A 6-year-old child with enuresis has the following vital signs at their follow-up pediatrician visit to address enuresis: HR 92, BP 100/64, RR 20, temperature 37.2° C. The nurse discusses first-line management with the family. Which recommendation is most appropriate?

A. Insert an indwelling catheter at night: Catheterization is invasive, carries infection risk, and is not used in the management of functional enuresis. It is inappropriate for a 6-year-old child. B. Restrict or eliminate fluids and snacks after evening meal: First-line management for enuresis includes behavioral modifications such as limiting fluids, especially those with caffeine, before bedtime. This reduces nighttime urine production and improves bladder control. C. Begin desmopressin acetate (DDAVP) therapy immediately: DDAVP can be used if behavioral strategies fail, but it is not the initial step. Starting pharmacologic therapy right away is not recommended without first attempting conservative measures. D. Punish the child when bedwetting occurs to reinforce responsibility: Punishment increases shame, anxiety, and stress, which can worsen enuresis. Positive reinforcement and supportive approaches are more effective for long-term improvement.