Urinary Problems and Injuries, Age 11 and Younger

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.

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your child's symptoms.

Other Symptoms to Watch For

Does your child have any of the following symptoms?

• Abdominal pain: Go to the topic Abdominal Pain, Age 11 and Younger.
• Diaper rash: Go to the topic Diaper Rash.
• Diarrhea: Go to the topic Diarrhea, Age 11 and Younger.
• Constipation: Go the topic Constipation, Age 11 and Younger.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Starting home treatment at the first minor signs of an urinary tract infection may prevent the problem from getting worse and help clear up your child's infection.

• 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. Cranberry or blueberry juice may be a good choice.
• 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, 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, such as Basis, Cetaphil, Dove, or Oil of Olay, 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.
• Call your child's doctor if your child's symptoms have not improved after 48 hours of antibiotic treatment.
• Follow up with your child's doctor as instructed after your child has finished the course of antibiotics. Many children will require additional testing. For more information, see the topic Urinary Tract Infections in Children.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your child's symptoms 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.
• Symptoms get worse after home treatment.
• Symptoms do not improve after 24 hours of home treatment.
• 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 frequent, get worse, or interfere with daily activities.

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 Basis, Cetaphil, Dove, or Oil of Olay, and use as little soap as possible.
  • Do not use deodorant soaps on your child.
  • Avoid bubble baths, powders or perfumed soaps, which can irritate and dry the skin.
• Wash your child's clothes with a mild soap, such as CheerFree or Ecover, 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.

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

You can help your child's health professional 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.

• Abdominal Pain, Age 11 and Younger
• Child Abuse and Neglect
• Constipation, Age 11 and Younger
• Cuts
• Diaper Rash
• Diarrhea, Age 11 and Younger
• Exposure to Sexually Transmitted Diseases
• Fever, Age 3 and Younger
• Toilet Training
• Urinary Tract Infections in Children
• Vomiting, Age 3 and Younger

When to See a Doctor

See significance of inability to urinate if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your child's symptoms.

	Call your child's health professional immediately if you answer "Yes" to any of the following questions.
Yes	Does your child have severe pain?
Yes	Has your child been unable to urinate or had a dry diaper for longer than 12 hours?

	Call your child's health professional today if you answer "Yes" to the following question.
Yes	Does your child have mild to moderate pain?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

When to See a Doctor

See significance of urinary symptoms after an injury if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your child's symptoms.

	Call your child's health professional immediately if you answer "Yes" to any of the following questions.
Yes	Is your child unable to urinate?
Yes	Does your child have bloody urine? Note: Check to see whether the bleeding is coming from another area. If there is a cut in the genital area, blood may become mixed with urine. For more information, see the topic Cuts.
Yes	Do you think that your child's injury was caused by physical or sexual abuse?

	Call your child's health professional today if you answer "Yes" to the following question.
Yes	Does your child have any urinary symptoms, such as difficulty urinating?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

When to See a Doctor

See significance of urinary tract infection if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your child's symptoms.

	Call your child's health professional immediately if you answer "Yes" to the following question.
Yes	Does your child have severe pain with urination?

	Call your child's health professional today if you answer "Yes" to any of the following questions.
Yes	Does your child have burning pain with urination that does not seem to be caused by genital skin irritation?
Yes	Does your child have to urinate often without being able to pass much urine?
Yes	Does your child have pain in the back just below the rib cage, on one side of the body (flank pain)?
Yes	Does your child have bloody urine?
Yes	Is your child vomiting?

	You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions.
Yes	For the past 24 hours, has your child urinated slightly more often and passed smaller amounts of urine than usual?
Yes	For the past 24 hours, has your child had cloudy, bad-smelling urine without other symptoms?

	Your child needs an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question.
Yes	Has your child had mild urinary symptoms off and on for 2 weeks or longer?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

When to See a Doctor

See significance of vaginal discharge if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your child's symptoms.

	Call your child's health professional immediately if you answer "Yes" to the following question.
Yes	Do you think that your child's symptoms may have been caused by abuse?

