Overview

Urinary problems and injuries are a concern in children. A young child may not be able to tell you about his or her symptoms. This can make it hard to decide what your child needs. An older child may be embarrassed about his or her symptoms. When your child has a urinary problem or injury, look at all of his or her symptoms to decide what steps to take next.

The urethra, bladder, ureters, and kidneys are the structures that make up the urinary tract.

Pain during urination (dysuria) and a frequent need to urinate are common symptoms in young children. When your child has only one of these symptoms, or when the symptoms are mild, home treatment may be all that's needed to prevent the problem from getting worse and help relieve symptoms. Mild symptoms include:

• A frequent need to urinate. A child's bladder is small and doesn't hold as much urine as an adult's bladder. For this reason, frequent urination is common. It may not be a sign of a urinary problem. Your child may urinate more often because he or she is drinking extra fluid or feeling nervous. Or it may simply be from habit.
• Burning pain when urine touches irritated skin around the vagina or urethra. Pain during urination because of skin irritation occurs more often in girls (genital skin irritation) than it does in boys.

These symptoms can also mean that your child has a urinary tract infection. Urinary tract infections (UTIs) are the second most common bacterial infection in children. When your child has an infection, bacteria grow in the bladder and irritate the bladder wall. This causes pain as soon as a very small amount of urine reaches the bladder. You may find your child trying to urinate more often than usual to try to soothe the pain. But your child will pass very little urine because the bladder has only collected a small amount since the last time he or she urinated. Symptoms of a UTI vary depending on a child's age.

Urine colour and odour

Many things can affect urine colour, including fluid balance, diet, medicines, and diseases. How dark or light the colour is tells you how much water is in it. Vitamin B supplements can turn urine bright yellow. Some medicines, blackberries, beets, rhubarb, and blood in the urine can turn urine red-brown.

Some foods (such as asparagus), vitamins, and antibiotics (such as penicillin) can cause urine to have a different odour. A sweet, fruity odour may be caused by uncontrolled diabetes. A urinary tract infection (UTI) can cause a bad odour.

Newborns and children younger than 2

Babies and very young children who have UTIs often have symptoms that don't seem specific to the urinary tract. Symptoms may include:

• A fever, especially without other signs of infections, such as a cough or runny nose. In babies, a fever may be the only symptom of a UTI.
• Urinating more or less often than usual.
• Strong or bad-smelling urine.
• Dark or blood-streaked urine. But note that it's common for newborns to pass some pink urine in the first 3 days of life. This may be from crystals in the urine. Parents will notice a pink colour to the urine in the diaper.
• Lack of interest in eating, or refusing food.
• Diarrhea.
• Vomiting.
• Squirming and crankiness.
• Diaper rash that doesn't go away.

Children age 2 years and older

Young children who have a UTI usually have symptoms that are more clearly related to the urinary tract. Symptoms may include:

• Burning with urination (dysuria). This is the most common symptom of a UTI.
• A fever.
• Frequent need to urinate (frequency) without being able to pass much urine.
• A strong desire to urinate (urgency).
• Strong or bad-smelling urine.
• Blood in the urine (hematuria). Urine may look pink, red, or brown.
• Belly pain.
• Pain in the flank. This is felt just below the rib cage and above the waist on one or both sides of the back.
• Vomiting.
• Discharge from the vagina.
• Sudden, new daytime wetting after a child has been toilet trained.

UTIs are caused when bacteria such as Escherichia coli (E. coli), which are normally in the digestive tract, enter the urinary tract. Two common types of UTIs are:

• Bladder infections. They occur when bacteria get into the bladder by travelling up the urethra.
• Kidney infections. They usually occur when bacteria get into a kidney by travelling from the bladder up the ureters. Kidney infection also may occur if bacteria from an infection in another part of the body travel to the kidneys through the bloodstream.

Except during the first 3 months of life, girls are more likely than boys to have urinary problems. Girls are also more likely than boys to have more than one UTI.

Babies and young children who have problems with the structure or function of the urinary tract may be more likely to have UTIs. A problem such as vesicoureteral reflux or an obstruction in the urinary tract may make it hard to empty the bladder completely. This will allow bacteria to grow and spread more easily through the urinary tract. These problems may be present at birth (congenital). Or they can be the result of surgery, injury, or past infection.

During the first year of life, boys are more likely than girls to have a structural (anatomic) reason for urinary problems. If your child has a known structural or functional problem with the urinary tract, follow your doctor's instructions about when to seek care for urinary symptoms.

In rare cases, a urinary symptom may be a sign of a more serious illness, such as diabetes.

An injury, such as getting hit in the back or genital area, may cause urinary problems. A visit to a doctor is usually needed if your child has trouble urinating, can't urinate, or has blood in his or her urine.

Self-Care

If you think that your child may have a urinary tract infection, use these home treatment measures until you can arrange to have your child seen by a doctor.

• Encourage your child to drink extra fluids.

  Do this as soon as you notice the symptoms and for the next 24 hours. It will help dilute the urine, flush bacteria out of the bladder, and decrease irritation.

• Don't give your child caffeinated or fizzy drinks.

  They can irritate the bladder.

• Encourage your child to urinate often and to empty his or her bladder each time.
• Have your child bathe in warm water.

  This may help soothe your child's genital pain and itching. Avoid using bubble bath or perfumed soaps, which may cause genital skin irritation. It's okay if your child urinates in the bath water. This may help relieve some of his or her pain.

• Look at your child's genital area with each diaper change.

  Increased redness may mean skin irritation. Change your child's diapers often to avoid further irritation.

• Air-dry the skin on your child's bottom when you can.
• Avoid any soap or laundry detergent that may be causing your child's skin irritation.

  If you think this may be the problem, try a different product. Choose one that is unscented, such as CheerFree or Ecover, rather than a detergent. Rinse twice to remove all traces of the cleaning product. Avoid strong detergents.

• Use gentle soaps.

  Examples are Basis, Cetaphil, Dove, and Oil of Olay. Use as little soap as you can. Don't use deodorant soaps on your child.

When to call for help during self-care

Call a doctor if any of the following occur during self-care at home:

• Not being able to urinate, or having more trouble urinating.
• New belly pain or pain in the flank, which is just below the rib cage and above the waist on either side of the back.
• New fever, vomiting, or blood in the urine.
• Symptoms occur more often or are more severe.

Preparing For Your Appointment