If your toddler is not urinating, when should you start worrying?
Find out for how long a toddler can go without urinating, what the reasons might be, and what to do about it.
My 18 months old toddler did not urinate for 6 hours, is it wrong? I am worried that he is sick, but he seems ok. Should I contact the Dr or are there signs to look for that something is really wrong? He is happy.
Toddler is Not Urinating – Guide to Reasons and Remedies
In this article…
I agree that 6 hours seems like quite a long time for a toddler to hold his urine, especially during the daytime. However, if the diaper remained dry overnight, and he did not wake to feed, this may be completely normal.
Normal Urination Frequency in Toddlers
In general, a toddler “should go” every two to three hours. Their bladder size is 3-5 ounces, and, during the daytime, it should take around 2 hours to become full.
Voiding frequency also varies with your toddler’s mastery of toilet training. By the age of four, many children have developed this ability. Those with some skill may, therefore, tolerate longer voiding intervals, including up to six hours.
On the other hand, there are some scenarios where decreased urination is a sign of a problem. For example, 4 to 12 hours without a wet diaper may be a sign of dehydration. In other cases, reduced urine output is caused by an outflow obstruction, bladder dysfunction, or infection.
Let’s further discuss what would be considered abnormal urinary patterns for a toddler.
Reasons Why a Toddler is Not Urinating
Because there are some concerning reasons that your toddler may be urinating less often, it is important to identify the cause.
Here are the most probable ones:
In this situation, your toddler produces very small amounts of urine. The diaper may seem dry, or, if toilet trained, very little urine is passed. Diapers are very effective in absorbing urine, and small volumes can easily “disappear” into the core materials. This could happen if your toddler has been active, but does not drink enough fluids throughout the day.
If your toddler is happy and shows no signs of illness, inadequate hydration is most likely the case. Urine output may be decreased, however, when associated with fluid losses from vomiting, diarrhea, or persistent fever.
You can learn more about the signs of dehydration here.
Urinary tract infections typically cause pain with urination. Because of anatomy, these infections are more common in girls than boys. Older toddlers may cry and express discomfort during urination, even refusing to use the toilet for fear of experiencing this pain. Alternatively, they may have frequent urinary accidents due to bladder irritation from the infection (source).
Urinary tract infections under the age of two can be more difficult to detect because symptoms differ from those of older children and adults. A fever or foul-smelling urine is sometimes the only symptom. You can read find more details about UTI symptoms in toddlers here.
3. Some sort of blockage
Constipation is the most common cause of urinary “outflow obstruction” in toddlers. Reduced stooling frequency causes the impacted stool to compress the bladder, resulting in incomplete voiding and, if toilet trained, daytime accidents . Once the constipation is remedied, normal voiding patterns resume.
Serious, but less common reasons for a blockage could be bladder cysts, polyps, or inflammation from an injury.
4. Neurogenic Bladder
When an underlying neurological problem exists or there has been a birth injury, innervation of the bladder muscles may be impaired, causing difficulty with urination. Examples of this include cerebral palsy, neonatal stroke, and spina bifida .
Learn more about neurogenic bladder in this excellent video:
5. Bladder Control
On a happier note – reduced urination can be a sign of bladder control, especially when the extended dry period is at night. The age that a toddler develops this ability can vary. Prior to 12 months, infants do not have the physical or cognitive ability to learn this skill.
Depending on your family situation and cultural norms, some parents begin small steps toward toilet training after the first birthday. In clinical practice, I have seen 18-month-olds who have full bladder control during the day, but others who have not mastered it until age four. Night-time control typically develops later. It is not uncommon for a five-year-old to still need a “pull up” at night.
How to Know Why a Toddler is Not Urinating
Some things to consider when your toddler is not urinating:
- Did your child eat or drink less the usual amounts during the day?
- Was the urine a light yellow color with a faint odor? If it instead had a dark yellow color and a sharp smell, the urine is very concentrated because the body is attempting to conserve fluid.
- Is your child making excessive efforts NOT to void? He or she could be holding back because it is painful.
- Is there a fever or any other sign of illness that could indicate a urinary tract infection?
- Has your child failed to pass stool for several days?
If none of these signs are present, there is little cause for concern. Offering sips of water should remedy the situation.
What to Do When a Toddler is Not Urinating
What to do when a toddler is not urinating, of course, depends on the reasons why.
For mild dehydration, try to find ways to encourage your toddler drink a bit more. 18-month-olds are often very active and on the go, so it may be a bit difficult to persuade them to take a hydration break. You can provide a sippy cup of water to carry around and drink throughout the day. It is important to avoid juices and sugary drinks to prevent cavities.
If the decrease in voiding is due to better bladder control, then not much needs to be done, of course! If you feel that your toddler has been holding urine a bit longer than expected, you can remind him or her try “to use the potty”. It may even be helpful go to the bathroom together.
Remember that your child is still very young, and each toddler develops interest in toilet training at different times.
If there is a suspicion of illness, you should consult a doctor.
When to Call the Doctor
So to be clear, if your baby seems ill or to be in pain, refuses to eat or drink, has a fever, has malodorous or bloody urine, or voids less than four times in a 24 hour period, contact a doctor.
If you are at all worried about an obstruction of urine flow, call a doctor immediately or head to the ER. This is not a “wait and see” situation.
If infrequent voiding continues, you should contact a doctor, even if no signs of illness are present.
I hope this helps!
P.S. Here are two excellent reference books for baby health issues and injuries:
- My Child Is Sick!: Expert Advice for Managing Common Illnesses and Injuries
- Caring for Your Baby and Young Child by The American Academy of Pediatrics
More Babies That Are Not Peeing
- Daytime Accidents & Bladder Control Problems: Voiding Dysfunction Explained
- Pediatric urodynamics: basic concepts for the neurosurgeon
- Urinary Tract Infections (UTIs)
- Urinary Tract Infections in Children
- Pedriatic Neurogenic Bladder
- The Right Age to Toilet Train
- Nocturnal enuresis in children: Management
Who else’s toddler is not urinating..? Add your comments below.