Back to School Pediatric Urology Tips

By: Urology Care Foundation | Posted on: 09 Sep 2020

Back to School Pediatric Urology Tips

Now that Labor Day is beyond us, it's the time of year kids head back to school.

Dr. Amanda North joined the Urology Care Podcast for a recent episode to discuss back to school advice for parents as summer vacation comes to an official end.

Dr. North is a pediatric urologist who specializes in the care and treatment of children with complex voiding problems and congenital anomalies of the urinary tract at Montefiore Medical Center in New York.

She also serves on the Urology Care Foundation's Pediatric Health Committee. You can listen to the episode via the embedded podcast player below, or read a transcript of the podcast below.

Urology Care Podcast - Episode Transcript

Host: Welcome back to the "Urology Care Podcast." Today, our guest is Dr. Amanda North, and I'm gonna have her introduce herself and tell us a little bit about the work she does before we jump into today's discussion.

Dr. North: Hi, I'm Dr. Amanda North. I'm an associate professor of Pediatric Urology at Montefiore Medical Center, and I work at the Children's Hospital. I am the Chair of the AUA Workforce Workgroup. I'm also on the AUA Data Committee, as well as being part of Urology Care Foundation. And today, we are going to talk about bladder health and other issues for children as they return to school.

Host: That's exactly correct. So I wanna kick off the discussion by asking you, how much water should kids be drinking for optimal bladder health?

Dr. North: Well, what I always tell my patients is that there's no set amount that's right for everybody and there's no set amount that's right for one person every day. So I advise my patients to pay attention to the color of their urine. Ideally, their urine should look almost like water. And if it starts to look more yellow, like lemonade or even like orange juice, they're not drinking enough. And so, the first pee of the day is allowed to be yellow because you're not drinking while you're sleeping. But after that, if you notice that your urine looks dark, it's time to drink more water. The amount that they need during a day will depend on the weather, how active they are that day. If you're going out for two hours of football practice, you need to drink more water than if you're sitting on the couch playing video games all day. And so, going by the color of their urine is the best way to tell how much water they should drink.

Host: And how important is it for kids to stay hydrated when it comes to kidney health?

Dr. North: Hydration is very important and it's something that I think most Americans don't do an adequate job of maintaining. More than just kidney health, for overall body health, drinking water is very important. When kids are dehydrated, they tend to get headaches that can contribute to constipation. And obviously, it's not good for their kidneys either. So, staying adequately hydrated is important for your total body health and not just your urology health.

Host: Can we discuss the importance of hydration for kids as they go back to school? What are, kind of, some of the things to think about as kids return to a physical classroom?

Dr. North: Well, hoping that kids go back to school this August or September, depending on where you live, I know as a parent, I'm praying for my kids to go back to school. Hydration is really an issue during school. Most schools have the kids rely on water fountains, when they're able to go get a little sip of water from the fountain. And that's really not adequate hydration. I tell my patients that it's really important for them to have a water bottle with them at all times while they're in school so they can sip whenever they need to. I know for some high schools, this has been an issue as kids sometimes hide things other than water in their water bottles. But especially for younger children, making sure they have a water bottle with them all day is really important. We give our patients a school bathroom note that includes the instruction to allow the child to have a water bottle.

The problem is, many kids don't drink at all during the school day or drink minimally during the school day, and they then come home and drink their entire day's worth of water in the late afternoon/early evening. For kids who are prone to bedwetting, that can cause a huge issue because when they pee that water out is while they're supposed to be sleeping. And for other kids that causes them to need to wake up during the night. Like I said before, being dehydrated can make the kids have headaches, which certainly impairs their ability to learn. And some schools don't have air conditioning. When the kids go back at the beginning of the school year, it can be very hot in the classroom. Anything we can do to keep the kids well-hydrated during the school day will make them more attentive and better students.

Host: And what about holding it in? What kind of negative impacts can that have?

Dr. North: There are a lot of problems of having kids hold their pee all day. And trust me, we see a lot of patients who either think the school bathrooms are dirty or they're too shy to raise their hand. They're afraid the teacher is gonna embarrass them if they need to go to the bathroom. So for younger kids, especially in elementary school, the most obvious problem is they can have accidents at school. And there's nothing more embarrassing than being the kid who peed in your pants in the middle of the classroom. And so, helping kids have a bathroom schedule can avoid embarrassment. It's super important for, you know, psychological development of these kids to not feel different or outside of their peers, like would happen if you're one of those kids who has a lot of accidents at school.

But some kids are actually able to hold it all day. And those kids are at huge risk for recurrent urinary tract infections. One of the most common causes of urinary tract infections in elementary school kids is just holding it all day. We really encourage all of our patients to be on a regular bathroom schedule, where they go to the bathroom every two to three hours. In order to not disrupt the learning process, we ask the teachers to help the kids set up a bathroom schedule so that they can go use the bathroom in between lessons, rather than in the middle of a lesson. The advantage of having a preset bathroom schedule is you're not disrupting learning. You're letting the kid go to the bathroom in between math and science or after reading time, go use the bathroom. And that way, the child doesn't have emergencies during the day, can have the full benefit of the educational content in the classroom, but doesn't have any problems with having accidents or urinary tract infections.

