The initiation of a phenylalanine-restricted diet soon after birth prevents most of the neuropsychological complications in phenylketonuria. However, the diet is difficult to maintain and compliance is often poor, especially in adolescents, young adults, and pregnant women. Tetrahydrobiopterin stimulates phenylalanine hydroxylase activity in about 20% of patients and in those patients serves as a useful adjunct to the phenylalanine-restricted diet because it increases phenylalanine tolerance and allows some dietary freedom.

Bedwetting is a widespread and distressing condition that can have a deep impact on a child or young person’s behavior, emotional wellbeing, and social life. If the child was dry for more than six months before the present episode started, explore possible triggers such as emotional upset or recent illness. The management of bedwetting is not different for secondary bedwetting, but a trigger might need treatment in its own right. Urine analysis is not indicated unless bedwetting started in the past few days or weeks, or in the presence of daytime urinary problems or suspected diabetes. Further assessment is to be done for severe daytime urinary problems, previous history of urinary infections, known or suspected congenital physical abnormalities (posterior urethal valves or myelome-ningocele) or neurological problems. Waking a child during the night to take him/her to the toilet will help to keep them dry in the long term. Offer an alarm as initial treatment for children and young people whose bedwetting has not responded to advice on fluids, toileting, or an appropriate reward system. If alarm treatment is not successful, offer desmopressin (a synthetic analogue of antidiuretic hormone) as well as use of the alarm. Alternatively, if the parents, care givers, child, or young person no longer wants to use an alarm, offer desmopressin alone.

Physical activity and 24-hour dietary recall information and anthropometric indices were collected from 1138 children (53% girls; age, 11.2 ± 0.7 years). Five lifestyle behavioral patterns were identified. The "dinner, cooked meals and vegetables pattern," a multidimensional lifestyle pattern including the consumption of vegetables, cooked meals, and eating dinner, was negatively associated with all obesity indices, even after adjustment for potential confounders.