Strong Urine Smell in Babies:Causes & Symptoms

Taking care of a baby is not easy, and as a first-time parent, you may find it challenging. There are countless things that could go wrong and this forces parents to be on their toes at all times. You are likely to worry about every minor and major health issue that your little one may experience, and rightly so, you’re a parent, after all. For instance, if you notice a strong smell of urine from the baby, you’re likely to worry if something’s wrong with your baby, and you might panic. But should you? Read this article to find out!

What Are the Causes of Smelly Urine in Babies?

There could be many reasons for your baby’s urine to smell pungent. It is not always something that you need to worry about but here are some causes for why baby urine smells strong.

1. Urinary Tract Infection

UTI happens bacteria enter the urinary tract. Although UTI is not contagious, it can be unpleasant and a nuisance to deal with and could also lead to foul-smelling urine. A UTI affects girls more than it does boys due to human anatomy. Since a UTI is hard to detect amongst infants, you must watch out for other symptoms like fever, vomiting, irritability etc.

2. A Mother’s Feeding Habits

Bad smelling urine in a baby could be something as simple as the food that the mother consumed. Eating vegetables and herbs like asparagus, onion, and garlic can make a baby’s urine to smell. At any point, if you notice that your baby’s urine colour is far from clear, keep a track of what you eat and drink, as it could be due to your diet or dehydration.

3. Additional Requirement for Milk

For most babies, the only way they get any kind of water in their system is through breastmilk. Their nutritional requirements are met through the breast milk, and they must be fed thoroughly so that at no point they go hungry. Being hungry and dehydrated can concentrate their urine and in turn, lead to the foul-smelling urine. If you find out that your breastfeeding supplies are running low, there are methods that you can find online to increase it.

Why Does a Baby’s Urine Smell Like Ammonia?

Sometimes, an infant’s urine may smell of strong ammonia. Ammonia has an unpleasant and pungent smell. This smell can sometimes be a bit overwhelming but you need not worry. It can happen during early morning or if the baby is dehydrated. The kidney is required to process more than it usually does and this causes the urine to smell of ammonia.

Why Does a Baby’s Urine Smell Like Poop?

This could be a simple sign of your baby having a UTI. Sometimes, the bacteria from the anus can enter the urinary tract of your baby, leading to an infection. Make sure to clean and wipe properly so that the next time, your baby is not feeling miserable.

Why Does a Baby’s Urine Smell Like Vinegar?

If your baby’s urine smells like vinegar, it could be due to dehydration or a UTI, or something you ate. Vinegar smell from urine could also mean that your baby may come down with a cold. If your little one is already sick, her urine may smell of vinegar. It could be also due to acid reflux. Also, if the baby’s body is not able to produce enough lactose to keep up with the amount of lactose that she is fed, it can lead to smelly urine.

Symptoms of Smelly Urine in Infants

If your baby’s urine smells bad, there are some symptoms that you should watch out for so that you can decide if you need medical intervention or if it can be controlled at home. Here are the symptoms.

Is Smelly Urine a Sign of Teething?

Many parents think that smelly urine is a sign of teething in babies, but there is no scientific evidence to support this. If your baby’s urine smells a lot, you should check with a doctor without making any assumptions or trying home remedies.

When to Consult a Doctor

In case it seems like the symptoms are persisting or getting worse, make sure to take your baby to a doctor. You can also carry a soiled diaper with you so that the doctor has a better idea of what he/she is tackling. It is easy to brush off some symptoms at home because many parents live in denial about their baby being unwell. However, if your baby has blood in their stools, vomiting, fever or anything remotely harmful to their health, you must make sure that you take them to a doctor and provide the right treatment.

If your baby’s urine smells a lot, without delay you must consult a doctor. If you are confident enough about being able to handle it at home, then again consult with your doctor before trying any home remedial measures.

Also Read:

Mucus in Infant’s Poop
Infant Poop: What’s Normal & What’s Not
Abnormal Signs In Your Infant’s Pee & Poop That Need Immediate Attention!

Just A Dirty Diaper, Or Worse? Smelly Urine May Mean Infection : Shots

Stinky urine in a feverish child should be a red flag for doctors.

Swilmor/iStockphoto.com

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If you’ve spent any time around very young children, you know they can sometimes be pretty stinky. But particularly pungent urine in a child who is fussy or feverish could be a sign of infection.

Urinary tract infections are common in kids, leading to more than 1 million visits to pediatricians’ offices each year in the U.S. Bacteria or other microbes enter the body and can infect the urethra (urethritis), bladder (cystitis) and kidneys (pyelonephritis). Antibiotics knock out most cases, though serious infections may cause kidney scarring or blood poisoning if not treated.

So it’s important to diagnose quickly, which can be difficult to do in children younger than 3. The symptoms — unexplained fever, irritability or vomiting — aren’t all that specific, and collecting a reliable urine sample usually involves a catheter, which is invasive.

Reports of stinky urine in a feverish child should be another red flag for doctors, according to a newly published study by Canadian researchers in Pediatrics.

“If the child has fever and at the same time his urine smells stronger than usual, the risk of having a urine infection is a little bit increased compared to a child not having smelly urine,” Dr. Marie Gauthier, a pediatrician at Sainte-Justine University Hospital Center in Montreal, tells Shots.

She and her fellow researchers studied 331 children ranging in age from 1 month to 3 years old who were brought into Sainte-Justine’s emergency room and had a urine culture because doctors suspected infection. Parents were asked to complete an eight-question survey, including two questions about whether their child’s urine smelled stronger than normal or offensive.

Parents mentioned malodorous pee in 57 percent of the 51 kids diagnosed with a urinary tract infection and in 32 percent of the 280 children who didn’t have infection, according to the Pediatrics report.

Gauthier says the foul odor may be due to the production of ammonia from bacteria. While this is often cited as a symptom of urinary tract infection, previous studies have been contradictory.

She emphasizes that the latest findings are mostly something for doctors to think about, not parents.

Stinky pee accompanied by fever increases the likelihood of infection — but the association isn’t strong enough to make a diagnosis one way or the other, Gauthier says. Still, the presence of another risk factor might help doctors decide whether to collect urine from a child when doing so might require invasive measures.

“I think that most of us do not ask parents this question when we assess a young child in the ER for unexplained fever,” says Gauthier, who also teaches at the University of Montreal’s Department of Pediatrics. “If the answer is yes, well, it’s not necessarily a reason to do a urine test, but we should be a little bit more cautious.”

Other things can also cause a funny smell. If a child hasn’t eaten for 12 or 24 hours and has vomited and is a little dehydrated, it could cause a different or strong odor, she says. Certain foods such as asparagus can also produce a funky whiff.

So when should parents be concerned? Gauthier says if a young child has an unexplained fever for more than 24 hours, call the doctor.

Urinary tract infections (UTIs) – BabyCentre UK

What is a urinary tract infection (UTI)?

Your baby’s urinary tract consists of her kidneys, bladder, ureters and urethra. The ureters are the tubes that connect her kidneys to her bladder. The urethra is the tube that runs from her bladder down to her genitals (NHS 2016).

