Differential Diagnosis for Bed-Wetting in a 7-Year-Old Boy
- Single Most Likely Diagnosis
- Primary Nocturnal Enuresis: This condition is characterized by bed-wetting in children who have never achieved nighttime dryness. Given the child's history of never staying dry overnight for more than 3 consecutive nights and achieving daytime dryness at age 4, this diagnosis is the most likely. The strong urinary stream and lack of other urinary symptoms also support this diagnosis.
- Other Likely Diagnoses
- Attention Deficit Hyperactivity Disorder (ADHD): The child's irritability, inattentiveness, and disruptive behavior at school suggest ADHD. While not directly causing bed-wetting, ADHD can contribute to difficulties with bladder control and nocturnal enuresis.
- Constipation: Although not explicitly mentioned, constipation is a common cause of nocturnal enuresis in children. The abdominal examination was normal, but constipation can be intermittent and may not always be detected on physical examination.
- Do Not Miss Diagnoses
- Diabetes Mellitus: Although the urinalysis was normal, diabetes mellitus can cause nocturnal enuresis due to polyuria. It is essential to consider this diagnosis, as untreated diabetes can lead to severe complications.
- Neurogenic Bladder: A neurogenic bladder can cause urinary incontinence, including nocturnal enuresis. Although the child's urinary stream is strong, and there are no other urinary symptoms, a neurogenic bladder should be considered to rule out any underlying neurological conditions.
- Obstructive Sleep Apnea: The child's symmetrically enlarged tonsils and irritability suggest possible obstructive sleep apnea, which can contribute to nocturnal enuresis.
- Rare Diagnoses
- Spinal Cord Anomalies: Spinal cord anomalies, such as spina bifida, can cause neurogenic bladder and nocturnal enuresis. Although rare, these conditions should be considered, especially if other symptoms or signs are present.
- Urological Anomalies: Urological anomalies, such as ureteropelvic junction obstruction or bladder exstrophy, can cause nocturnal enuresis. These conditions are rare but should be considered if other symptoms or signs are present.