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. 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 color and odor
Many things can affect urine color, including fluid balance, diet, medicines, and diseases. How dark or light the color 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 odor. A sweet, fruity odor may be caused by uncontrolled diabetes. A urinary tract infection (UTI) can cause a bad odor.
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 color to the urine in the diaper.
- Lack of interest in eating, or refusing food.
- 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.
- 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 traveling up the urethra.
- Kidney infections. They 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 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.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, 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.
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, herbal remedies, or supplements 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.
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.
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.
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.
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), ear, or rectal temperature
- High: 104° F (40° C) and higher
- Moderate: 100.4° F (38° C) to 103.9° F (39.9° C)
- Mild: 100.3° F (37.9° C) and lower
A forehead (temporal) scanner is usually 0.5° F (0.3° C) to 1° F (0.6° C) lower than an oral temperature.
Armpit (axillary) temperature
- High: 103° F (39.5° C) and higher
- Moderate: 99.4° F (37.4° C) to 102.9° F (39.4° C)
- Mild: 99.3° F (37.3° C) and lower
Note: For children under 5 years old, rectal temperatures are the most accurate.
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.
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.
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.
Many prescription and nonprescription medicines can cause urinary symptoms. A few examples include:
- Blood thinners (anticoagulants).
- 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.
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.
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. Or they might be concerned about the cost. 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.
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 Cheer Free 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
You can help your doctor diagnose and treat your condition by being prepared for your appointment.
Current as of: October 18, 2021
Author: Healthwise Staff
William H. Blahd Jr. MD, FACEP - Emergency Medicine
E. Gregory Thompson MD - Internal Medicine
Kathleen Romito MD - Family Medicine
Adam Husney MD - Family Medicine