A urinary tract infection (UTI) can happen when bacteria spread into the urethra from the skin around your baby’s bottom and genitals. The bacteria can cause inflammation at any point along the tract.

There are two types of UTI:

• an upper UTI is a kidney infection, or an infection of the ureters
• a lower UTI is a bladder infection (cystitis), or an infection of the urethra
  (NHS 2016)

How will I know if my baby has a UTI?

It can be difficult to tell if a baby has a UTI. If your baby is unwell with any of the following, it could mean she has a UTI:
If your child is older and potty trained, she may need to wee a lot and it may be painful when she does (NICE 2007, 2017). She may not want to empty her bladder if it hurts to wee, and she may complain of a tummy ache.

Should I take my baby to the doctor?

It’s important to take your baby to your doctor if you think she has a UTI. If she has an upper UTI that’s left untreated, the infection could cause kidney problems.

If your baby has signs of a UTI, your doctor may need to collect a sterile urine sample to find out which bacteria are causing it (Harding 2016, NHS 2016a, NICE 2007).

It can be tricky to get a sterile urine sample from your baby (Kaufman et al 2017, NICE 2017a). Your doctor can explain the best way to do this. It may be a case of leaving your baby’s nappy off and then watching and waiting until she does a wee. You may then be able catch some of your baby’s wee in a clean pot (NICE 2017a).

Another method of collecting wee is putting an absorbent pad in your baby’s nappy, which can then be syringed to draw out a urine sample (Harding 2016, NICE 2007). However, this method doesn’t often give a sterile enough sample as it’s easy for the pad to be contaminated with other bacteria (NICE 2017a).

Your doctor may make a referral for other tests and treatment at the hospital if your baby:

• is younger than three months and has any kind of UTI or
• is older than three months and has a suspected upper UTI
  (Harding 2016, NICE 2007, 2017)

Your GP will refer your baby urgently if she’s concerned that she could become seriously ill as a result of a UTI (NICE 2007, 2017). Rarely, an untreated UTI can develop into sepsis (NICE 2007, 2017).

Sepsis happens when a bacterial infection triggers the body to attack its own tissues and organs (UK Sepsis Trust nd). Sepsis is rare, but it’s important that your baby’s symptoms are checked by a doctor, just in case.

At hospital, your baby may have a scan called a renal ultrasound (NICE 2007). The scan will look at how her kidneys and bladder are working.

How will my baby’s UTI be treated?

Your doctor will prescribe your baby a course of antibiotics to take at home for three days (Harding 2016).

If the infection is in your baby’s kidney, she will need antibiotics for between seven days and 10 days (Harding 2016, NICE 2007, 2017).

Make sure you give your baby the antibiotics as instructed by your doctor or pharmacist (NHS 2016b).

Take your baby back to the doctor if she’s getting more poorly, or if she has any new symptoms (NICE 2007, 2017).

If your baby is under three months old or very poorly, she will need to go to hospital, where nurses will give her antibiotics through a drip (NHS 2016a, NICE 2007, 2017).

Your doctor may recommend a follow-up scan in the weeks or months after your baby’s infection, depending on her age, how many UTIs she’s had, or the seriousness of the infection. If your baby keeps getting UTIs, despite treatment, your doctor may recommend daily antibiotics to tackle the infection (NICE 2007).

Is there anything I can do to prevent my baby getting a UTI?

Some babies are more prone to UTIs, but there are a few things you can do to help protect your baby:

• Wipe your baby’s bottom from front to back when you change her nappy.
• Change her nappy as soon as she’s done a poo. She may get tiny bits of poo in her urethra if she has a dirty nappy, especially if she’s squirmy while being changed.

How to change a nappy

A midwife explains the best way to change your baby’s dirty nappy.More baby videos

• Exclusively breastfeed your baby for the first six months to boost her immune system and to help prevent her from becoming constipated. If your baby is constipated, it can cause her bowel to press on her bladder, making it harder for her to wee normally. Speak to your GP or health visitor if your baby is constipated.
• Make sure your baby has plenty of fluids to help prevent constipation and to flush out bacteria. Her wee should be pale and clear during the day. Let her breastfeed whenever she wants. If your baby is formula-fed, offer her cooled, boiled water as well (NHS 2016, NICE 2007).
• Don’t bath your baby in scented bath products.
  (NHS 2016)

Did you know that a condition called kidney reflux can cause repeated UTIs in babies? Find out more about kidney reflux.

Last reviewed: April 2018

References

Harding, M. 2016. Urinary tract infection in children. Patient. patient.info [Accessed April 2018]

Kaufman J, Fitzpatrick P, Tosif S, et al. 2017. Faster clean catch urine collection (Quick-Wee method) from infants: randomised controlled trial. BMJ 357:j1341 www.bmj.com

NHS. 2016a. Urinary tract infections in children. NHS Choices, Health A-Z. www.nhs.uk [Accessed April 2018]

NHS. 2016b. Antibiotics. NHS Choices, Health A-Z. www.nhs.uk [Accessed April 2018]

NICE 2007. Urinary tract infection in under 16s: diagnosis and management. Updated 2017. National Institute for Health and Care Excellence, Clinical guideline, 54. www.nice.org.uk [Accessed January 2018]

NICE 2017a. Urinary tract infection in under 16s: Evidence reviews for UTI diagnosis in under 3 years. National Institute for Health and Care Excellence, Clinical guideline, 54 – Guideline Updates Team. www.nice.org.uk [Accessed April 2018]

NICE 2017b. Urinary tract infection – children. National Institute for Health and Care Excellence, Clinical Knowledge Summaries. www.nice.org.uk [Accessed April 2018]

UK Sepsis Trust. nd. What is sepsis? Support, sepsistrust.org

Maple syrup urine disease – NHS

Maple syrup urine disease (MSUD) is a rare but serious inherited condition.

It means the body cannot process certain amino acids (the “building blocks” of protein), causing a harmful build-up of substances in the blood and urine.

Normally, our bodies break down protein foods such as meat and fish into amino acids. Any amino acids that are not needed are usually broken down and removed from the body.

Babies with MSUD are unable to break down the amino acids leucine, isoleucine and valine. Very high levels of these amino acids are harmful.

One of the characteristic symptoms of MSUD is sweet-smelling urine, which gives the condition its name.

Diagnosis of maple syrup urine disease

At around 5 days old, babies are offered newborn blood spot screening to check if they have MSUD. This involves pricking your baby’s heel to collect drops of blood to test.

If MSUD is diagnosed, treatment can be given straight away to reduce the risk of serious complications.

With early diagnosis and the correct treatment, the outcome can be greatly improved. However, treatment for MSUD must be continued for life.

Without treatment, severe, life-threatening symptoms can develop, including seizures (fits) or falling into a coma. Some children with untreated MSUD are also at risk of brain damage and developmental delay.

