Desmopressin — Free SCA Practice Case
Mother of an 8-year-old bedwetter requesting desmopressin
Station Timer
Golden Minute
Initial Introduction
•Introduce yourself
•Ask an open question — "How can I help you today?"
•Listen — don't interrupt
•Catch early cues
Data Gathering
History, ICE & Diagnosis
Clinical Management
Diagnosis, Plan & Decisions
Safety Net
Follow-up & Close
Materials for Candidate
Please review before starting the consultation
Full Name
Charlie Mercer
Age
8 years
Consultation Type
TelephoneAge
8
Situation
Telephone Consultation. The child's mother is calling.
Reason for Encounter
"My son still wets the bed most nights. He's got a school residential coming up and he's mortified. I've read about desmopressin — can we try that?"
Medical Records (Charlie Mercer)
- ●PMH: Nil significant. Immunisations up to date. Growth normal.
- ●Medications: None.
- ●Allergies: NKDA.
- ●Recent notes: Nil relevant.
Patient Script
For the friend playing the patient role
Character Overview: You are Rebecca, mother of Charlie, who is 8. He has wet the bed most nights for as long as you can remember — he has never had a reliable dry spell. He is dry during the day with no daytime accidents or urgency. He has a residential school trip in about six weeks and is embarrassed and anxious about it. You have read about desmopressin online and would like to try it. You have not tried an alarm. You are a caring, slightly frustrated parent who does not want Charlie to feel ashamed. If the doctor explains the options clearly, you are open to advice.
Opening Sentence: "Hello Doctor. My son Charlie, he's eight, still wets the bed nearly every night. He's got a school residential coming up in a few weeks and he's really embarrassed about it. I've read about desmopressin — could we try that for him?"
History if Asked (Data Gathering Phase)
- ●The bedwetting: "Most nights. He's never really been dry at night — no long dry patches that I can remember."
- ●Daytime: "He's fine in the day — no accidents, no rushing to the loo."
- ●The trigger: "It's the school residential in about six weeks. He's mortified about the other kids finding out."
- ●What's been tried: "Nothing much, really. We've just been managing with waterproof sheets. We've not tried an alarm."
- ●What she wants: "I've read desmopressin can help. I'd like to try it, especially before the trip."
ICE — Ideas, Concerns, Expectations
The caller does not volunteer this information unprompted. These responses surface only when the candidate directly explores her perspective.
- ●Ideas: Rebecca thinks desmopressin (a medicine) is the answer, having read about it online. "I've read that desmopressin can stop it, so I thought a tablet might be the simplest fix."
- ●Concerns: Her dominant concern is Charlie's embarrassment and self-esteem, especially around the residential trip, and that he not feel ashamed. "My worry is how ashamed he feels, and the trip coming up."
- ●Expectations: She expects to be able to try desmopressin. "I'd like to give the medicine a go."
If Asked — Enuresis Assessment Screen
The caller answers these only when directly asked.
- ●If asked about primary vs secondary (ever been dry): "He's never had a proper dry spell — it's been there all along." (Primary nocturnal enuresis.)
- ●If asked about daytime symptoms (wetting, urgency, frequency): "No daytime accidents, no urgency, normal frequency."
- ●If asked about constipation/bowels: "Now you mention it, he does tend to be constipated — he doesn't go every day and strains a bit."
- ●If asked about fluid intake / caffeine / evening drinks: "He has squash through the day, and often a big drink in the evening. He likes cola sometimes."
- ●If asked about how many nights/wet volume: "Most nights, a full wet bed."
- ●If asked about diabetes symptoms (excessive thirst, weight loss, passing lots of urine in the day): "No excessive thirst or weight loss, and he's fine in the day."
- ●If asked about family history: "My husband wet the bed until he was about nine, apparently."
- ●If asked about sleep / waking / lifting: "He sleeps very deeply and doesn't wake to go."
- ●If asked about impact and how Charlie feels: "It's really knocking his confidence, and he's dreading the trip."
- ●If asked about safeguarding/home changes or stressors: "No, nothing's changed at home, he's happy otherwise."
Responses to Management (The Negotiation Phase)
- ●If the Doctor explains bedwetting is common and gives lifestyle advice: "So it's common and not his fault? And things like his drinks and constipation matter?" (The tested point is reassurance, and addressing lifestyle and constipation first.)
- ●If the Doctor recommends an enuresis alarm as first-line for a lasting result: "An alarm? I hadn't thought of that. How does that work, and how long does it take?" (The tested point is explaining the alarm as first-line for long-term cure, and its commitment.)
- ●If the Doctor explains desmopressin's role (rapid/short-term, e.g. the trip): "So desmopressin could help specifically for the trip, even if we use the alarm for the long term?" (The tested point is negotiating desmopressin's appropriate short-term role rather than simply refusing or simply prescribing it.)
- ●If the Doctor counsels on desmopressin safety (fluid restriction): "There are rules about drinking in the evening with it? Why's that?" (The tested point is counselling on evening fluid restriction to avoid hyponatraemia.)
- ●If the Doctor involves Charlie and arranges follow-up: "Should Charlie be involved in the decision? And would you review how he gets on?"
Mark Scheme
Domain 1: Data Gathering and Diagnosis
Domain 2: Clinical Management and Medical Complexity
Domain 3: Relating to Others
Clinical Learning Points
Nocturnal Enuresis — Common and Not the Child's Fault
- ●Nocturnal enuresis (bedwetting) is common in school-aged children, often has a family history, and usually resolves with time. Reassurance, a no-blame approach, and avoiding punishment are foundational.
Assess and Distinguish
- ●Distinguish primary (never reliably dry) from secondary enuresis (relapse after being dry — prompts a search for a cause/stressor). Screen for daytime symptoms (bladder dysfunction), constipation (a common contributor), diabetes (polydipsia/polyuria/weight loss), fluid/caffeine intake, and psychosocial factors.
Treat Constipation and Optimise Lifestyle First
- ●Treat constipation, optimise daytime fluids while reducing evening drinking and caffeine, encourage toileting before bed, and use positive reward systems for agreed behaviours (not for dry nights per se).
The Enuresis Alarm — First-Line for a Lasting Result
- ●An enuresis alarm is first-line for children needing active treatment who want a long-term cure and can commit to it (it works by conditioning over several weeks). It requires motivation and support.
Desmopressin — Role and Negotiation
- ●Desmopressin is appropriate where a rapid or short-term result is needed (e.g. a sleepover/residential trip) or where an alarm is unsuitable, unwanted, or ineffective. Negotiate its role within stepped care rather than refusing or prescribing on demand.
Desmopressin Safety
- ●Counsel on evening fluid restriction with desmopressin (to avoid hyponatraemia/fluid overload), taking it at bedtime, not using it if fluid restriction cannot be followed, and reviewing response.
Involve the Child, Refer When Needed, and Follow Up
- ●Involve the child (motivation is key). Refer for daytime symptoms, secondary enuresis with concerning features, or failure of stepped care. Safety-net and arrange follow-up.
Common Candidate Mistakes in This Case
- ●Prescribing on demand or refusing outright: rather than negotiating desmopressin's role within stepped care.
- ●Missing constipation: overlooking a common, treatable contributor.
- ●Not offering the alarm: omitting the first-line treatment for a lasting result.
- ●Desmopressin without safety counselling: forgetting evening fluid restriction.
- ●Ignoring the child and the trip: not involving Charlie or addressing the specific, time-limited concern.