What questions should be asked to the mother to gather additional information for evaluating diagnostic criteria?

Essential Questions for Maternal History in Diagnostic Evaluation

The mother must be systematically questioned about urinary symptoms, bowel function, developmental history, family dynamics, and prior treatment attempts to complete the diagnostic criteria for the child's condition. 1

Urinary and Bladder Symptoms

Daytime Symptoms

• Ask specifically about current or previous daytime incontinence: How often does it occur and in what situations? 1
• Inquire about voiding patterns: How many times does the child urinate during normal days? 1
• Question about holding maneuvers: Does the child squat, stand on tiptoe, or press the heel into the perineum to delay urination? 1
• Assess stream characteristics: Does the child have a weak urinary stream or need to use abdominal pressure to pass urine? 1
• Ask about interrupted micturition: Does the child stop and start while urinating? 1

Nighttime Symptoms

• Determine frequency of bed wetting: Does it occur every night or only sporadically? 1
• Establish if primary or secondary: Has the child always been wetting, or was there a dry period? 1
• Ask about nocturia: Does the child wake up to urinate during the night? (This indicates the child is not extremely difficult to arouse from sleep) 1

Urinary Tract History

• Question about urinary tract infections: Has the child had any UTIs, current or previous? 1

Bowel Function Assessment

Bowel habits must be thoroughly evaluated since bladder and bowel function are closely interrelated, and untreated constipation may prevent achieving dryness. 1

• Ask about bowel movement frequency: Does the child have bowel movements every second day or less often? 1
• Inquire about stool consistency: Is stool consistency usually hard? 1
• Screen for fecal incontinence: Does the child have episodes of fecal soiling? (This is common in constipated children and should be specifically asked about) 1

Fluid Intake and General Health

• Estimate daily fluid intake: What and how much does the child drink throughout the day? (Best assessed with a bladder diary, as this helps detect polyuria from diabetes or kidney disease, and identifies habitual polydipsia which makes desmopressin therapy dangerous) 1
• Screen for systemic illness: Has the child recently become tired or lost weight? (To detect kidney disease or diabetes) 1

Developmental and Prenatal History

• Obtain prenatal and perinatal data: Were there any complications during pregnancy or delivery? 1
• Assess general development: Are there concerns about the child's overall development or growth? 1

Previous Treatment Attempts

Understanding prior management strategies is critical to avoid repeating ineffective approaches and to determine if treatments were used correctly. 1

• Ask what strategies the family has used: Do parents routinely wake the child at night? Has evening fluid intake been decreased? 1
• If alarm therapy was tried: Was it used correctly and for an adequate duration? 1
• If pharmacological treatment was attempted: Which medications were used, at what doses, for how long, and why were they discontinued? 1

Behavioral and Psychological Assessment

• Screen for psychiatric comorbidity: Ask general questions about the child's behavior, or provide parents with a screening questionnaire 1
• Assess the child's perception: Does the child consider the bed wetting a big problem? 1
• Evaluate motivation: Estimate the motivation of both the child and the caregivers for treatment 1
• Screen for ADHD: Does the child have attention deficit hyperactivity disorder symptoms? (May need psychiatric treatment in parallel with anti-enuretic therapy) 1
• For secondary enuresis: Did the recurrence of wetting coincide with any major family event? 1

Sleep-Related Questions

• Ask about snoring and sleep apnea: Does the child have heavy snoring or nocturnal sleep apnea? (Some children become dry after upper airway obstruction is relieved) 1

Family Context and Demographics

• Obtain family composition: Names and ages of parents and siblings, current household composition including non-biological members 1
• Assess family health history: Health and psychiatric status of family members 1
• Inquire about family dynamics: What is the interactional context of the symptomatic behavior? Are there typical sequences of family interaction associated with the problem? 1
• Determine blame patterns: Is one particular person blamed for the problem? 1

Common Pitfalls to Avoid

• Do not rely solely on family recollection for voiding frequency—completion of a frequency-volume chart provides much more reliable data 1
• Direct questions to the child, not just the parent, especially regarding bowel symptoms 1
• Distinguish between children with only urgency/moderate incontinence versus those with weak stream/continuous incontinence—the latter must be sent to a specialized center without delay 1
• Always ask about constipation first—if not treated, it may be difficult to achieve dryness 1