Symptoms of maple syrup urine disease

Symptoms of MSUD usually appear within the first few days or weeks after birth. More general symptoms include:

• sweet-smelling urine and sweat
• poor feeding or loss of appetite
• weight loss

Babies with MSUD may also have episodes known as a “metabolic crisis”, sometimes early in their life. Symptoms of a metabolic crisis include:

• lack of energy
• vomiting
• irritability
• breathing difficulties

It’s important to get medical help immediately if your baby develops symptoms of a metabolic crisis. Your doctor will give you advice to help you recognise the signs.

In some cases, a metabolic crisis may be triggered later in childhood by an infection or illness. The hospital will provide you with emergency treatment instructions to follow if your child is ill, which helps prevent these symptoms developing.

Treating maple syrup urine disease

Diet

Children diagnosed with MSUD are first referred to a specialist metabolic dietitian and given a low-protein diet. This is tailored to reduce the amount of amino acids your baby receives, especially leucine, valine and isoleucine.

High-protein foods need to be limited, including:

• meat
• fish
• cheese
• eggs
• pulses
• nuts

Your dietitian will provide detailed advice and guidance, as your baby still needs some of these foods for healthy growth and development.

Some children need to take supplements of isoleucine and valine alongside the prescribed diet. This helps to maintain a healthy level of these amino acids in the blood without causing harm. Blood tests are needed to monitor these levels.

Breastfeeding and baby milk also need to be monitored and measured, as advised by your dietitian. Regular baby milk contains the amino acids that need to be restricted, so a special formula is used instead. This contains all the vitamins, minerals and other amino acids your baby needs.

People with MSUD need to follow a low-protein diet for the rest of their life to reduce the risk of a metabolic crisis. As your child gets older, they’ll eventually need to learn how to control their diet and will stay in contact with a dietitian for advice and monitoring.

Emergency treatment

If your baby develops an infection, such as a high temperature or cold, their risk of having a metabolic crisis increases. It’s possible to reduce the risk by changing to an emergency diet while they’re ill.

Your dietitian will provide detailed instructions, but the aim is to replace milk and foods containing protein with special high-sugar drinks and amino acid supplements.

If your baby can’t keep down their emergency feeds or has repeated diarrhoea, contact the metabolic team at the hospital to let them know you’re heading straight to the accident and emergency (A&E) department.

You should also be given a leaflet to bring with you in the event of an emergency in case the doctors have not seen MSUD before.

Once in hospital, your baby can be monitored and treated with fluids given directly into a vein (intravenous fluids).

You should also take your baby to hospital if they develop the symptoms of a metabolic crisis, such as irritability, loss of energy or breathing difficulties.

Liver transplant

A liver transplant is sometimes an option to treat MSUD. If a person with MSUD receives a donated liver, they’ll no longer be at risk of a metabolic crisis and can have a normal diet.

However, a liver transplant is a major procedure with its own risks. You will have to take medicine to suppress the immune system (immunosuppressant medication) for the rest of your life to stop your body rejecting the new liver.

It’s important to consider all the pros and cons before deciding whether or not to have a liver transplant. Your doctor will be able to discuss whether this is a suitable option.

How MSUD is inherited

The genetic change (mutation) responsible for MSUD is passed on by the parents, who usually do not have any symptoms of the condition. This is called autosomal recessive inheritance.

This means a baby needs to receive two copies of the altered genes to develop the condition – one from their mother and one from their father. If the baby only receives one mutated gene, they’ll just be a carrier of MSUD.

If you’re a carrier of the affected genes and have a baby with a partner who’s also a carrier, your baby has:

• a 1 in 4 chance of developing the condition
• a 1 in 2 chance of being a carrier of MSUD
• a 1 in 4 chance of receiving a pair of normal genes

Although it’s not possible to prevent MSUD, it’s important to let your midwife and doctor know if you have a family history of the condition. Any further children you have can be tested for the condition as soon as possible and given appropriate treatment.

You may also wish to consider genetic counselling for support, information and advice about genetic conditions.

Information about your child

If your child has MSUD, your clinical team will pass information about him or her on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS).

This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time.

Find out more about the register.

Page last reviewed: 18 June 2018
Next review due: 18 June 2021

The Pediatric Infectious Disease Journal

To the Editors:

Aerococcus urinae is an infrequently reported Gram-positive coccus mostly associated with urinary tract infection in elderly females. Sporadically, the organism has been described as the cause of severe infections.¹ We report a young boy who had malodorous urine as the only sign of colonization with A. urinae.

This 7-year-old boy was seen at the outpatient clinic because he exuded a bad odor. He was in good health and his medical history was unremarkable. Urinating was not painful and he had no fever. His mother described that after the boy urinated the whole house smelled bad. The general practitioner had found no leucocyturia or nitrite in the urine. Because it was believed that the smell occurred from smegma from under the preputium, a circumcision had been performed but this had no effect on the odor.

At physical examination, he was a healthy boy with normal weight and height. The examination, including the genitals, was normal. A metabolic screen was reported normal. Repeated urine cultures consistently revealed significant growth (10⁵ colony forming units/mL) of alpha hemolytic colonies identified as A. urinae. A course of 7 days treatment with co-trimoxazole was given and the smell disappeared. A follow-up urine culture was negative. Echography of the urinary tract revealed no abnormalities.

This boy had repeatedly A. urinae in his urine with a foul smell as the only sign. A single course of antibiotics totally resolved the problem of the malodor.

A. urinae is reported in about 0.2–0.3% of urine specimens sent in for culture. More than 90% of the patients are females >65 years of age. Most patients have a local or systemic underlying condition, predisposing to urinary tract infection.¹ There is no relation between odor and urinary tract infections in the elderly.² In young patients, A. urinae is reported rarely; we found only 1 article reporting pyelonephritis in a 12-year-old boy who had a history of pyeloplasty for vesicoureteral reflux.³ Our patient had no signs of an underlying disease.

Although co-trimoxazole resistance has been described as a key feature in the identification of A. urinae, it was found recently that this is an in vitro effect. Most strains are susceptible to co-trimoxazole.⁴

A foul smell in children can be a result of bad hygiene, certain food stuffs, undesired loss of urine or feces or even of a metabolic disease. Although some do believe that the malodor of urine is a sign of an urinary tract infection, it has been demonstrated that this is not always true.⁵

Tjalling W. de Vries, MD, PhD

Department of Pediatrics

Medical Centre Leeuwarden

Leeuwarden, The Netherlands

Afke H. Brandenburg, MD, PhD

Izore, Centre for Infectious Diseases

Leeuwarden, The Netherlands

REFERENCES

1. Sierra-Hoffman M, Watkins K, Jinadatha C, et al. Clinical significance of Aerococcus urinae: a retrospective review. Diagn Microbiol Infect Dis. 2005;53:289–292

2. Midthun SJ, Paur R, Lindseth G. Urinary tract infections. Does the smell really tell? J Gerontol Nurs. 2004;30:4–9

3. Murray TS, Muldrew KL, Finkelstein R, et al. Acute pyelonephritis caused by Aerococcus urinae in a 12-year-old boy. Pediatr Infect Dis J. 2008;27:760–762

4. Humphries RM, Lee C, Hindler JA. Aerococcus urinae and trimethoprim-sulfamethoxazole. J Clin Microbiol. 2011;49:3934–3935

5. Struthers S, Scanlon J, Parker K, et al. Parental reporting of smelly urine and urinary tract infection. Arch Dis Child. 2003;88:250–252

What is the cause of smelly urine in toddlers?

