kidney stone in children

Overview

A kidney stone is a hard, pebble-like piece that forms in the kidney when certain substances in urine become concentrated and stick together. In children, these stones can be tiny or up to the size of a small pebble, and they can cause pain and problems with urination.

Kidney stones are much less common in children than in adults. However, the number of children with kidney stones has been rising. Some studies suggest about 1 in 1,000 children will have a kidney stone by the time they are 18, but the exact number may vary by country.

Kidney stones can affect children of any age, but they are most often diagnosed in teenagers. They can happen in babies and younger children too, though less often. Children who have certain medical conditions, take some medicines, do not drink enough fluids, or have a family history of kidney stones may be more likely to develop them.

Symptoms

Common symptoms

• Sudden, sharp pain in the side or back
• Pain in the lower belly
• Pain when urinating
• Blood in the urine (pink, red, or brown)
• Feeling sick to the stomach or throwing up

Symptoms in children

• In babies and young children, symptoms can be harder to spot. Look for fussiness, crying that is hard to soothe, vomiting, a fever, or blood in the nappy or diaper.
• Older children may complain of stomach pain or back pain.
• Urinating more often or a strong urge to go may also be signs.

Symptoms in older adults

• Although this article is about children, it can help to know that adults may also have back or side pain, pain that spreads to the groin, cloudy urine, or a painful burning feeling when urinating.
• Older adults may not feel pain as strongly, so they may only notice blood in urine or a fever.

Causes

Main causes

• Kidney stones form when the urine has more of certain substances — like calcium, oxalate, or uric acid — than the fluid can keep dissolved.
• When urine becomes too concentrated, tiny crystals form and grow into a stone.
• In children, this can happen because of not drinking enough fluids, an unbalanced diet, a urinary tract infection, or an inherited condition that makes the kidneys remove too much of a substance.

Risk factors

• Not drinking enough water or other fluids
• Eating a diet very high in salt or sugar
• Having a family history of kidney stones
• Having certain medical conditions, such as kidney disease, diabetes, or inflammatory bowel disease
• Taking some medicines that can affect the kidneys
• Having had previous kidney stones

When to see a doctor

See a doctor urgently if:

• Your child has a fever with pain or blood in urine
• Your child cannot keep any fluids down
• Your child is not urinating as much as usual
• The pain is severe and not relieved by home care

Book a routine appointment if:

• Your child has had pain in the side or back more than once
• You notice blood in your child's urine
• Your child often feels the need to urinate or complains of burning when urinating

Diagnosis

To diagnose a kidney stone, a doctor will ask about your child's symptoms and medical and family history, and do a physical examination. They will usually order tests to confirm the stone and see its size and location.

Tests that may be done

• Urine test to check for blood, infection, or stone-forming substances
• Blood test to check kidney function and look for high levels of certain minerals
• Imaging tests, such as an ultrasound or a low-dose CT scan, to see the stone

What to expect at your appointment

The doctor may ask your child to drink extra fluids and collect urine in a special container for 24 hours. Imaging tests are painless, though your child may need to lie still for a short time. If the stone is small, the doctor may suggest a 'wait and see' approach at home with fluids and pain relief.

Treatment

Treatment for kidney stones in children depends on the size, location, and cause of the stone, as well as the child's age and overall health. For many children, the stone will pass on its own with plenty of fluids and home pain relief. If the stone is too large, causes severe symptoms, or blocks the flow of urine, a doctor may recommend a procedure to break it up or remove it.

Self-care at home

• Give your child plenty of water to drink, unless the doctor says otherwise
• Encourage your child to move around, as this may help a small stone pass
• Use a warm, damp cloth on the belly or back for comfort, but check with your doctor first for pain relief options
• Watch how much your child urinates and look for the stone in the urine (you can strain the urine through a mesh filter if the doctor suggests it)

Medical treatments

Doctors may prescribe medicines to help control pain or to make urine less likely to form stones. Medicines are chosen carefully for children, and any medicine should only be given under the guidance of your child's healthcare team. If the stone does not pass, a urologist (a doctor who specialises in the urinary system) may use sound waves, a laser, or a very small instrument to break up or remove the stone. These procedures are done in hospital, usually under general anaesthetic so your child is asleep and feels no pain.

When is surgery considered?

Surgery is only considered when a stone is very large, blocks urine completely, or has not passed after a reasonable time. It may also be needed if there is a reason the stone is unlikely to pass, such as a birth difference in the urinary tract. The type of procedure depends on the stone's size and position.

Living with this condition

Most children can return to normal activities as soon as they feel better. After treatment, your child's doctor may ask you to collect urine for a day, make small diet changes, or keep a record of any future symptoms. It is important to go to follow-up appointments and to let the doctor know quickly if symptoms come back.

Lifestyle tips

• Encourage your child to drink enough water every day, especially when it is hot or when playing sport
• Limit sugary drinks, especially cola and other fizzy drinks
• Make sure your child has a balanced diet with not too much salt
• If your child takes vitamins or supplements, ask the doctor if they are needed

Diet and exercise

A child who has had a kidney stone may benefit from a diet that matches the cause of the stone. For example, some children need to eat fewer foods high in oxalate (like spinach, rhubarb, and nuts), while others need to increase fluids. In general, offer plenty of water, fresh fruits and vegetables, and foods with enough calcium — not too much and not too little. Physical activity is good, and can help keep the kidneys working well, but always make sure your child drinks enough water when exercising.

Mental health and emotional wellbeing

Living with kidney stones can be stressful for a child and for the family. Pain, hospital visits, and worry about it coming back can make a child feel anxious or upset. It is normal to have these feelings. Talk to your child about what is happening in simple, calm words, and let them ask questions. If you notice ongoing sadness, fear, or changes in sleep or appetite, ask your healthcare team about support. In an urgent mental health crisis, call your local emergency number.

Prevention

Not all kidney stones can be prevented, but many can. The most important step is making sure your child drinks enough fluid, especially water, so urine stays dilute and less likely to form crystals. If your child has had a stone, the doctor may run tests to find the cause and suggest a specific prevention plan.

Screening programmes

If your child has had repeated kidney stones or a family history of stones, the doctor may suggest simple urine or blood tests to check for risk factors. This is not the same as a screening test for all children, but it can help guide prevention for your child.

Complications

If left untreated

• A stone that blocks the flow of urine can cause pain, infection, and damage to the kidney over time
• A blocked kidney can lead to a painful condition called hydronephrosis (swelling of the kidney)
• An untreated urinary infection with a blocked stone can become severe and spread to the bloodstream, which is a medical emergency

Long-term outlook

With the right care, almost all children with kidney stones recover well. Many pass the stone without needing any procedure, and others have a simple treatment that removes it. Once the cause is worked out, you and your child's team can make a plan to lower the chance of future stones. Most children go on to live healthy, active lives.

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