Urinary Problems and Injuries, Age 11 and Younger

Topic 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, which 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 determine 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 is 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 does not hold as much urine as an adult's bladder. For this reason, frequent urination is common and is not necessarily a sign of a urinary problem. Your child may urinate more because he or she is drinking extra fluid, feeling nervous, or simply 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.

Pain during urination and a frequent need to urinate can also mean 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 in an effort 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, or 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 do not seem specific to the urinary tract. Symptoms may include:

Fever, especially without other signs of infections, such as a cough or runny nose. In babies, fever may be the only symptom of a urinary tract infection.
Frequent or infrequent urination.
Strong or bad-smelling urine.
Dark or blood-streaked urine. Note: It is 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 irritability.
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 urinary tract infection.
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). Note: Urine may look pink, red, or brown.
Belly pain.
Pain in the flank, which 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 present in the digestive tract, enter the urinary tract. Two common types of UTIs are:

Bladder infections, which occur when bacteria get into the bladder by travelling up the urethra.
Kidney infections, which 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 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 indicate 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, cannot urinate, or has blood in his or her urine.

Check your child's symptoms to decide if and when your child should see a doctor.

Check Your Symptoms

Does your child have problems with urination?

Yes

Urinary problem

How old are you?

Less than 3 months

3 to 5 months

6 months to 3 years

4 to 11 years

12 years or older

Are you male or female?

Male

Female

The medical assessment of symptoms is based on the body parts you have.

If you are transgender or non-binary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
If your symptoms aren’t related to those organs, you can choose the gender you identify with.
If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.

Does your baby seem sick?

A sick baby probably will not be acting normally. For example, the baby may be much fussier than usual or not want to eat.

Yes

Baby seems sick

How sick do you think your baby is?

Extremely sick

Baby is very sick (limp and not responsive)

Sick

Baby is sick (sleepier than usual, not eating or drinking like usual)

Did your child's symptoms begin after an injury?

An injury could be from a blow to the belly, groin, or lower back (the kidney area).

Yes

Symptoms began after an injury

Did the injury happen within the past 2 weeks?

Yes

Injury within past 2 weeks

Is there any blood in your child's urine?

Yes

Blood in urine

Does your child seem to be in pain?

Yes

Appears to be in pain

How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?

Signs of pain in a baby or toddler are different than signs of pain in an older child.

5 to 10: Moderate to severe pain

Moderate to severe pain

1 to 4: Mild pain

Mild pain

Is your child having trouble urinating?

Yes

Difficulty urinating

Is your child able to urinate at all?

Yes

Able to urinate

Unable to urinate

On a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine, how bad is the pain that comes from not being able to urinate?

Signs of pain in a baby or toddler are different than signs of pain in an older child.

8 to 10: Severe pain

Severe pain

5 to 7: Moderate pain

Moderate pain

1 to 4: Mild pain

Mild pain

Has it been more than 12 hours since your child was last able to urinate?

Yes

More than 12 hours since last able to urinate

Does your child have pain on one side of his or her back, just below the rib cage?

This is called flank pain. It sometimes is a symptom of a problem with the kidneys.

Yes

Flank pain

How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?

Signs of pain in a baby or toddler are different than signs of pain in an older child.

8 to 10: Severe pain

Severe pain

5 to 7: Moderate pain

Moderate pain

1 to 4: Mild pain

Mild pain

Does your child have pain when he or she urinates?

Yes

Pain when urinating

How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?

Signs of pain in a baby or toddler are different than signs of pain in an older child.

8 to 10: Severe pain

Severe pain

5 to 7: Moderate pain

Moderate pain

1 to 4: Mild pain

Mild pain

Has your child had pain while urinating that has lasted more than a day?

Yes

Pain when urinating has lasted more than 1 day

Does your child have a more frequent urge to urinate?

You may notice that even though your child feels like he or she needs to urinate, there isn't much urine when he or she tries to urinate.

Yes

Urinary urgency

How bad is the urge to urinate?

Severe (very uncomfortable)

Urinary urgency is severe and very uncomfortable

Moderate to mild (somewhat uncomfortable)

Urinary urgency is noticeable but not severe

Has your child's frequent urge to urinate lasted more than a day?

Yes

Urinary urgency for more than 1 day

Is your child nauseated or vomiting?

Nauseated means you feel sick to your stomach, like you are going to vomit.

