Bedwetting diagnostic quiz

The Bedwetting Diagnostic Quiz is an aid to help speed up the process of assessing your child's condition. Before visiting your doctor, take a few moments to print this page and answer the included questions. Take it with you to your child's next appointment.

1. Your child's name
   
   ____________________________
   
   Age
   
   ____________________________
   
   Sex
   
   ____________________________
   
   Weight
   
   ____________________________
   
   Height
   
   ____________________________
   
   
2. How long have you considered bedwetting a problem (answer in months)
   
   ____________________________
   
   
3. Does your child have any of the following symptoms:
    Cloudy urine
    Frequent trips to the bathroom
    Burning feeling on urination
    Other
   
   
4. Have there been other bedwetters in the family? Check all that apply:
    Brothers/sisters
    Parents
    Uncles/aunts
    Cousins
   
   
5. Has your child ever been diagnosed as having a urinary tract infection?
    Yes      No
   
   
6. How many times a week does your child wet the bed?
   
   ____________________________
   
   
7. How many hours does your child sleep before wetting the bed?
    2-3
    4-5
    6-7
    8-9
    Over 9
    Don't know
   
   
8. Does your child wet his or her clothes during the day?
    No
    Rarely
    Occasionally
    Often
    Daily
   
   
9. Do you do any of these things now to help treat the problem?
    Limit fluids
    Wake child up
    Punish failure
    Reward success
    Other (please specify)
   
   ____________________________
   
   
10. Is your child ever teased, bullied, or humiliated for being a bedwetter?
     Yes      No      Don't know
    
    
11. Has your family, or your child, had to miss any of these activities because of bedwetting?
     Sleeping out
     Sleepover visits
     Family vacation trips
     Class trips
     Summer camp
    
    
12. From your child's point of view, please check all the reasons he or she wants to overcome bedwetting. Please circle the most important.
     Build self-esteem
     Feel more confident
     Avoid humiliation
     Share family experiences
     Be equal with other children
     Go to camp or sleepovers
     Be able to share a bed with their siblings
     Other