General Paediatrics

Bedwetting is developmentally normal in young children. Young children often don't produce enough ADH (a hormone that helps retain fluids overnight), and deep sleepers may not be woken by the urge to urinate. In an otherwise healthy child, bedwetting often doesn't need treatment until at least 6–7 years of age. Medical review should be considered at this age, particularly if bedwetting is causing distress.

Rarely, bedwetting can be associated with another medical condition. A medical review should be sought if there are unusual daytime symptoms, or if a child who was previously dry at night for at least six months has started bedwetting again.

For more information, see this factsheet from the Sydney Children's Hospital Network.

If bedwetting is associated with another medical condition such as constipation, this should be treated first. Behavioural strategies like a bedwetting alarm are highly successful when used consistently for several weeks. It is rare to require medication for uncomplicated bedwetting.

The most common cause of constipation in young children is 'functional' constipation — toddlers and young children may ignore the urge to defecate, then develop anxiety after a painful bowel movement. Continued avoidance leads to stool building up in the rectum and large bowel. Investigations are not needed to diagnose functional constipation, but may be required if other less common medical causes are suspected.

Functional constipation is usually treated with a combination of diet and behaviour modification and medications such as stool softeners and laxatives. A common reason for treatment failure is stopping laxatives too early — the bowel can take many months to fully heal, so treatment often needs to be prolonged and tapered gradually.

For further information, see this factsheet from the Sydney Children's Hospital Network.

• Sharing Knowledge About Immunisation (SKAI) — an Australian website with simple, reliable information about vaccines and common safety concerns.
• AusVaxSafety — monitors vaccine safety and includes up-to-date Australian data on common side effects.
• Let's Talk Shots — a video library from Johns Hopkins Institute for Vaccine Safety.

The national schedule covers at least 15 diseases, but there are some additional vaccines worth considering:

• Meningococcal B vaccine (Bexsero) is strongly recommended for all infants (and is funded for Aboriginal and Torres Strait Islander infants).
• A second chickenpox dose is recommended for all children but must be purchased privately — often given at 4 years of age.
• Annual influenza vaccine is free for children aged 6 months to 4 years, and recommended for all children.
• Additional vaccines may be recommended based on your child's medical risk factors or travel plans — discuss with your GP.

• Infant and baby nutrition — Sydney Children's Hospital Network
• Infant formula factsheet — explains the different categories of infant formula
• Monitoring weight and growth — Tresillian

Reflux is when the contents of the stomach come back up the oesophagus — sometimes into the mouth. All young babies have some degree of reflux, because the ring of muscle separating the oesophagus from the stomach is weak in young babies, and because they are fed lying down. Reflux naturally improves from about 4 months of age.

Most babies do not need treatment for reflux, as it naturally improves over time. Treatment may be considered if there are concerning features such as signs of pain during feeding, feed refusal, poor weight gain, or vomiting blood — this is called gastroesophageal reflux disease (GORD). Treatment options include positioning, feed thickeners and medication.

For more information, see the Sydney Children's Hospital Network reflux factsheet.

Tongue tie is when the lingual frenulum — the tissue connecting the tongue to the bottom of the mouth — is too short or tight, limiting tongue mobility. Most babies with tongue tie can successfully breastfeed without any intervention.

Severe tongue tie can affect a baby's latch when breastfeeding, causing nipple pain — though many other factors can also cause nipple pain, most commonly incorrect positioning. In rare cases, tongue tie can affect speech later in childhood. Severe cases can be managed by cutting the restrictive tissue (frenotomy), but only after careful assessment by an experienced health professional.