If your toddler is not peeing, when should you start worrying?
Find out how long a toddler can go without urinating, what causes a toddler not to pee, and what to do about it.
My 18-month-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 doctor, 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.
Generally, a toddler “should go” every two to three hours.
Normal Urination Frequency in Toddlers
In general, a toddler “should go” every two to three hours. A toddler’s bladder size is 3-5 ounces, and it should take around 2 hours to become full during the daytime.
Voiding frequency also varies with your toddler’s mastery of toilet training. By the age of four, many young children have developed this ability. Therefore, those with some skill may tolerate longer voiding intervals, including up to six hours.
So, the good news is that your toddler’s lack of peeing could be completely normal, and due to increasing bladder control, especially if it happened overnight.
On the other hand, there are some scenarios where decreased urination is either a sign that the child is drinking too little or a health problem. For example, if a child is not urinating for 4 to 12 hours, this may be a sign of dehydration. In other cases, reduced urine output is caused by an outflow obstruction, bladder dysfunction, or infection.
Reasons Why a Child is Not Urinating
Unless you are certain that your child’s dry diapers or potty are due to bladder control, the first step is to find out what is causing the toddler not to pee.
Here are some of the most common causes:
In this situation, your toddler produces minimal amounts of urine. The diaper may seem dry, or, if toilet trained, very little urine is passed. This could happen if your toddler has been active but does not drink enough fluids throughout the day. Hot weather is another common reason for dehydration.
(Remember that diapers effectively absorb urine, and small volumes can easily “disappear” into the core materials. Hence, it is possible that your child is peeing in small amounts, but much less urine output than usual is still a concern.)
Important symptoms of dehydration are, in addition to low urine output, a dry mouth, and the fact that the child is thirsty and less active. Severe dehydration can also lead to sunken eyes, lack of tears when crying, cold hands and feet, rapid breathing, a fast heart rate, and the toddler being drowsy. Find more signs of dehydration here.
If your toddler is happy and shows no signs of illness, inadequate hydration is most likely the case. However, urine output may be decreased when associated with fluid losses from vomiting, diarrhea, or persistent or high fever. In these cases, your child may need medical attention.
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.
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 find more details about UTI symptoms in toddlers here.
A urinary tract infection must be detected and treated, as it can otherwise lead to a kidney infection – a much more severe medical condition that can lead to kidney damage.
3. Some 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.
Common signs of constipation in toddlers are less dirty diapers, hard stools, abdominal pain, and sometimes blood on the surface of the stools.
Serious but less common reasons for a blockage could be bladder cysts, polyps, or inflammation from an injury.
Some medications, such as, e.g., antihistamines and decongestants, can have reduced urination as a side effect. These medicines are usually not given to toddlers, but if you have recently given any new medication to your child, check with their healthcare provider if the reduced urine output could be a side effect and what you should do in such a case.
5. Neurogenic Bladder
When an underlying neurological problem exists, or there has been a birth injury, innervation of the bladder muscles may be impaired, causing urinary problems. Examples of this include cerebral palsy, neonatal stroke, and spina bifida.
Learn more about neurogenic bladder in this excellent video:
6. Stress and Anxiety
Has there been any major change of routines, or has anything happened that could cause stress for your toddler? Sometimes, toddlers may hold their urine if they have experienced something that triggered a fear of peeing, for example, pain or potty training stress.
7. Bladder Control
On a happier note, reduced urination can be a sign of bladder control, especially if the extended dry period is at night. The age at which a toddler develops this ability can vary. Before 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 with 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 Peeing
Some things to consider when your toddler is not urinating:
- Did your child eat or drink less than the usual amounts during the day? Toddlers that are weaned from breast milk or formula to a larger share of solid foods need increased fluid intake in other ways, for example, by drinking more water.
- 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 would be very concentrated because the body is attempting to conserve fluid.
- Is your child making excessive efforts NOT to pee? They 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 had fewer bowel movements for several days – indicating constipation?
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 Child is Not Peeing
What to do when a child is not urinating, of course, depends on why.
For mild dehydration, try to find ways to encourage your toddler to 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, nothing needs to be done, of course! If you feel that your toddler has been holding urine a bit longer than expected, you can remind them to try “to use the potty”. It may even be helpful to go to the bathroom together.
Remember that your child is still very young, and each toddler develops an 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 or toddler seems ill or is in pain, refuses to eat or drink, has a fever, has malodorous or bloody urine, or voids less than four times in 24 hours, contact a doctor.
If you are at all worried about 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 your child’s doctor, even if no signs of illness are present.
I hope this helps!
Read Next About Babies That Are Not Peeing
- Daytime Accidents & Bladder Control Problems: Voiding Dysfunction Explained
- Kitchens, D. M., Anthony Herndon, C. D., & Joseph, D. B. (2007). Pediatric urodynamics: basic concepts for the neurosurgeon, Neurosurgical Focus FOC, 23(2), E8. Retrieved Apr 18, 2023, from https://doi.org/10.3171/FOC-07/08/E8</li>
- Urinary Tract Infections (UTIs)
- Urinary Tract Infections in Children
- Pedriatic Neurogenic Bladder
- Nocturnal enuresis in children: Management
- Braga AANM, Veiga MLT, Ferreira MGCDS, Santana HM, Barroso U Jr. Association between stress and lower urinary tract symptoms in children and adolescents. Int Braz J Urol. 2019 Nov-Dec;45(6):1167-1179. doi: 10.1590/S1677-5538.IBJU.2019.0128. PMID: 31808405; PMCID: PMC6909859.
- Allpeds: Antihistamines
Who else’s toddler is not urinating? Add your comments below.
Paula Dennholt founded Easy Baby Life in 2006 and has been a passionate parenting and pregnancy writer since then. Her parenting approach and writing are based on studies in cognitive-behavioral models and therapy for children and her experience as a mother and stepmother. Life as a parent has convinced her of how crucial it is to put relationships before rules. She strongly believes in positive parenting and a science-based approach.
Paula cooperates with a team of pediatricians who assist in reviewing and writing articles.