As a mother of two young children I was surprised to read the NICE
guidance on management of bedwetting. NICE does not advise positive
rewards for dry nights. I therefore turned to the original full text. This
recommendation is based on studies of small numbers of children at
enuresis clinics. Clearly these children are the ones for whom simple
reward systems have not worked. In effect the children who do not respond
to positive rewards for dry nights and therefore attend enuresis clinics
are then found in RCTs not to respond to positive rewards for dry nights.
The vast majority of children do respond to positive rewards for dry
nights and so do not attend these clinics and therefore never make it into
a trial. NICE then guides all health professionals in the country against
using a simple rational technique on the basis of data from a small subset
of children. NICE's method of issuing guidelines divorced from their
reasoning is demeaning to thinking professionals and leads to misleading
and unhelpful instructions.
Competing interests: No competing interests