Yes

Nausea or vomiting

Does your child have only one kidney or a Foley catheter in place?

Yes

One kidney or a Foley catheter

Do you think that the urinary problem may have been caused by abuse?

Yes

Urinary problem may have been caused by abuse

Does your child have diabetes?

Yes

Diabetes

Is your child's diabetes getting out of control because your child is sick?

Yes

Diabetes is affected by illness

Do you and your child's doctor have a plan for what to do when your child is sick?

Yes

Diabetes illness plan

Is the plan helping get your child's blood sugar under control?

Yes

Diabetes illness plan working

Diabetes illness plan not working

How fast is it getting out of control?

Quickly (over several hours)

Blood sugar quickly worsening

Slowly (over days)

Blood sugar slowly worsening

Do you think your baby has a fever?

Yes

Fever

Did you take your child's temperature?

This is the only way to be sure that a baby this age does not have a fever. If you don't know the temperature, it's safest to assume the baby has a fever and needs to be seen by a doctor. Any problem that causes a fever at this age could be serious. Rectal temperatures are the most accurate. Taking an axillary (armpit) temperature is also an option.

Yes

Temperature taken

Is it 38°C (100.4°F) or higher, taken rectally?

This would be an axillary temperature of 37.5°C (99.5°F) or higher.

Yes

Temperature at least 38°C (100.4°F) taken rectally

Do you think your child has a fever?

Yes

Fever

Did you take your child's temperature?

Yes

Temperature taken

How high is the fever? The answer may depend on how you took the temperature.

NOTE: Most people have an average body temperature of about 37°C (98.6°F). But it can vary by a degree or more and still be considered normal. If a low body temperature is the only symptom, it’s usually not something to worry about. But be sure to watch for other symptoms.

High: 40°C (104°F) or higher, oral

High fever: 40°C (104°F) or higher, oral

Moderate: 38°C (100.4°F) to 39.9°C (103.9°F), oral

Moderate fever: 38°C (100.4°F) to 39.9°C (103.9°F), oral

Mild: 37.9°C (100.3°F) or lower, oral

Mild fever: 37.9°C (100.3°F) or lower, oral

How high do you think the fever is?

High

Feels fever is high

Moderate

Feels fever is moderate

Mild or low

Feels fever is mild

How long has your child had a fever?

Less than 2 days (48 hours)

Fever for less than 2 days

From 2 days to less than 1 week

Fever for more than 2 days and less than 1 week

1 week or longer

Fever for 1 week or more

Does your child have a health problem or take medicine that weakens his or her immune system?

Yes

Disease or medicine that causes immune system problems

Does your child have shaking chills or very heavy sweating?

Shaking chills are a severe, intense form of shivering. Heavy sweating means that sweat is pouring off the child or soaking through his or her clothes.

Yes

Shaking chills or heavy sweating

Has your child had a bladder or kidney infection with the same symptoms before?

Yes

Same symptoms as in a previous bladder or kidney infection

Does your child have any new discharge from the vagina?

Yes

Vaginal discharge

Is your child urinating more often than usual?

This sometimes can be an early sign of diabetes.

Yes

Increased urination

Does your child have any other symptoms of diabetes?

Yes

Other diabetes symptoms

Has your child started wetting his or her pants or underwear?

This only applies to toilet-trained children.

Yes

Urinary incontinence

Did the bladder control problem start within the past 2 weeks?

Yes

Incontinence began within past 2 weeks

Do you think that a medicine may be causing the urinary problems?

Think about whether the problems started after you began using a new medicine or a higher dose of a medicine.

Yes

Medicine may be causing urinary symptoms

Have the urinary problems lasted for more than a week?

Yes

Urinary problems for more than 1 week

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

Your age. Babies and older adults tend to get sicker quicker.
Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, or natural health products can cause symptoms or make them worse.
Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

Try home treatment to relieve the symptoms.
Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

HomeTreatment

RelatedInformation

A baby that is extremely sick:

May be limp and floppy like a rag doll.
May not respond at all to being held, touched, or talked to.
May be hard to wake up.

A baby that is sick (but not extremely sick):

May be sleepier than usual.
May not eat or drink as much as usual.

Pain in children under 3 years

It can be hard to tell how much pain a baby or toddler is in.