	Call your child's health professional today if you answer "Yes" to the following question.
Yes	Does your child have mild urinary symptoms?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

When to See a Doctor

See significance of fever in a baby younger than 3 months of age if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your child's symptoms.

Note:

If you need information on how to take a temperature, see the topic Body Temperature.

	Call your child's health professional immediately if you answer "Yes" to any of the following questions.
Yes	Does your baby have a rectal temperature of 100.4°F (38°C) or higher?
Yes	Do you think that your baby has a fever, but you are unable to measure his or her temperature?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

When to See a Doctor

See significance of fever in a child older than 3 months of age if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your child's symptoms.

Note:

The guidelines below use rectal temperatures. A child has a fever when his or her temperature is 100.4°F (38°C) or higher, measured rectally. For information about taking accurate temperatures in babies and children, see the topic Body Temperature.

	Call your child's health professional immediately if you answer "Yes" to any of the following questions.
Yes	Has your child had an operation or other medical procedure in the past 2 weeks?
Yes	Does your child have a medical condition or take a medicine that affects the immune system?

	Call your child's health professional today if you answer "Yes" to any of the following questions.
Yes	Does your child have a temperature of 104°F (40°C) or higher?
Yes	Do you think that your child has a high fever, but you are unable to measure his or her temperature?
Yes	Has your child had a temperature of 102°F (39°C) to 104°F (40°C) after 12 hours of home treatment and medicine?
Yes	Do you think that your child still has a moderate to high fever after 12 hours of home treatment or medicine, but you are unable to measure his or her temperature?
Yes	Does your child have a temperature of 100.4°F (38°C) or higher with any other symptoms of a UTI?
Yes	Do you think that your child has a fever with any other symptoms of a UTI, but you are unable to measure his or her temperature?
Yes

	You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions.
Yes	Has your child had a temperature of 100.4°F (38°C) to 102°F (39°C) for 24 hours or longer?
Yes	Has your child had a fever off and on for 24 to 48 hours?
Yes	Do you think your child has had a mild to moderate fever off and on for 24 to 48 hours, but you are unable to measure his or her temperature?

	Your child needs an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions.
Yes	Does your child have frequent fevers and other symptoms of illness?
Yes	Does your child have frequent fevers without an obvious cause?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

When to See a Doctor

See significance of a previous UTI if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your child's symptoms.

	Call your child's health professional today if you answer "Yes" to any of the following questions.
Yes	Is your child acting like he or she did when diagnosed with a previous urinary tract infection (UTI)?
Yes	Is your child reporting the same or similar symptoms that he or she had when diagnosed with a previous UTI?

	You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question.
Yes	For the past 24 hours, have you thought your child may have a UTI, but he or she does not have any clear-cut urinary symptoms now?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

When to See a Doctor

See significance of structural problem with the urinary tract and urinary symptoms if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your child's symptoms.

Note:

If your child has a known structural problem with the urinary tract, follow your doctor's instructions regarding when to seek care for urinary symptoms.

	Call your child's health professional today if you answer "Yes" to the following question.
Yes	Is your child acting like he or she did when diagnosed with a previous urinary tract infection (UTI)?

	You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question.
Yes	For the past 24 hours, have you thought your child may have a UTI but he or she does not have any clear-cut urinary symptoms?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

When to See a Doctor

See significance of urinating more frequently if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your child's symptoms.

	Call your child's health professional today if you answer "Yes" to the following question.
Yes	Does your child have symptoms of a urinary tract infection (UTI)?

	Your child needs an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions.
Yes	Has your toilet-trained child begun to wet his or her pants, but he or she does not have other signs of a UTI?
Yes	Does your child have increased urination but no other symptoms of a UTI?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

When to See a Doctor

See significance of urinary symptoms despite treatment with antibiotics if you need information to help you answer the question below.

Review health risks that may increase the seriousness of your symptoms.

	Call your child's health professional today if you answer "Yes" to the following question.
Yes	Have your child's symptoms not improved after 48 hours of treatment with antibiotics?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.