urination, frequent

As you might guess, there are a number of causes of frequent urination in children. This discussion will certainly not exhaust all possibilities, but give you some framework to think about the question.

Sometimes urinary frequency is more perceived than real - parents or grandparents may believe that a normal amount of urination is too much or too often. If this is really an issue for an older family member, one approach to answering the question is to measure the child's urine production for a 24 hour day. All urine is collected in a large container, and then measured and compared to the child's body weight. This may seem like a lot of trouble to go to, but it does answer the question. In younger children, fluid intake per day runs to something like 2-3 ounces per pound of body weight per day, and about half of that comes out as urine.

Diabetes

Diabetes, or diabetes mellitus, can indeed produce increased urination (polyuria); this is one of the hallmark symptoms. A child with a sudden increase in urinary output, especially if there are any other symptoms such as increased fluid drinking (polydipsia), increased appetite (polyphagia), weight loss, or sudden onset of significant bedwetting in a previously dry child. At this point - increased urination - the disease should be diagnoseable with a simple urine dipstick test for sugar (glucose). In the old days, the doctor tasted the urine; not currently recommended.

Diabetes insipidus

Diabetes insipidus is a condition of urination of truly prodigious urinary production and extreme thirst to match. It is caused by lack of a pituitary gland hormone: anti-diuretic hormone (ADH)

This deficiency is caused in childhood by a type of slow-growing benign brain tumor called a craniopharyngioma, which arises in the pituitary gland, destroying it insidiously over a number of years. When the production of anti-diuretic hormone is lost, the child will begin to consume very large quantities of fluid - gallons a day - with equally large output of extremely dilute urine. The extreme dilution of the urine is the tipoff with diabetes insipidus: no sugar is found, but the concentration of the urine after fluid restriction does not rise.

Urinary tract infection

Frequent or increased urination can be a symptom of urinary tract infection, but ordinarily we expect other symptoms to accompany or predominate: pain or burning with voiding (dysuria), abnormal appearance of the urine (cloudiness, blood), and sometimes abnormal odor.

Kidney disease

There are so many different types of disease of the kidneys that there are doctors who specialize in the study and treatment of them (nephrologists). Kidney disease that has increased urination as the first symptom is rare. Ordinarily decreased urine production or other symptoms such as abnormal urine or increased blood pressure are more likely to be noticed. Some kidney conditions are hereditary, so children with any significant family history of kidney conditions and a change in urinary habits should have a medical checkup and urine test.

Behavioral causes

Behavioral reasons for frequent urination abound. One source of increased urine production and frequent potty breaks is unnecessarily large fluid intake during the day. Some children walk around the house with cup or bottle in hand, demanding "Juice, juice!" Their pestering leads to frequent refills, and frequent, voluminous urination. Restriction of fluids, while it may produce a tantrum, also produces a marked drop in urine output and confirms the diagnosis of behaviorally related increased urination.

This is something that really ought to be addressed, not only to allay worries about the frequent urination, but also to get that kid off all that juice or milk! Juice dissolves the soft enamel of the baby teeth, and excessive milk intake can lead to anemia.

Habit piddling

This is generally a behavioral quirk of normal boys, about 3-1/2 to 4 years old. The lad becomes apparently fascinated with urination, especially when he is out and about at the mall, grocery store, and so forth. He seems to need to stop and make a little deposit at each restroom he comes to; not unlike a puppy's behavior. This curious little habit may last about 6 months or so, but if the urine is checked and found to be normal, parents can take a relaxed attitude about it. It is "just a phase."

Frequent urination at school

This can be a dodge that children in the early primary grades sometimes discover. The child gets into a cycle of going to the restroom, and on the way back, gets a drink at the water fountain. An hour or so later, he or she has to go again. Teachers are usually pretty good at putting a stop to this, especially once a urine test shows there is no diabetes or infection. Schedule that checkup for after school - do not reward the behavior any more than you have to.

Vaginal voiding

This may be confused with frequent urination or incontinence.

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