Dr Sharma tells you what can cause a peculiar odour in your baby’s urine

Written by Bhakti Paun Sharma | Updated : August 11, 2016 10:42 AM IST

Read this in HINDI

Do you get a strong stench from your little one s pee? What could be the reason for it? Even babies who only breastfeed can get smelly urine. We asked Dr Sonia Sharma, Consultant Paediatric Nephrologist, PSRI Hospital, New Delhi to shed some light on this topic. Here s what she has to say.

There are several causes of smelly urine in babies. Here is a list.

Dehydration It is quite possible that the fluid intake of your baby is insufficient. In the case of toddlers, keeping track of fluid intake is difficult. The body s requirement of fluids obviously differs with age. It depends on factors like gender, weight, daily physical activity, and age. Dehydration could very well lead to smelly pee in infants or toddlers. Find out if breast milk is enough for your baby.

Urinary Tract Infection It may sound surprising but infants can suffer from UTI too. They will be unable to complain about the burning sensation or discomfort but mild fever and strong odour in urine can be signs of UTI. Fever, cloudy or bloody urine, vomiting, diarrhoea are some of the symptoms of UTI in kids. Urine tests will help diagnose this better. Parents should read up on 10 things you must not do when your child has a fever.

Other conditions: Maple syrup urine disorder (MSUD) in toddlers are also a cause of foul odour from urine. Though this disorder is not very common, its possibility cannot be ruled out. This can also cause urine to turn black when exposed to sunlight. So if you have observed any such symptom, speak to your doctor.

A visit to the paediatrician is a must when you observe smelly urine for more than a week. Parents need to ensure that all the urine and associated tests are done at a genuine laboratory, Dr Sharma suggests.

Image Source: Shutterstock

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Recognising serious illness in children

Most childhood illnesses are minor. But it can be difficult to know if your child is seriously ill.

You should seek help immediately if your child:

• is unusually drowsy, floppy, listless or unresponsive
• has changed colour and is pale, or has blueish or ashen skin, or has a purple or red rash that does not turn skin coloured (blanch) when pressed
• has difficulty breathing, has fast, shallow breaths or is grunting while breathing
• has a fever with a temperature above 38°C and is under 3 months of age
• is refusing to drink, or is drinking less than half their normal fluid intake
• is not passing urine or is wetting less than half of their normal amount of nappies
• is having seizures
• is vomiting repeatedly, or if the vomit has a green tinge
• has a high-pitched, weak or continuous cry
• has a bulging fontanelle, which is the soft spot on top of your baby’s head

For more information on the symptoms of serious illnesses visit the healthdirect Symptom Checker.

How to check your child’s temperature

A body temperature above 38°C indicates fever. Checking body temperature by feeling your child’s forehead is not reliable. Always use a thermometer.

There are different types of thermometer and the results may vary depending on what you use:

• digital thermometer, which is placed under the tongue or armpit. Oral readings (under the tongue) are usually the most accurate. It’s best to take oral temperatures in children aged over 4
• digital ear thermometer, which are quick and easy but can be a little inaccurate
• temporal artery thermometers, which scan the forehead to give a reading

Plastic tape thermometers used on the forehead are not reliable.

Some thermometers are more suitable for particular age groups so follow the manufacturer’s directions to get an accurate reading or ask your doctor or child health nurse for advice.

Fever is a common symptom of many childhood illnesses and often it is nothing to worry about. However, always get an infants under 12 months checked if they have a fever. If your baby is under 3 months and has a fever, seek medical advice immediately, even if they have no signs of being sick.

For more information on taking a child’s temperature, visit the Raising Children Network website.

Diabetes

Diabetes is a long-term condition characterised by very high blood sugar levels. In children, diabetes is usually caused by a lack of insulin.

Children with diabetes might pass a lot of urine. This can result in bed-wetting during the night. The urine may also smell sweet due to blood sugar being lost through the urine.

Other signs of diabetes in children include tiredness, weight loss, abdominal pain and increased hunger and thirst.

If diabetes is left untreated, children with diabetes can feel very tired, have a sweet, fruity, alcohol-like smell on their breath, vomit or have seizures.

Meningitis

Meningitis is a swelling of the membrane that surrounds the brain. It is commonly caused by infection.

Meningitis often begins with flu-like symptoms such as high temperature, chills, and cold hands or feet. The child may become drowsy or less alert, have a poor colour or be pale, and not drinking or passing urine. A stiff neck, a blotchy red or purple rash and breathing difficulties may also develop. A child with meningitis might have persistent headache or a sore neck, and bright lights might hurt their eyes.

Meningitis is a medical emergency and needs immediate treatment. It can kill within hours, so early diagnosis and treatment is vital. Do not wait for the purple rash to appear as that is a late stage of the disease. If you think your child might have meningitis, take them straight to the nearest hospital emergency department.

Vaccines against some types of viruses and bacteria that cause meningitis are available.

Here is more information on vaccinating your child against meningitis.

How to seek help

If you think your child’s condition requires urgent medical attention, call triple zero (000) for an ambulance or take them to the emergency department of your nearest hospital.

If you’re unsure of the seriousness of your child’s illness, call healthdirect to speak to a registered nurse on 1800 022 222 (known as NURSE-ON-CALL in Victoria).

90,000 norm and deviations, how to decipher the results of urine analysis?

Any pathology detected at an early stage is much easier to treat than its chronic form. This rule is especially important for a child’s body, because a child’s disease often develops faster than an adult. Therefore, it is necessary to carefully monitor the appearance of the first alarms, which can become the beginning of serious health problems for the baby. Clinical tests, including the study of the child’s urine, allow to detect pathology at the initial stage.

Indicators of the general analysis of urine of children: norm and deviations

First of all, let’s find out what indicators are examined during the analysis of urine of the child.

Organoleptic indicators

At the first stage of the study of the biomaterial, organoleptic indicators are analyzed: the appearance and smell of urine, as well as some other characteristics.

Vol. There are norm values ​​according to which a child must produce a certain amount of urine per day.Of course, this indicator depends not only on the state of health and age, but also on external factors – air temperature, the amount of fluid and food consumed, physical activity. You can calculate the approximate normal level of daily urine volume using the following formula [1]:

600 + 100 × (N – 1) = amount in ml,

where N is the child’s age.

Using this formula, you can get the value of the norm with an error of 200-300 ml.If a child’s daily volume exceeds the result obtained by more than two times, then hypothermia, cystitis, neurosis or an inflammatory process may be the cause. If the volume is less than a third of the norm, it may be a sign of kidney disease.