Severe pain (8 to 10): The pain is so bad that the baby cannot sleep, cannot get comfortable, and cries constantly no matter what you do. The baby may kick, make fists, or grimace.
Moderate pain (5 to 7): The baby is very fussy, clings to you a lot, and may have trouble sleeping but responds when you try to comfort him or her.
Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds when you try to comfort him or her.

Pain in children 3 years and older

Severe pain (8 to 10): The pain is so bad that the child can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain. No one can tolerate severe pain for more than a few hours.
Moderate pain (5 to 7): The pain is bad enough to disrupt the child's normal activities and sleep, but the child can tolerate it for hours or days.
Mild pain (1 to 4): The child notices and may complain of the pain, but it is not bad enough to disrupt his or her sleep or activities.

Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in children are:

Diseases such as diabetes, cystic fibrosis, sickle cell disease, and congenital heart disease.
Steroid medicines, which are used to treat a variety of conditions.
Medicines taken after organ transplant.
Chemotherapy and radiation therapy for cancer.
Not having a spleen.

A severe urgency problem means that:

You are uncomfortable most of the time.
You get the urge to go again right after you have just urinated.
The problem interferes with your daily activities.
The urge keeps you from sleeping at night.

A moderate or mild urgency problem means that:

The urge to urinate comes more often than you are used to, but it is not constant.
It does not interfere much with your daily activities.
It usually does not keep you from sleeping.

If you're not sure if a child's fever is high, moderate, or mild, think about these issues:

With a high fever:

The child feels very hot.
It is likely one of the highest fevers the child has ever had.

With a moderate fever:

The child feels warm or hot.
You are sure the child has a fever.

With a mild fever:

The child may feel a little warm.
You think the child might have a fever, but you're not sure.

Temperature varies a little depending on how you measure it. For children up to 11 years old, here are the ranges for high, moderate, and mild according to how you took the temperature.

Oral (by mouth) temperature

High: 40° C (104° F) and higher
Moderate: 38° C (100.4° F) to 39.9° C (103.9° F)
Mild: 37.9° C (100.3° F) and lower

A forehead (temporal) scanner is usually 0.3° C (0.5° F) to 0.6° C (1° F) lower than an oral temperature.

Ear or rectal temperature

High: 40.5° C (104.9° F) and higher
Moderate: 38.5° C (101.3° F) to 40.4° C (104.7° F)
Mild: 38.4° C (101.1° F) and lower

Armpit (axillary) temperature

High: 39.8° C (103.6° F) and higher
Moderate: 37.8° C (100° F) to 39.7° C (103.5° F)
Mild: 37.7° C (99.9° F) and lower

Note: For children under 5 years old, rectal temperatures are the most accurate.

An illness plan for people with diabetes usually covers things like:

How often to test blood sugar and what the target range is.
Whether and how to adjust the dose and timing of insulin or other diabetes medicines.
What to do if you have trouble keeping food or fluids down.
When to call your doctor.

The plan is designed to help keep your diabetes in control even though you are sick. When you have diabetes, even a minor illness can cause problems.

It is easy for your diabetes to become out of control when you are sick. Because of an illness:

Your blood sugar may be too high or too low.
You may not be able take your diabetes medicine (if you are vomiting or having trouble keeping food or fluids down).
You may not know how to adjust the timing or dose of your diabetes medicine.
You may not be eating enough or drinking enough fluids.

Symptoms of diabetes may include:

Increased thirst and more frequent urination, especially at night.
An increase in how hungry you are.
Losing or gaining weight for no clear reason.
Unexplained fatigue.
Blurred vision.

Many prescription and non-prescription medicines can cause urinary symptoms. A few examples include:

Antihistamines.
Decongestants.
Opioid pain medicines.
Tricyclic antidepressants.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

Call your doctor now to discuss the symptoms and arrange for care.
If you cannot reach your doctor or you don't have one, seek care in the next hour.
You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

Call your doctor today to discuss the symptoms and arrange for care.
If you cannot reach your doctor or you don't have one, seek care today.
If it is evening, watch the symptoms and seek care in the morning.
If the symptoms get worse, seek care sooner.

HomeTreatment

RelatedInformation

Make an Appointment

Based on your answers, the problem may not improve without medical care.

