Updated: Mar 7, 2019
I'm so happy to be able to share this blog post, guest-written by Samantha Kimura RN, BScN and Mama Coach! Urinary tract infections can be a major concern when potty training, and Sam helps shed some light on the subject from a medical (yet practical!) perspective!
Having a child with a urinary tract infection (UTI) can be scary as a parent. UTI’s can appear seemingly overnight in young kids, which can leave you feeling guilty for not catching it sooner. The important piece to remember as parents is that some kids are just prone to UTI’s. You can clean and bath every night, wipe the correct direction and change their diaper as often as needed, and your child may still contract a UTI. Its easy to blame ourselves when our babies are sick - however this does not mean you have done anything wrong.
What is a urinary tract infection?
Most adults have had a urinary tract infection at one point in their lifetime. Bacteria becomes overgrown, leading to an infection in the bladder, kidneys and the tubes leading up to the bladder and in between the kidneys. In children this can be hard to diagnose because they can have very vague symptoms. Before toddlers are able to communicate how they are feeling or when they can’t find words to describe pain or discomfort, they may display the infection in less common ways.
In babies, you may notice symptoms such as:
· Lack of appetite
· Foul smelling urine in diapers
· Uncharacteristic irritability
In toddlers who are potty trained, you may notice:
· An increased need to urinate
· Pain before, during or after urinating
· More accidents and loss of bladder control
· Pink, cloudy, or foul smelling urine
· Lower tummy pain or back pain
Urinary tract infections require antibiotics in order to heal. If you notice any of these symptoms with your child, it is important to have an assessment completed by your family doctor. Urinary tract infections can be very serious and need attention quickly. If your child is very sleepy, unable to eat or drink, or is having intense pain call 911 or take your child to emergency as soon as possible.
How to collect a urine sample for your doctor
Your doctor will ask for a urine sample to send to the lab, which is really hard to collect in a baby and toddler!
If you suspect a urinary tract infection, it will save you a lot of time by bringing in a well-contained sample in to the office with you. However, this is much easier said than done when you’re trying to precariously balance a Tupperware under a toddler’s bum. In order for the test to be accurate, you want to keep the sample as clean as possible, which means pouring it out of a floor potty is not ideal. The only 100% accurate way of testing urine without contamination is to complete an “in-and out” catheter—a procedure that is done in hospitals with trained professionals and sterile equipment. For most purposes, a “clean catch” is what a family physician will ask for.
Before collecting, clean your child’s perianal area very well. You can ask for obstetrical wipes from your doctor or try to collect after a bath or wash.
If your child is still in a diaper or will wear a pull up, the easiest way to collect a sample is to put 5-10 cotton balls in their diaper, wait for your child to void and then (with a gloved hand if possible) squeeze the urine in to a Ziploc bag. Tape the bag so you don’t spill, and give this to the nurse at the doctor’s office. If this is mixed with stool, unfortunately it can’t be used and try again next time.
If your child is using the floor potty, clean the potty with disinfectant and line it with saran wrap. This is helpful for ensuring that the urine is as clean as possible. Alternatively, use a large Ziploc bag and fold down the edges, making it easy for your child to urinate in to the bag.
If your child is using a big toilet, the easiest way to catch urine is to watch and wait - and try to move quickly with a small, clean, plastic container.
Caring for your child with a UTI
Sometimes this can throw off potty training progress for young kids. Children are often afraid to use the washroom if it hurts to void, and then will hold in urine until they have an accident. Once your child is on antibiotics, they will feel better very quickly but it is still important to give the medicine for the entire length of time that is prescribed so the infection doesn’t return.
Encourage lots of fluids! Water is the best fluid when your child is sick, however if your child will drink watered down juice or milk, this will be beneficial for them too. Smoothies and fruit pouches are high in fluid and will count for fluid intake as well. At a minimum, your child should be drinking 15-20ml/kg/hour while awake during the day.
Encourage your child to use the bathroom as often as needed. Every 1.5-2 hours during the day is ideal to prevent stagnant urine and bacterial growth. By encouraging lots of fluids, this will encourage your child to void often. Tylenol and ibuprofen can be given for discomfort, as prescribed by your doctor or pharmacist.
Night sleep may be disturbed by the discomfort of a UTI - allow your child to use the washroom as often as needed, without making it a game. Symptoms should resolve within 2-3 days of antibiotic use, so if your toddler is still jumping up 4 times a night after this, its likely turning in to a habit rather than a need to use the toilet.
How does withholding increase risk for a UTI?
The bladder wall and the pelvic floor are very much connected to the pressure that constipation causes. Many children are afraid to stool on the toilet and will withhold for a long time before they will finally release. When this occurs, the pressure in their bowels can push on the bladder, which causes more urinary accidents, but it could also weaken the bladder walls and muscles. The trouble with weak bladder muscles is that it promotes incomplete emptying of the bladder when they do void, which leaves for stagnant urine and is more likely to cause an infection. Allison Jandu is a great resource for helping your child avoid constipation!
Its important to be patient with urinary tract infections as your toddler will respond to how you’re reacting. Extra cuddles and time together will be comforting, as well as knowing that once your child is feeling better, you can resume all of your previous routines!
About Sam Kimura
Sam Kimura is part of a nationwide group of Registered Nurses in Canada, who are committed to making motherhood easier with science, empathy and support. Sam provides sleep coaching, lactation support, prenatal classes and CPR instruction for parents anywhere in the world, ensuring that your family values and goals are met with evidence-based research and personalized care.
You can find her here: