A common symptom in preteen girls is pain with urination. Although it is important to consider a urinary tract infection (UTI) in this situation, the following conditions can cause painful urination because they irritate the tissues around a child’s urinary opening. These conditions are more common than UTIs.
- poor hygiene (or wiping in the wrong direction)
- bubble baths
- prolonged bathing where a child washes herself and then sits in a soapy tub
- staying in a wet bathing suit for long periods of time during the summer
If your child has mild urinary symptoms without fever, vomiting or abdominal pain, you can consider trying to relieve her vaginal irritation by cleansing her bottom before taking her to the doctor. (Although it is helpful for dads to know about this problem, moms should usually be the ones to assist their daughters with treatment.)
Fill an 8- to12-ounce plastic bottle with warm water (it is important that the bottle has a “nozzle” on top to so it will produce a stream of water when squeezed). Have your child sit on a toilet with her legs spread and her labia majora pulled to the side. Position the bottle a few inches from the vagina and gently shower the tissues with water. Do the procedure twice a day for a couple of days. If the symptoms increase or do not improve quickly, see your doctor.
Doctor’s visits can be unsettling for children so I usually examine infants and toddlers on the parent’s lap. However, once boys reach the age of three or four, it’s important to do the testicular examination while they are standing.
Prior to adolescence, the main problem we look for is an inguinal hernia. Although parents may notice a bulge in their child’s groin before the checkup, the finding can be missed if a child isn’t standing when he’s examined. The reason for this is because an inguinal hernia is the result of a small opening between the abdominal cavity and the scrotum. If a person is standing, gravity “pushes” intestinal contents downward making the hernia easier to find.
Doctors look for inguinal hernias in adolescents as well, but this age group can also develop something called a varicocele. A varicocele is a painless swelling in the scrotum due to enlarged veins. (It feels like the scrotum is partially filled with worms or cooked spaghetti.) Like hernias, the problem can be missed if the testicles are examined when a person is lying down because the swelling goes away in this position.
If your child’s genital exam isn’t done while he’s standing, tell the doctor you know someone whose hernia or varicocele wasn’t found until he was checked in this position. Also, because adolescents usually ask parents to leave during the genital exam, make sure your son knows about the importance of being examined while standing.
Although inguinal hernias are much more common in boys, they can occur in girls as well. Therefore, it’s a good idea to do a brief genital check in girls when they are standing.
Lots of kids continue to wet the bed at night even though they are successfully using the potty during the day. (Even at six years of age, 12% of kids wet the bed.) Most parents use Pull-Ups during this period of nighttime wetness to make the morning routine easier for everyone. However, most kids become dry gradually and many of them will still be in Pull-Ups even though they are dry three or four nights per week. If your child is dry at night, you do not need the Pull-Up away the next morning. In most cases, a child can reuse a dry Pull-Up five or six times before it gets so tattered or baggy that it needs to be thrown away.
Most parents know that certain symptoms that can be associated with serious medical conditions. The most common ones are as follows:
- stiff neck may mean meningitis
- abdominal pain may mean appendicitis
- bad cough may mean pneumonia
Testicular torsion is a rare condition that most parents have never heard of. However, as with the problems noted above, it is important to get urgent medical attention for the condition. Although testicular torsion can occur at any age, it is most common in 12- to 18-year-olds.
In order to prevent the testicles from twisting, they are anatomically anchored within the scrotum. Sometimes, this anchoring is in the wrong place, which allows the testicle to twist 360 degrees. If this happens, the artery that supplies blood to the testicle will twist thereby cutting off its blood supply. Shortly after this occurs, a child will experience pain and swelling because the testicle is being deprived of oxygen. Although this is not a life-threatening condition, the testicle itself may die if the problem is not diagnosed and treated within eight to ten hours.
Although doctors know about the importance of diagnosing and treating testicular torsion as soon as possible, lay people don’t. In addition, since adolescents may be reluctant to discuss genital symptoms with their parents, further delays can occur before the diagnosis is made. You can remedy this situation by asking your doctor to discuss the problem at your next checkup. If a teenager knows that testicular pain is an emergency, he will hopefully be more proactive reporting the problem to his parents.