Keeping a bladder diary helps us to make an assessment of how your child’s bladder
is working and helps identify the best treatment.
Please record the following and bring this form with you to your clinic appointment:
• Number of drinks your child had during the day and approx. total volume of drinks.
• Type and time of drink your child had before sleep.
• Whether your child is dry or not at parent’s bed time.
• Whether your child woke in the night to use the toilet.
• Whether your child achieved a completely dry night.
• If wet, the size of the wet patch (small= coin size patch, medium = dinner plate size
and large = wet from head to toe).
• Number of times your child went to the toilet for a wee during the day.
• On at least 3 days please measure one wee (not the 1st wee in the morning) in a
plastic jug and record in the last column.
Bed wetting assessment chart
| date |
number of drinks / volume |
Last drink | parent check wet /dry | woke self to toilet Yes / no | dry night | size of wet patch | number of times to toilet in day | bowels open? y/n | measurement of urine in MLS |
| example 21/01/2021 | 4 drinks 800mls / day | 18:00 cup milk | dry | n | n | large | 6 | y | 230mls |
Useful contact details
If you have any questions or concerns about completing this chart, or if you would like any
further information, please contact:
Paediatric Continence Service
Whitegate Health Centre
150-158 Whitegate Drive
Blackpool, FY3 9ES
Tel: 01253 953042