Host: As kids go back to school, of course, playground activity ramps up. So, as a pediatric urologist, what are some common playground accidents that you would see a patient about? And what should parents, and perhaps school nurses as well, know about this to keep kids safe?

Dr. North: Absolutely. Good question. So, although, I have seen some unusual playground accidents, I had a child once who had a kidney injury from falling off the monkey bars, and you can certainly get kidney injuries from falling off of a bicycle that's going very fast, the most common playground injury that we see are straddle injuries. And this can happen on a bike or on the monkey bars where the child falls with something landing between their legs into their genital area. With girls, this can present with vaginal bleeding or even blood in the urine. And with boys, especially if you see blood at the tip of the penis or there's blood in the urine when the child urinates, or if the child can't urinate after the accident, it's extremely important for the child to be seen right away. The tube that travels from the bladder outside is called the urethra. And in boys, because of the urethra passing through that area, right, where they land when they have the straddle injuries, that type of injury can have very serious long-term consequences. And so if you suspect that the child has had that kind of injury, it's very important to go to the emergency room and be seen right away so that your pediatric urologist can help prevent long-term damage.

Host: And children's bladder health is definitely a subject you are clearly passionate about. So, why is it so important for us to have these discussions and get this type of education out there into the public?

Dr. North: I think people are surprised by how often these types of problems present themselves. When I see children for bedwetting, for example, I'm often surprised by how little information there is about bedwetting in the general population. Children and parents are embarrassed. Parents are often angry at their children or even punish them for wetting the bed when the children have no control over that. Many times the children feel social isolation when they're having accidents at school or when they wet the bed, they don't want their friends to know. There are a lot of things we can do to improve bladder health in children to make them not have urinary tract infections, to help them not have accidents that are socially embarrassing, to help them not wet the bed at night. And people have so little information about this that they don't realize that help is available.

There are a lot of pediatric neurologists who would be happy to help you and your child address these issues to make life a little bit easier. We all know that bullying happens in school. And we all know that cliques happen in school. And these types of social situations can make it very hard for children who have bladder issues to feel part of the group. We know that bullying and other types of, you know, feeling left out for kids can have long-term psychological effects. And there are so many easy solutions to these problems that can make children's lives better, make parents' lives better, and decrease the fighting between parents and children for these types of issues. And so I just really encourage people to seek help when they feel that their child has an issue.

Host: Will a child's bladder get weaker if they hold in their urine regularly? Essentially, what I'm asking is, are there consequences to the child's bladder later in life if they hold in their urine regularly?

Dr. North: Great question. So, sometimes yes and sometimes no. I mean, what we call dysfunctional voiding or these holding behaviors that we see in childhood are sometimes things that kids can outgrow. We teach them better habits and things improve as they practice their new bathroom habits. However, we see children whose bladder capacity or the amount of urine they can hold in their bladder gets so big, that we know that the bladder muscle is being impacted by this holding behavior. And if we don't reverse this behavior, it can have long-term bladder damage. We do see older women who no longer have good bladder function because of years and years and years of holding their urine. So these kind of bladder health measures that we teach our patients have long-term benefits into adulthood. When these kids, you know, get older, and you worry about having bladder health issues, the better the habits you learn in childhood, the better the habits you have as an adult. It's not unlike nutrition, when we teach our children good nutrition habits, those habits persist into adulthood. When we teach our children good bladder habits, those habits also persist into adulthood.

Host: And Dr. North, if you just have any other final thoughts or anything else you wanted to discuss with us today, please just let us know now.

Dr. North: As we look towards return to school this fall, and like I said, I'm hoping along with everyone else, that we have a normal return to school, I think it's really important that we think about how regular use of the bathroom, access to water during a school day can have really positive effects on all of our children. Even the kids who aren't having obvious issues, like accidents or urinary tract infections, benefit from consistent scheduling. I know even when kids are going to school at home, having them on a regular bathroom schedule with access to water can be beneficial. So, if we're not returning to school in a normal way this year, parents can still help their kids by setting timers and reminding them to stop what they're doing and going to the bathroom every two to three hours. But it would be really beneficial if all of our teachers, especially at the elementary school level, set a time for kids to use the bathroom on a regular basis and allow their children to have water when they're at their desks. I also encourage parents and children who feel that they have bladder issues, whether it's urinary tract infections, bedwetting, frequent accidents, these are all things that we can address. One final thought on this, bladder health is very much related to bowel health. And constipation is a huge issue with the American diet.

And I strongly encourage all of my patients to take fiber supplements. I tell them I take fiber supplements every day myself. I make my children take fiber supplements every day. And I encourage all my patients who are able to take fiber supplements to think about it. The American diet certainly doesn't have enough fruits and vegetables and other high fiber foods in it, in general, and most of us would benefit from having some fiber supplements. By having regular bowel movements, it increases our bladder health and can make everyone's bodies healthier. And so we have to think about the bladder and the bowel as working together. And so kids should be drinking plenty of water, using the bathroom every two to three hours, and making sure that their bowel health is as good as their bladder health.

Host: You've been listening to Dr. Amanda North. She is a pediatric urologist with Montefiore Medical Center in New York. Thank you, Dr. North, for making time for us today.

Dr. North: Thank you. I am on Twitter @anorth21 if anyone wants to follow me. And I really appreciate you taking the time to talk to me about these issues.

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