When A Child Pees, And Pees And Pees Again

     After age three, many young children develop the complaint of needing to urinate frequently. I have heard parents say that they have to stop at a number of gas stations on any short trip and that they have learned where the bathrooms are in most of their favorite stores. The child urinates a small amount and then needs to go again within an hour. This only occurs during the day (there is no new bedwetting or frequent urination at night) and the child does not have pain on urination.

     Sudden onset of frequent urination in a child can be a sign of urinary infection or diabetes, so it always has to be evaluated by the child’s caregiver. But simple examination of a urine sample will rule out both of these problems. Constipation can also cause frequent urination, but the history usually includes abdominal cramping, gas and large stools. Parents also need to be sure that the child is not drinking excessive fluids, especially juice. But if the child has no other symptoms and has a normal urine sample, he probably has simple frequent urination.

     For most of these children, the problem is a behavior problem. Although medications are sometimes used for this, reassurance and support are the best cures. If the examination by the child’s caregiver doesn’t show any disease, that can be the first step in reassuring the child that he is healthy and that this problem will go away. The parents can then explain to the child that “we need to practice holding our pee for a little longer.” After the child urinates, set a time that is longer than the time the that child wants to urinate again and explain that it will be all right if the child waits to go longer and that he won’t have an accident - “I know you feel like you need to pee, but it will be fine if we wait just a little longer. Don’t be afraid.“ When the child successfully waits, praise him. Some physicians recommend a small “reward”, but I’ve found that rewards need to be continually increased. A parent’s praise is the most important reward a child can receive. As the time between urinations increases, start setting other rules: “Please pee just before we leave because we are not going to stop the car on the way. Don’t worry, you can go again when we get to the store”. These children will frequently get very upset if told that they won’t be allowed to urinate, so I always reassure them that they will be able to urinate, but “we are just going to wait a little longer”.

     Keep extending the time between urinations. Tell the child’s teacher that the same program can be followed at school or daycare. Because the problem usually resolves with behavior modification, I do not recommend medications unless the child has some other problem that has been proven to respond to medication.