Dr. George T. Klauber

4 - 5 times/day

Daughter may well have a UTI, thus should have her urine tested. Girls are prone to UTIs because their urethra is very short so it s easy for bacteria to gain access to the bladder & then multiply. Bubble-bath causes UTIs as can sitting in soapy bath water, constipation frequently causes UTIs. Infrequent urination as well has failure to separate thighs during urination. Latter requires pulling panties down to ankles, otherwise firmly closed labia can cause vaginal trapping of urine & bacteria can thrive on trapped urine.

She may have a UTI. Thus should have a urinalysis.

Stop fluid intake after dinner or 7.00 pm which ever is earlier. Wake him 2 hours after going to bed to urinate. I these simple measures fail then try & use a bedwetting alert. Best value is the "Wet-stop", available at Amazon or via the internet. Mechanism is identical to the more expensive alarms. There is a season which clips onto underpants just in front of penis which connects to a buzzer/vibrator which clips onto t-shirt or PJ top. Arlarm sounds as soon as sensor is activated. Sensor must be opened & button on buzzer/vibrator pressed to silence it. Parent needs to do this if child does not wake to do it himself. Principle is that brain eventually senses that there was a sensation of bladder fullness & thus need to urinate prior to alarm sounding off. Success rate of alarm is about 70%. Try it for 6 weeks. Also continue for 4 - 6 weeks after child is dry, this reduces possible relapse rate. Medication with Desmopressin (DDAVP) can be tried if above measures have not succeeded.

Your son is likely uncircumcised. UTIs in boys with a tight foreskin is best managed with circumcision. Constipation is 2nd most likely cause.

Pediatric urologists can fix this with skin flap or graft if too much skin has been removed and your son has pain or significant discomfort when he has an erection.

Fortunately, most girls with recurrent UTIs have do not have a kidney problem unless UTI is accompanied by fever. Needs kidney & bladder ultrasound plus VCUG (bladder X-Ray with X-ray contrast (dye) if fever present with UTIs. In any case preventative measures should be used, these include: 1) Treat & prevent constipation, 2) Shower rather than taking baths, also never ever use bubble-bath, 3) Cotton underpants, 4) pull pants down to ankles & separate thighs with urination, this prevents urine trapping by closed labia, 5) Cranberry juice is a good UTI preventative as it reduces bacterial adherence to bladder wall.

UTIs are quite common in prepubertal girls. Symptoms are most commonly frequent urination, burning pain sensation with urination & foul urinary malodor. May also have some wetting, day & or night. UTIs can be due to constipation, failure to widely separate thighs with urination causing some vaginal trapping of urine which then becomes infected, bubble bath or non-cotton panties. Thong panties can cause UTIs in older girls.

UTIs are of concern if associated with fever. Children who have had 2 or more febrile UTIs should be worked up with kidney & bladder ultrasound plus bladder x-ray (voiding cystourethrogram) as they may have urinary reflux or some other bladder or urethral abnormality. This confirms guidelines of American Academy of Pediatrics & Society of Pediatric Urology. Non-febrile UTIs are almost invariably benign.

Your son may have a UTI thus a urinalysis is recommended. Alternatively, might high have urethral metal stenosis (narrowing of urinary opening).

A 3-year-old should show some interest in becoming potty-trained, in which case she could come out of diapers. Diapers or "Pull-ups" are very reasonable to be used at night for bed-wetters of any age. Diapers would be an extremely uncommon cause of UTIs, in my opinion. Bubble baths should be avoided and showers are preferable to taking a bath. Constipation, if present, should be treated.

Vesicoureteral reflux is a congenital abnormality due to an incometent ureteral opening (valve) in the bladder. Frequently length of ureter running into bladder is too short compared to its diameter. Reflux commonly runs in families, a child may inherit abnormality from parent & thus have a genetic component in the inheritance. Hence we often advise parents to get kidney & bladder ultrasound examination of siblings if & when they have a child with significant reflux.

Diapers are an unlikely cause of a UTI. Constipation is common cause of UTIs as are bubble baths, which should not be used for little girls. UTIs, at around age 3 years can also be in part caused by girls withholding urination. It's an age when children realize that there is one thing in their lives that they can control!