Not Urinating

Dear Lisa,

My baby daughter has not urinated in about a week what can be the cause of this?

“Baby not Urinating”

Dear “Baby not Urinating”,

If your baby has not urinated in a week she would be extremely ill. Infants and children are expected to urinate approximately 6 times in a twenty-four hour period. Urine is produced hourly at the rate of 1 ml of urine per kilogram of weight per hour.(1) Therefore if your infant weighs 22 pounds or 10 kg she should urinate 10 ml which is equivalent to two teaspoons per hour. This is such a small amount of urine that it can easily go unnoticed.

It is expected that an infant will urinate every 1 ½ hours. Children that are potty trained have the ability to hold in their urine for a few hours and will urinate at intervals throughout the day. Many times parents believe that their child is not urinating because the amount of urine that a child passes is so small that it is difficult to detect in the diaper. This is particularly true for children who wear disposable diapers. Disposable diapers are so absorbent that it is sometimes impossible to tell if a child urinated. To make matters worse, children often urinate at the same time that they have a bowel movement. When this occurs it is too difficult to decipher what part of the dirty diaper is stool and what part is urine.

If you are not sure if your child is urinating, you should rip apart the inside part of the diaper and expose the gel like beads that are beneath the surface. These beads will feel wet and smell like urine if your child urinated. If the inside of the diaper is dry, you should recheck the diaper in 1 ½ hours.

If it is too difficult to determine whether or not the beads are wet, you should bring your baby and the diaper to your Doctor’s office for an evaluation. They will be able to tell if your baby has urinated by weighing her diaper on an infant scale. You should also bring a dry diaper from the same package so that the weight of the two diapers can be compared. If the diaper that your child is wearing weighs more than a brand new diaper, then you will know that your child has urinated.

The conditions that cause a child not to urinate include dehydration, urinary obstruction, renal failure and medication side effects.(1) Other signs of dehydration include dry mucus membranes, a sunken fontanelle (soft spot), decreased tear production during crying, sunken eyeballs, weight loss, increased heart rate, non-elastic skin turgor, weak cry, high pitched cry, muscle weakness, irritability or lethargy.(1) The principle manifestation of Acute Renal Failure is oliguria or anuria. Oliguria is the medical term for scant urine output and anuria is the term for no urine output. Additional signs of Acute Renal Failure include edema(swelling), drowsiness, and fast breathing (1)

The severe reduction or absence of urination in an infant or child is a sign of a serious problem. Any child experiencing decreased or absent urination needs to be evaluated by a health care professional without delay in order to determine and treat the cause.

If you are interested in reading other Pediatric Advice Stories covering topics discussed:

Detecting Urine Output

Particles in Urine

Burning with Urination

Dehydration

References:
(1) Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994: 928-932, 1538.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

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