Color . The normal shade of urine in children is light yellow, amber. Shades of urine that differ from normal are caused by certain foods (eg, beets) and medications [2]. If these factors are not taken into account, then colorless or pale urine may be evidence of diabetes mellitus, and a rich red tint may be a sign of kidney injury.

Pay attention!

Urine of a newborn can change color from transparent to brick-orange. This is normal and is associated with the formation of the genitourinary system of the body.

Odor. The urine of a newborn practically does not smell, with age, the discharge acquires a characteristic specific odor, but most often it is not very pronounced. A pungent odor can be a signal of acetonemia [3], diabetes mellitus, or an infection in the urinary system.

Foam content. If you shake the bottle with the collected material, an unstable white foam will appear on the surface of the liquid, which will quickly disappear. This result is considered normal. If the foam does not settle for a long time, this indicates the presence of protein in it [4]. For babies, this is the norm. But if the baby is already out of infancy, then increased foaminess may indicate stress, allergies, hypothermia, dehydration, or the recovery period after an infectious disease.

Transparency. Fresh urine in children is usually clear. However, after standing for a while, it can become cloudy. Such a reaction may be due to the characteristics of the diet or other external factors and is considered normal if it does not become permanent. Otherwise, a change in the transparency of urine may be evidence of uric acid or calcium oxalate diathesis [5].

Physicochemical indicators of urine analysis of children

Density , also called specific gravity, may vary depending on age and some external factors.The normal value is 1.010–1.017 g / l [6], and in newborn children it is usually close to the lower limit, increasing as they grow older. Increased urine density occurs with diabetes mellitus, excessive fluid intake, dehydration, or oliguria [7]. A low reading may indicate diabetes insipidus, kidney failure, or polyuria.

Acidity (pH level). Normal acidity is 5-7 on the pH scale. If the biomaterial is collected after eating, a slight excess of this level may be recorded.In all other cases, an increased pH level can mean chronic renal failure or tumors of the genitourinary system, and a lower pH can mean diabetes mellitus, dehydration, diarrhea, or tuberculosis [8].

Biochemical indicators

The biochemical composition of a child’s urine allows you to assess how well the kidneys and organs of the genitourinary system work. What is the rate of general urine analysis in a child?

Protein. The protein level is one of the most revealing characteristics of the general analysis of urine in children.If there is no pathology, then the protein content should be as close to zero as possible, no more than 0.14 grams [9] (with physical exertion, no more than 0.25 grams [10]). If the indicator is overestimated, we can talk about the presence of inflammatory diseases of the urinary tract in the child (for example, cystitis or urethritis), tumors, kidney tuberculosis and some other specific diseases.

Sugars (glucose). This indicator, like the previous one, should be practically equal to zero [11].It may be slightly higher in case of abuse of sugary foods or after severe stress, but such changes are short-lived. If the glucose level stably remains high for no apparent external reason, then a blood glucose test should be taken as soon as possible. An exception is newborn babies: for them, the content of some sugar in the urine is normal.

Bilirubin. The presence of this substance may indicate a malfunction of the liver or the presence of stones in the kidneys and urinary tract.It is also possible that the cause of the increased bilirubin level was an unbalanced diet, in particular, an excess of carbohydrates in the daily diet.

Ketone bodies. This term is understood as the content in the child’s urine of substances such as acetone, acetoacetic and beta-hydroxybutyric acids [12]. With a strong deficiency of glucose in the body, an active breakdown of fats begins, as a result of which ketone bodies are excreted with respiration and urine. The store of sugar in the liver in children is less than in adults [13], so high levels of ketone bodies in urine can be caused by severe stress, starvation, or lack of carbohydrates.But there are also pathological reasons: various infectious diseases or diabetes mellitus.

Urobilinogen [14]. This substance can be found in the urine of a healthy child, but only in small (“trace”) amounts. When the level of urobilinogen in urine exceeds 10 μmol (6 mg), pathology is suspected – liver failure or intestinal inflammation.

Microscopic characteristics of the child’s urine

The study of these characteristics is carried out after a special procedure, which is necessary to obtain a sediment.Using a centrifuge, the contents of the test tube are “shaken” for several minutes until a characteristic dense suspension is obtained at the bottom of the vessel. It is this sediment that becomes the object of study under a microscope. All indicators of microscopic analysis of the child’s urine are divided into two types: organic and inorganic . What is the composition of the child’s urine?

It is very important to observe the rules of hygiene before taking urine for analysis: if the external genital organs of the child are not washed well enough, then the test result may be inaccurate.In particular, when studying the sediment, an increased level of leukocytes can be detected. There is no reason to worry if the number of white blood cells in the field of view does not exceed five pieces [15], otherwise one of the kidney diseases can be suspected.

The number of erythrocytes in the urine of a healthy child should not be more than two pieces in the field of view [16]. The increased content indicates any viral infection associated with an increase in body temperature, urolithiasis or poisoning with toxins.

Also, the microscopic characteristics of the general analysis of urine in a child include the number of cylindrical particles of various types: hyaline, granular and waxy. The normal indicator for each variety is their complete absence. If hyaline cylinders are found in the baby’s urine, then one should be wary of the presence of infectious diseases (flu, chickenpox, measles, rubella and others). Granular casts are frequent companions of fever and renal tubular damage.And the cylindrical waxy particles may be evidence of chronic kidney disease.

Bacteria found in a child’s urine are a rather dangerous signal, usually accompanied by other symptoms such as painful urination and burning in the lower abdomen. The presence of bacteria is a possible sign of an infectious disease of the urinary system. If there are no alarming symptoms, but the analysis showed the presence of bacteria in the urine, it is worth retaking: perhaps the reason lies in non-compliance with hygiene standards.

Amylase – is an enzyme that is produced in the pancreas [17]. In case of any disturbances in the work of this organ, the substance enters the bloodstream, and then into the urine. The normal content of amylase in urine is considered to be up to 460 U / L [18].

Another indicator is yeast . Their presence, as a rule, indicates candidiasis, which, in turn, is often the cause of inappropriate antibiotic treatment.

The inorganic substances that may be contained in the urine of a child include various salts . Most often, their presence in the sediment does not mean any pathology, but only serves as a sign of the child’s malnutrition.

In order for all these indicators of the analysis of children’s urine to serve as a reliable indicator of the presence or absence of diseases, you should know what can affect the accuracy of the urine analysis.

What factors can affect the accuracy of the results of the general analysis of the child’s urine

First of all, before taking the material, you should take care of compliance with all hygiene rules.Otherwise, the analysis result may be distorted by various impurities. The day before, the baby should be limited in the use of certain foods that can affect the color of the discharge, such as beets, carrots, rhubarb and others. Some medications can have a similar effect, for example, aspirin can give urine a pinkish tint. Therefore, if it is undesirable to interrupt the course of drug therapy, then it is better to consult a doctor before the analysis.

The ability to decipher the results of urine analysis in a child is a useful skill that can be useful when choosing a specialist in case of suspicion of pathology.But in no case can one make a diagnosis on his own: only a professional doctor can assess the clinical situation on the basis of a combination of factors.

