A 4-year-old boy is still wet at night. What is the best initial management approach?

In the case of a 4-year-old boy who is still experiencing nocturnal enuresis (bedwetting), the best initial management approach is reassurance. This approach is grounded in the understanding that bedwetting is common in young children and often resolves naturally as they grow older. Most children outgrow this condition without any intervention.

Reassurance helps alleviate the anxiety parents or caregivers may feel about the situation, particularly when they are concerned about the child's development and wellbeing. Providing information that highlights the normal developmental variations in bladder control can help normalize the experience for both the child and the family.

Other options may be considered at a later stage if the condition persists. For instance, desmopressin is a medication that can be used for more persistent cases, while behavioral therapy involves techniques that can also aid in developing bladder control. Referral to surgery is typically reserved for very specific medical conditions related to enuresis, which are not common in otherwise healthy children.

The focus on reassurance first allows for the observation of natural progress and helps to avoid unnecessary interventions when the child is still within the common age range for this developmental stage.