Enuresis may be nocturnal or diurnal. Bed-wetting can occur as a response to acute stress such as birth of a new sibling, parental divorce or starting a new school. If this is the case, it is more likely to be secondary enuresis, and this tends to be self-limiting. Enuresis may occur in response to chronic stress such as an unhappy relationship between the parents, domestic violence or sexual abuse. Diurnal enuresis is more common in girls. If children develop daytime wetting after having been dry, it is important to rule out urinary infection and to consider the fact that bladder sensation can be reduced if a child is preoccupied. Paediatric referral may be necessary for investigation, particularly in cases of diurnal enuresis. If an emotional cause is suggested by the history, referral to a child and adolescent health service may be useful, but nocturnal enuresis will respond to a behavioural programme whoever supervises it.