All information related to health and medicine is presented for informational purposes only and is not a reason for self-diagnosis or self-medication.

Pheromones: Secret of Sexual Attractiveness or Misconception?

• Alex Riley
• BBC Future

May 25, 2016

Photo by Getty

Does human scent actually carry pheromones that act as aphrodisiacs, attracting potential sexual partners? Observer

BBC Future decided to find out the whole truth.

In 2010, several dozen people gathered at an art gallery in Brooklyn, New York to sniff dirty T-shirts.

Fetish party? Not at all – the audience just wanted to test whether it was possible to use the sense of smell to win the sympathy of the opposite sex.

The rules at the “pheromone party” were simple: a person opened a sealed bag with a number, where a T-shirt was lying, which the other participant had already been wearing.

If the opener liked the smell, a date could be arranged with the owner of the T-shirt.

The unusual event was a success, and since then similar meetings have already taken place in Los Angeles and London. As one magazine wrote, this is a great option for those who “seek love, relying on their nose and holy faith in the omnipotence of science.”

The idea that pheromones can help a person find a sexual partner and life partner is deeply rooted in popular culture. Some even buy perfume that is advertised as a “love potion”.

Some of these perfumes contain androstenone – the most powerful substance among those designed to increase sex drive.

According to sellers, it enhances female libido and makes men more attractive.

Another substance, androstenol, is said to facilitate the transition to closer communication.

According to advertisements for various pheromones, they can make a person more relaxed, emphasize masculinity or help relax during sexual intercourse.

What does science think about this? Can pheromones make us sexier? Is love really in the air – or is it just a banal smell of the human body?

Photo author, Getty

Photo caption,

The term “pheromone” appeared in 1959, when scientists were carried away by a new direction of science

The term “pheromone” appeared in 1959, when Peter Carlson and Martin Luscher from the Max Planck Institute of Biochemistry in Munich, it was suggested that in the cloud of molecules emitted by animals, there are those that play a special role.

These substances are somewhat similar to hormones, however, they do not circulate in the blood, but are released outside in order to influence the behavior and physiology of other animals.

Unlike ordinary odorous substances, the molecules of which can cause very different reactions, the mechanism for the release of pheromones has evolved in the course of evolution to achieve a very specific goal when representatives of the same species interact.

In the same year, the first pheromone, bombicol, was discovered. It is a substance secreted by female silkworms (Bombyx mori) and attracts males many kilometers away.

Thus, Bombicol became the first known sex pheromone – a natural aphrodisiac, carried through the air.

Bombicol perfectly fits the definition of a pheromone: firstly, it is a simple substance, consisting of only one molecule. Secondly, its action is narrowly focused – it acts on only one species of butterflies.

And thirdly, it stably causes the same reaction: males rush to the source of this substance, even when there is not a single female nearby.

The scientific community was gripped by excitement. Hormones were immediately forgotten as the last century, everyone rushed to the study of pheromones.

Soon after the publication of a couple of sensational studies, one author wrote: “The last 40 years have been a truly brilliant time for endocrinology; now we are on the cusp of exocrinology.”

Photo author, Thinkstock

Photo caption,

Mouse receptors can pick up a variety of chemical signals, but humans cannot

And the flowering really began.Pheromones are increasingly mentioned in the pages of scientific journals.

It turned out that all forms of life, from microbes to mice, use these chemical regulators to change the behavior of their fellow tribesmen.

Pheromones permeate the air, earth and the World Ocean. Some of them are even transmitted directly, from individual to individual, as personal molecular messages.

In addition, the sexual pheromones were just the beginning. Scientists began to find molecules with ever new functions: from regulating the reproductive cycles of potential partners to participating in the memory mechanism.

And in 1971, pheromone researchers reached humans.

First, a discovery was made, which in our time will not surprise anyone: women who have been in the same space for a long time have synchronized menstrual cycles.

This pattern was noted in the famous study by Martha McClintock, published in the journal Nature, when she was still a student at Wellesley College in Massachusetts.

McClintock drew attention to the fact that 135 girls, who lived in the same suburban student dormitory for six months, had their menstrual cycles shifted towards synchronization.

Since then, this study has been repeatedly cited as evidence of the existence of human pheromones capable of synchronizing the reproductive period in women.

“Anyone who tells stories like this wants it to be true,” says Tristram Wyatt of Oxford University.

Numerous researchers who tried to reproduce McClintock’s results were never able to do this, and at some point one of her researchers, having carefully studied the data, came to the conclusion that the observed phenomenon could be nothing more than a statistical artifact.

Author of the photo, SPL

Caption to the photo,

The olfactory receptors in our nose perfectly perceive smells, but pheromones are a completely different matter

In other words, both chemical communication and commonplace could lead to the same result with equal probability accident.

The length and frequency of the menstrual cycle (5 days out of 28), as well as its irregularity, make such synchronization very likely.

However, in the 70s, this alleged discovery turned the head of many.Based on McClintock’s research, British physician Alex Camfort wrote an article entitled “The Probability of Detecting Human Pheromones”, where he expressed confidence that very little remained before the discovery of pheromones homo sapiens .

In the same year, a letter from H. Cook was published in the New Scientist magazine, where the author talked about the fact that he was able to detect at least two pheromones – in human respiration and sweat.

One, as far as the author could tell, had a garlic smell.

“It is contained in the air exhaled by a woman who is in a state of sexual arousal, and thus not associated with eating garlic,” – assured Cook.

He also suggested that this pheromone has an exciting effect on men, and that is why women have been adding garlic to their food since ancient times.

“The second human pheromone is the smell of fear, which is certainly felt by dogs,” the author continued, forgetting that pheromones, by definition, act within one species.

Of course, such statements were not taken seriously by the scientific community.

However, there were others that left a more significant mark. So, if we try to trace where the modern idea of ​​human sexual pheromones came from, then our searches will lead us to a conference that took place in 1991 in Paris.

Photo author, Thinkstock

Photo caption,

We have little evidence that humans or their primate brothers can sense the presence of chemicals in the air in the same way as, for example, mice

At the beginning of the same biochemists Linda Buck and Richard Axel of Columbia University in New York discovered in mice a group of receptors responsible for smell, each encoded by a separate gene.

It has been shown that receptors located in the nose of a mammal bind to certain odoriferous substances, triggering a cascade of signals going through neurons to the brain.

Depending on the volume and ratio of substances, different odors arise – the brain, in a sense, reads the olfactory barcode.

“That was the first time we saw how the sense of smell works,” says Wyatt. In 2004 Buck and Excel were awarded the Nobel Prize for this work.

At the 1991 conference, however, another study caught the attention of the public.Two psychiatrists from the University of Utah said they found two sex pheromones in humans.

“They made a splash then,” recalls Richard Doty, director of the Center for the Study of Smell and Taste at the University of Pennsylvania in Philadelphia.

Researchers stated that in 49 volunteers, “putative human pheromones” increased the intensity of electrical signals between the VNO and the brain.

In mice, as well as many other mammals, this organ, also called the “secondary nose”, picks up a number of chemical signals – independent of the primary olfactory system.

