What is the recommended action for a child over 24 months with primary bedwetting and daytime incontinence symptoms?

For a child over 24 months who presents with primary bedwetting and daytime incontinence, referral to secondary care or an enuresis clinic is the most appropriate recommended action. This decision is based on the established guideline that after the age of five, ongoing bedwetting can indicate an underlying issue that may require more specialized evaluation and management.

Children who experience both nocturnal enuresis (bedwetting) and daytime incontinence may have a more complex situation that includes potential physiological, psychological, or behavioral components. A referral to a specialist ensures that the child receives a comprehensive assessment to rule out any secondary causes, such as urinary tract infections or anatomical abnormalities, and to identify more effective treatment options tailored to the child's specific needs.

While reassurance for parents, reward systems, or medications like Desmopressin may support treatment, these approaches are generally more appropriate for cases that have been evaluated and diagnosed as straightforward primary enuresis without accompanying daytime incontinence issues. Therefore, a referral to a specialized clinic is a crucial step in addressing these symptoms appropriately.