Infrequent Voiding and Possible Symptoms of Dehydration

Q. My son will be 3 yrs old soon. Last weekend he went 24hrs without wetting one diaper. I took him to our pediatrician and they did a urine sample, which has not shown anything yet. He acts fine, does not have fever or abdominal pains. He also had not had a bowel movement for 3 days last weekend. The doctor and I talked about dehydration. My frustration is that my son does not drink a lot. He may have 2-2 1/2 10oz cups of Juicy Juice (1/2 water-1/2 juice) & OJ for breakfast (3-4oz). When he did finally urinate there was a lot (leaked out of diaper). The next day he wet probably 3 diapers. Now today... he only has wet 1 diaper! I'm very frustrated. I make him take a sip of juice every time I think of it. He always has access to his juice. Should I ask his doctor to check his kidney & liver function via blood test? I do not believe in unnecessary testing, but I do not know of any child that wets only 1-2 diapers a day. Lee, Sarasota, FL

A. It would be unusual for a child to get dehydrated if he was able to drink whenever he wanted and he didn't have any other symptoms, like vomiting or diarrhea. And you would expect some other symptoms, like a dry mouth or some weight loss if he went that long without urinating because of dehydration. When you are dehydration, your body's thirst center is stimulated so that you want to drink more. So if he was dehydrated, you would simply expect him to drink more.

In fact, your son already drinks more than the recommended 4-6 ounces of 100 percent fruit juice that the American Academy of Pediatrics recommends. Does he drink any milk?

However you are right that it is unusual to only have 1 wet diaper a day. He should be going at least 4-5 times a day. There are some common medical conditions that may be causing his problem, including that:

• he is constipated, since you mention that he sometimes goes days without having a bowel movement. Children who are constipated often hold their bowel movements and urine.
• he has infrequent voiding because he doesn't want to take the time to go, especially if he has to sometimes use the potty to go, instead of simply going in his diaper. Many children don't want to stop playing and take the time to go to the bathroom and so they overcome the urge to urinate and hold it in. This can lead to their bladder stretching so that it can hold more urine. Eventually it can lead to a voiding dysfunction and having accidents.
• you have been potty training and he is resistant and this is his way of having some control over the situation
• he has a neurological problem that is not allowing the urinary sphincter of the bladder to relax so that he can urinate. This is much less likely since you don't mention any other symptoms
• he has a kidney problem, which is also unlikely, since he had a normal visit with his Pediatrician and a normal urinalysis. Hopefully they also checked his blood pressure and it was normal. If not, that would be an important thing to do.
• there is some kind of blockage, although that usually also causes pain and blood in his urine

For children with a voiding dysfunction, it often helps to put them on a voiding schedule, in which you remind them to urinate every two or three hours. This is a little harder if he isn't potty trained yet, but if he isn't resistant to potty training, you might take him to the potty at least every two or three hours. If you have been having a hard time with potty training and you think that you may have been pushing him too hard, then you might back off and leave him in diapers for now until this problem passes.

I agree that you don't want to do tests unnecessarily, but whether or not something is wrong, it isn't good for him hold his urine all day. It can lead to his getting urinary tract infections and other kidney problems. Your options are either to go back to your Pediatrician or consider getting a second opinion from a Pediatric Urologist.

If he seems healthy and seems to being having problems with constipation, potty training, or not wanting to take the time to go use the potty, then you might talk to your Pediatrician about addressing and treating those problems before getting too aggressive in looking for other causes for his infrequent voiding.

It does sound like dehydration, which you have focused on, may not be a very likely cause for his problem though.

Until you get it sorted it out, frequent visits to your Pediatrician to monitor his progress would be a good idea, and please keep us updated on how he is doing and what ends up working for him. You should especially call your Pediatrician if he begins to have bloody diarrhea, tissue swelling (like his eyes or legs), no urine output, a rash, abdominal pain, severe vomiting, or a fever.