A 2000 study by Martha McClintock confirmed these findings, leading to the rise in popularity of the idea of ​​human pheromones.

Photo author, Getty

Caption to the photo,

The smell, especially familiar, can be attractive, but it has nothing to do with pheromones

Nevertheless, there is no evidence that primates, to which humans also belong, are able to distinguish chemical signals just like a mouse.

In humans, the vomeronasal organ is just a rudiment left over from animal ancestors. It consists of only a few pores inside the nasal cavity, and there are almost no neural connections between it and the brain in primates.

“Humans don’t have anything like this,” says George Preti of the Center for the Study of the Chemical Sense Organs in Philadelphia.

But the same human pheromones can be found on the market today.

In fact, some researchers, including Richard Doty, director of the Center for Smell and Taste Research in Philadelphia, believe that pheromones have no significant effect on any mammalian species.

“There is no evidence to support the presence of signals that affect behavior in the way we would like to think,” – says the scientist.

This view was most popular in the 1970s and Doty was one of its main proponents.

Mammals, according to many researchers, are too complexly organized for such simple molecules to influence their behavior.

As one author wrote in 1976, “It is probably not worth twisting the concept of pheromone, which is so useful in the study of insect behavior and physiology, by using it to describe the behavior of mammals.”

Take, for example, copulins, molecules discovered in the late 1960s in laboratory rhesus monkeys.

Copulins, which are female vaginal secretions, cause sexual arousal, urge to masturbate and active sexual behavior in males.

Photo author, Thinkstock

Photo caption,

The effect of pheromones can be tested only on newborn babies.

However, they are not pheromones. The males participating in the study had already met those females earlier and were aroused because they recognized them by their characteristic scent.

Copulin is thus an aromatic substance rather than a pheromone. Indeed, it is often used in the production of perfumes.

And there are many such examples, notes Doty, – many studies suffer from such inaccuracy in terminology.

“Anything is called a pheromone – this word has long ceased to be a scientific term,” the scientist states.

A significant part of the so-called pheromones contain many chemicals, therefore they do not meet the simplicity criterion.

Some of them “work” only on certain subjects and have no effect on others.

And just as in the case of copulins, their effect is mainly due to the presence of previous experience of communication of individuals and recognition of a familiar smell.

A few years ago, Jane Hirst of the University of Liverpool agreed with Doty: mammals and even more so humans are too complex for pheromones to play any significant role in their lives.

However, in 2010, she discovered a new type of protein – darcin, which is found in the urine of male mice.

Named after all female favorite Mr. Darcy from Pride and Prejudice, this squirrel not only attracts females, but also acts as a memory stimulator, helping them remember the male’s specific scent and meeting place.

Thus, the protein functions both as an attractant (a substance that attracts the opposite sex) and as a memory enhancer.

Interestingly, without darcin, the only type of signaling protein, the female ceases to be interested in the opposite sex and does not remember previous relationships.

“I changed my mind,” says Hirst, who had previously strongly denied the idea that pheromones exist in humans. “There are certain chemicals that have the right to be called pheromones.”

In order to isolate darcin, Hirst and her colleagues had to go back to basics. They isolated the active substance from urine using a method taken from the original 1959 bombicol study.

The isolated pheromone was tested in mice. It turned out that pure darcinum causes the same reaction in animals as urine.

In order to exclude the factor of the familiar smell, the females were raised separately from the males – they did not see, hear or feel the smell of the male at any time in their life.

In such conditions, the reaction can only be innate – caused by genes and normal development, and not by experience gained during life.

The question is, can we do the same with people? Scientists answer: unlikely.

“It’s almost impossible to test pheromones in isolation in humans,” explains Hirst.

Many years of experience of communication with the opposite sex, personal preferences and the absence of reflex reactions are interference, the influence of which will inevitably distort the results of the study, no matter how carefully it is organized.

Human behavior is determined by such a huge number of external factors that it will be impossible to draw unambiguous conclusions from the experiment.

However, this may not apply to newborns. “Children are much easier to work with than adults — they haven’t gained experience and culture,” says Wyatt.

A study in 2009 indicated a possible way forward.

When breastfeeding, the glands near the mother’s nipple swell and secrete an additional secret with milk.

When the nipple is near the infant’s face, it invariably causes stereotypical behavior: babies open their mouths, stick out their tongue and begin to suck. They are so trying to get food.

An important fact is that a secret taken from other mothers causes exactly the same reflex reaction in children.

Therefore, it is possible to exclude the possibility that the children were simply recognizing the scent of their mother.

According to Tristram Wyatt, scientists hope to find the first human pheromone using this areolar secret.

If the desired substance can be isolated and synthesized in the laboratory, it can help children with problems with breast latch – one of the leading causes of infant mortality in many developing countries.

In rural Ghana, for example, it is estimated that one hour of delay in breastfeeding after birth is responsible for 22% of infant mortality.

This would also contribute to the study of pheromones in general.

“If we find a pheromone in the mammary glands, then we can more confidently search for other pheromones that can already affect the adult body,” notes Wyatt.

“Although in the end we can come to the conclusion that human pheromones do not exist: after all, not a single molecule of this kind has yet been found.”

It turns out that the only thing that can be said with certainty at the moment is that people have a smell …

Enzyme deficiency in children

Enzymes are protein catalysts, the production of which is regulated in the body by heredity.If for some reason these substances are not enough, ordinary products do not break down into constituent substances, or do not turn into other necessary ones. Enzyme deficiency is called a common word – fermentopathy.

Malabsorption syndrome

is a syndrome of malabsorption of food components in the small intestine. The absorption or absorption of monomers (fatty acids, amino acids, monosaccharides, etc.) is preceded by hydrolysis – the breakdown of food polymers (proteins, fats and carbohydrates) under the influence of digestive enzymes.Violation of the hydrolysis of polymers with a deficiency of digestive enzymes (digestive enzymes) is called maldigestion syndrome or digestive insufficiency syndrome. The combination of both types of disorders, malabsorption and maldigestion, which is often encountered in clinical practice, was proposed to be designated as malassimilation syndrome. However, in the medical literature, all disorders of intestinal absorption are traditionally called malabsorption, caused both by the pathology of the absorption process itself and by the lack of digestive enzymes.Malabsorption syndrome is accompanied by a whole group of diseases, the development of which is based on hereditary or secondary (with pathology of the pancreas or other organs of the digestive system) enzyme deficiency.

In the first year of life, malabsorption syndrome is most often a genetic hereditary pathology, the most famous hereditary fermentopathies are disaccharidase deficiency, celiac disease and cystic fibrosis.

Disaccharidase deficiency.