Make an appointment to see your doctor in the next 1 to 2 weeks.
If appropriate, try home treatment while you are waiting for the appointment.
If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

HomeTreatment

RelatedInformation

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Urinary Problems and Injuries, Age 12 and Older

Home Treatment

Home care isn't a substitute for medical care when it comes to treating a urinary tract infection (UTI). If you think your child may have a UTI, a doctor should see him or her right away.

Along with seeing the doctor, there are things you can do at home that may help your child.

Encourage your child to drink extra fluids as soon as you notice the symptoms and for the next 24 hours. This will help dilute the urine, flush bacteria out of the bladder, and decrease irritation.
Do not give your child caffeinated or carbonated beverages, which can irritate the bladder.
Encourage your child to urinate often and to empty his or her bladder each time.
A warm bath may help soothe your child's genital pain and itching. Avoid using bubble bath or perfumed soaps, which may cause genital skin irritation. It is okay if your child urinates in the bath water. This may help relieve some of his or her pain.
Skin irritation may increase your child's discomfort.
- Look at your child's genital area with each diaper change. Increased redness may mean skin irritation. Avoid further irritation by changing your child's diapers often. For more information, see the topic Diaper Rash.
- Air-dry the skin on your child's bottom when possible.
- An allergy to soap or laundry detergent may be causing your child's skin irritation. If you think this may be the problem, try a different product that is unscented, rather than a detergent. Rinse twice to remove all traces of the cleaning product. Avoid strong detergents.
- Use gentle soaps, such as hypoallergenic soaps, and use as little soap as possible. Do not use deodorant soaps on your child.

Constipation may be present if your child is not drinking enough fluids. For more information, see the topic Constipation, Age 11 and Younger.

If your child has been diagnosed with a urinary tract infection

Follow all home care instructions your child's doctor gave you.
Give your child his or her medicine exactly as prescribed. If you are having difficulty giving the medicine, call your child's doctor for advice.
Follow up with your child's doctor as instructed after your child has finished the course of antibiotics. Many children will require further testing. For more information, see the topic Urinary Tract Infections in Children.

Symptoms to watch for during home treatment

Call your doctor if any of the following occur during home treatment:

Your child is unable to urinate (retention) or has a dry diaper for longer than 12 hours.
New urinary symptoms develop, such as localized back pain (flank pain) or blood in urine (hematuria).
Other symptoms such as fever or vomiting develop.
Symptoms become more severe or more frequent.

Prevention

The following may help prevent urinary problems in children.

Encourage your child to drink more fluids. Water is best. This will help dilute the urine, flush bacteria out of the bladder, and decrease irritation.
Do not give your child carbonated or caffeinated beverages, which can irritate the bladder wall.
Wash the genital area once a day with plain water or mild soap. Rinse well and dry thoroughly.
- Use gentle soaps, such as hypoallergenic soaps, and use as little soap as possible.
- Do not use deodorant soaps on your child.
- Avoid bubble baths, powders, and perfumed soaps, which can irritate and dry the skin.
Wash your child's clothes with a mild soap rather than a detergent. Rinse twice to remove all traces of the cleaning product. Avoid strong detergents.
Change your child's diapers when wet and immediately after a bowel movement. Wash your hands before and after each diaper change.
Wipe your child from front to back when changing a diaper or helping with the toilet, and teach children to wipe in this direction. This may reduce the spread of bacteria from the anus to the urethra.
Dress your child in cotton underwear and loose clothing.
Encourage older children to urinate whenever they feel the need.
Avoid constipation. For more information, see the topic Constipation, Age 11 and Younger.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your child's doctor diagnose and treat your child's condition by being prepared to answer the following questions:

What are your child's symptoms?
When did the symptoms start?
What do you think may have caused the symptoms?
Has your child had a fever?
Has your child ever had a problem like this in the past? If so, when? What was done to treat it?
Does your family have a history of urinary problems?
Has your child had a recent injury to the belly, pelvis, or back?
What home treatments have you tried, and how effective were they?
Does your child have any health risks?

A urine specimen may be collected during your child's office visit. Do not encourage your child to go to the bathroom immediately before the office visit. Special urine collection bags or a catheter may be used to collect urine from a baby or toddler who is not toilet trained.

Credits

Current as of: July 1, 2021

Author: Healthwise Staff
Medical Review: William H. Blahd Jr. MD, FACEP - Emergency Medicine
E. Gregory Thompson MD - Internal Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine
H. Michael O'Connor MD - Emergency Medicine