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 difficult 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.
• Urine that is more concentrated and appears darker, if your child is slightly dehydrated. Give your child more fluids to prevent serious problems from dehydration. As your child drinks more fluids, the color of his or her urine will return to normal.
• 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. However, 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.

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 foul-smelling urine.
• Dark or blood-streaked urine. Note: It is very common for newborns to pass some pink urine in the first 10 days of life. This is caused by crystals that appear in the urine of newborns. Also during the first 10 days of life, girls may have pink urine from a small amount of normal vaginal bleeding. The parents will notice a pink color to the urine in the diaper in both cases.
• 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 foul-smelling urine.
• Blood in the urine (hematuria). Note: Urine may look pink, red, or brown.
• Belly pain.
• Pain in the back, just below the rib cage, on one side of the body (flank pain).
• 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 traveling up the urethra.
• Kidney infections, which usually occur when bacteria get into a kidney by traveling 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 difficult 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.

Review the Check Your Symptoms sections to determine if and when your child needs to see a health professional.

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Author:	Jan Nissl, RN, BS	Last Updated April 30, 2007
Medical Review:	Michael J. Sexton, MD - Pediatrics Peter Anderson, MD, FRCS(C) - Pediatric Urology
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