Written by Zest Pediatrics
Elimination patterns in children are often of concern to parents. Normal elimination patterns can be rather variable. Yet we all know that children should have regular bowel movements and urine production. This article will discuss normal and abnormal urinary habits and when you may want to call your pediatrician.
All children, other than in the first two days of life, should pee at least every 8 to 10 hours. Any amount less than this is abnormal and could be a sign a child is dehydrated.
The normal color of urine can vary from clear (very dilute) to intense yellow or golden (concentrated). Abnormal colors for urine are red, pink, orange, and tea-colored. If your child has urine any of these colors, you should call the doctor. If the color is associated with pain (back, belly, groin or while peeing) or fever, they should be seen soon.
Peeing more frequently than normal can be related to numerous reasons including vaginal or urethral irritation, the production of excessive urine (diabetes mellitus), anxiety, urinary tract infection, constipation, neurological bladder conditions, behavioral issues including excessive drinking, and a very common condition called urinary frequency of childhood. Increased urinary frequency in a girl may also be related to non-specific vaginitis (see below). Any child who is urinating more frequently than normal should be seen if it lasts more than a day or so. A visit can help to determine the cause.
Urgency is manifested by the immediate urge to go to the bathroom secondary to the fear of wetting the underwear in a toilet trained child. Urgency may be associated with frequency and pain or be isolated. Urgency is caused by vaginal or urethral irritation, urinary tract infections, neurologic bladder conditions and, often, behavioral issues when children wait to long prior to voiding. All children with urgency should be seen in the office for a visit unless the parent thinks the child is simply not frequenting the bathroom often enough, in which case scheduled bathroom breaks should fix the problem.
Pain with Urination – Dysuria
Pain with urination is called dysuria and can be seen with vaginal or urethral irritation and in urinary tract infections. The doctor can run a urine test to help determine the difference between the two. In girls, a common cause is non-specific vaginitis (again, see below).
Incontinence or wetting during the day can be related to the same issues as urgency and frequency. In early school-aged children it is usually due to not voiding frequently enough and can be solved with scheduled bathroom breaks. Constipation should also be considered as it can contribute to both frequency and wetting. Children with frequent and persistent wetting after toilet training is completed should be seen in the doctor’s office.
Bed-wetting can be primary or secondary. Primary nighttime incontinence is usually a developmental issue and is a normal occurrence in some children up to the age of 9-10. However, once a child has been consistently dry for 3-6 months at night and then again develops nighttime wetting, it is considered secondary and a cause should be sought. Children with secondary bed-wetting should be seen in the office to be evaluated for infection, constipation, diabetes, neurologic conditions, and psychological stressors.
Vaginal Itching and/or Pain
Vaginal itching and pain with peeing is very common in preschool age girls, especially after being toilet trained. Vaginal yeast infections, commonly thought to be the cause by parents, is very rare in pre-pubertal girls. The cause of vaginal itching is usually nonspecific vaginitis, or inflammation, and caused by excessive or vigorous wiping during toileting, learning to ride a bike, tight fitting clothes, and the most often blamed culprit – bubble baths. Other causes of vaginal inflammation in pre-pubertal girls include strep infections (often a rash is also seen) and rarely pinworms.
Prior to going to the doctor for vaginal itching or pain, warm sitz baths can be tried. Place two tablespoons of baking soda in warm water in the bathtub (enough water so the child’s vaginal area is submerged during the bath) for 15 minutes twice a day. If symptoms persist, or are associated with fever, abdominal or back pain, then the child should be seen.