American Medical Association Family Medical Guide - American Medical Association [203]
If your child is 7 or older and still wets the bed, your doctor may recommend using a special liquid-sensitive pad that sounds a loud alarm as soon as the first drop of urine touches the pad. Most children learn to wake up before the alarm sounds and get up to urinate. A few weeks of this treatment is usually effective; if your child begins wetting the bed again, use the pad again.
The doctor will recommend limiting your child’s intake of carbonated and citrus beverages, eliminating caffeine, and not having any dairy products at dinner or after. The doctor will assess the size of the child’s bladder by measuring urine output. If the child’s bladder is smaller than normal, the doctor may prescribe medication to stretch the bladder and thereby decrease the frequency of urination. Because constipation can contribute to bed-wetting, the doctor will probably recommend measures such as increasing the fiber in your child’s diet.
In persistent cases, a doctor may prescribe hormonal treatment to temporarily help control bed-wetting for special occasions such as sleepovers. For some children, treatment with a hormone called desmopressin (a synthetic form of the human hormone that naturally reduces the output of urine) controls bed-wetting.
Vesicoureteral reflux often occurs in children who were born with a neural tube defect such as spina bifida (see page 398), and also can occur in children who have a urinary tract abnormality such as a cyst, a stone, or an obstruction. In infancy the disorder is more common among boys; in early childhood it is more common among girls. Vesicoureteral reflux tends to run in families and occurs more often in whites than in blacks.
Symptoms
In many cases, a first-time urinary tract infection (see page 426) is the initial symptom of vesicoureteral reflux. Other possible signs and symptoms of vesicoureteral reflux include recurring urinary tract infections; problems with urination such as urgency, dribbling, and wetting; poor weight gain; and high blood pressure. In some children, swelling of the kidneys can produce a detectable lump in the abdomen.
Diagnosis
A diagnosis of vesicoureteral reflux is based on a child’s symptoms and the results of a physical examination. A doctor will order blood tests to evaluate kidney function and may order an X-ray of the urinary tract called a voiding cystourethrogram (see page 805) to check for vesicoureteral reflux and, if the condition is present, determine its severity. The doctor may also recommend an ultrasound (see page 111) of the kidneys to check their size and shape and to look for a cyst, a stone, an obstruction, or another abnormality.
Treatment
The treatment for vesicoureteral reflux depends on the severity of the disorder. Mild cases usually clear up on their own within about 5 years. Doctors often prescribe preventive treatment with antibiotics for children who develop frequent urinary tract infections. In some cases, medication is prescribed to control high blood pressure. In other cases, surgery is performed on the ureters to create a flap of tissue that works like a valve and prevents the backflow of urine. In severe cases the damaged kidney may be removed surgically. The remaining kidney will do the work of both kidneys.
Poststreptococcal Glomerulonephritis
Poststreptococcal glomerulonephritis (also called nephritis) is a rare condition that develops in a child after an infection with streptococcal bacteria. In response to the infection, the body’s immune system produces antibodies (infection-fighting proteins) to fight the bacteria, but because of a malfunction in the immune system, the antibodies continue to be active even after the bacteria have been destroyed, and attack the kidneys. The kidneys become inflamed and produce less urine than normal. Blood leaks from the glomeruli (the filtering units of the kidney) into the urine. With prompt treatment, most children recover completely from poststreptococcal glomerulonephritis. However, a few children