Disaccharides are the components of most carbohydrates. Their digestion processes are provided by special intestinal enzymes – disaccharidases. After the breakdown of disaccharides, monosaccharides are formed, which can then be absorbed by the intestinal transport systems. Intolerance to disaccharides in children is caused by the hereditary absence or decrease in the activity of one or more intestinal disaccharidases, resulting in incomplete breakdown of disaccharides in the small intestine. By peristaltic bowel movements, incompletely split disaccharides move to the lower parts of the digestive tract, where, under the action of natural microflora, they are converted into organic acids, sugars and hydrogen.These substances reduce the absorption of water and salts from the intestinal cavity, that is, the food gruel (chyme) liquefies, and this leads to the development of diarrhea in the child. Symptoms of primary disaccharidase deficiency usually appear in a child immediately after birth. This group of diseases is characterized by the fact that with age, there is some compensation for disturbed enzymatic functions, and the symptoms of the disease are mitigated or disappear altogether. Among the hereditary defects of disaccharidases, the most famous are the deficiency of lactose, sucrose, isomaltase, trehalase.Lactase deficiency is explained by a mutation of the gene that is responsible for the synthesis of lactose, as a result of which this enzyme is either not synthesized at all (alactasia), or its inactive form is synthesized (hypolactasia). Therefore, when lactose enters the intestine, it is not completely broken down by defective lactose, and a characteristic symptom of malabsorption, diarrhea, develops.

Lactose is the main component of milk, including female milk, therefore, the treatment of severe forms of lactose deficiency in infants is a rather difficult task.Lactase deficiency manifests itself from the first days of a child’s life, as soon as he begins to eat. There are two forms of lactose deficiency. The first form (congenital lactose intolerance of the Holcel type) is distinguished by a more benign course. Newborns with this form of the disease develop frothy, watery stools with a sour smell of vinegar or fermented wine, and streaks of mucus in the stool are possible. A rumbling is heard in the stomach, flatulence is expressed, gases are released abundantly. The general condition of the child is usually satisfactory, the appetite is not disturbed, the children suck well, the body weight increases normally.Some children tolerate small amounts of lactose well enough, they develop diarrhea only when it is received in quantities that lactose with reduced activity cannot cope with. With a favorable course, the symptoms of the disease completely disappear after the exclusion of milk from the diet of newborns. By 1-2 years of life, lactose deficiency is compensated to one degree or another. In severe cases, the addition of a secondary infection, it is possible to form metabolic disorders and chronic eating disorders that do not disappear with age.The second form (congenital lactose intolerance of the Durand type) is characterized by a more severe course. After the first feeding, the child develops watery stools, vomiting. Growth and weight gain are slowed down. Over time, severe metabolic disorders develop, the kidneys and the nervous system are affected. There may be hemorrhagic disorders. In some cases, vomiting is persistent (resembles vomiting with pyloric stenosis), leading to dehydration of the child. Treatment with a lactose-free diet is ineffective. The main component of lactose deficiency treatment for breastfed babies is the intake of enzymes (containing lactose), and for bottle-fed babies – the use of special formulas (lactose-free).

Parents need to know that lactose is found not only in whole women’s, cow’s and goat’s milk, but also in all types of powdered milk, in many fermented milk products (sour cream), condensed milk, and also in some medicines as a filler. Therefore, when prescribing a medicine, the doctor should be informed about the existing lactose deficiency and carefully read the annotation of the drug. In mild cases of lactose intolerance, milk products and milk treated with B-galactosidase preparations are given instead of milk.Children with lactose deficiency are shown products containing fructose (vegetable and fruit purees), which is well absorbed and does not undergo bacterial fermentation. In addition to medical nutrition, in the first days of the disease, enzymatic preparations are prescribed in a short course (5-7 days). Within 30-45 days, probiotics are used to normalize the intestinal. Sucrose and isomaltase deficiencies are more common together. In children who are bottle-fed, there are no signs of a deficiency of these enzymes.Symptoms of the disease appear after the child eats food containing sucrose and starch (sugar, potatoes, semolina, flour products) when transferring it to artificial feeding or after the introduction of complementary foods. After taking such food, a child has foamy watery stools, vomiting. With a severe form and the child being artificially fed with mixtures containing sucrose, vomiting becomes persistent, the child loses weight. The diagnosis of sucrose intolerance is confirmed by a sucrose-loaded test.Treatment consists in adherence to a diet with the exclusion of foods containing sucrose and starch. You can eat fruits and vegetables in which the amount of sucrose is small (carrots, apples). The prognosis is favorable. With age, enzyme deficiencies are compensated for, and the diet can be expanded.

Celiac disease (celiac disease)

is a chronic hereditary disease that develops due to a deficiency of enzymes involved in the digestion of gluten. In recent years, in connection with the improvement in the quality of diagnostics, celiac disease is being detected more and more often.Gluten is a gluten component of a number of cereals – wheat, rye, barley, oats. When gluten breaks down, a toxic product is formed – gliadin, which has a damaging effect on the mucous membrane of the small intestine. However, in normal healthy children, gliadin does not damage the mucous membrane, since specific enzymes break it down to non-toxic substances. With celiac disease, a deficiency of these enzymes is observed to varying degrees (up to their complete absence). As a result, gluten is not hydrolyzed in the intestine, but accumulates together with the products of its incomplete breakdown, exerting a toxic effect on the mucous membrane of the small intestine, the cells of the mucous membrane of the small intestine die, and the digestive and absorption functions are impaired.In typical cases of celiac disease, the disease has a chronic course with periods of exacerbation and remission.

The first signs of celiac disease appear in a child in the second half of life after the introduction of complementary foods, which include cereal gluten (semolina, wheat, oatmeal).

If a child is artificially fed with mixtures containing wheat flour, then the symptoms of the disease appear earlier. From the moment gluten-containing foods are introduced into a child’s diet until symptoms appear, it usually takes 4-8 weeks.The main signs of celiac disease are dystrophy, weight loss and stunting, diarrhea, steatorrhea (the presence of undigested fats in the stool), and damage to the central nervous system. The celiac disease clinic develops gradually. First, the child’s appetite decreases, lethargy, weakness, and frequent regurgitation appear. In the future, regurgitation turns into vomiting, diarrhea develops. Stool in celiac disease is sharply offensive, abundant, frothy, pale with a grayish tinge, shiny. The child stops gaining weight, and then his body weight decreases.Children are very stunted. The abdomen is enlarged, which, in combination with thin limbs, gives the child a characteristic appearance – “a backpack with legs”. The child’s expression is sad, mimicry is poor (“unhappy look”). Over time, other organs of the digestive system are affected – the liver, pancreas, duodenum. Cirrhosis of the liver may develop. There is a moderate increase in the size of the liver and spleen. Violation of the enzyme-forming function of the pancreas leads to an even greater suppression of the digestive process.The development of secondary insulin deficiency is possible, which explains the symptoms of diabetes mellitus (increased urine output and thirst) during an exacerbation of the disease. All types of metabolism suffer, especially protein. Amino acid deficiency develops, the concentration of total lipids, cholesterol decreases, and the number of ketone bodies in the blood serum increases. Metabolic disorders are manifested by rickets, polyhypovitaminosis, anemia. In children, baldness of the scalp (alopecia) may occur, and fractures of long bones are frequent.A secondary immunodeficiency state develops, children are prone to frequent colds, which are more difficult and long-lasting. All children have disorders of the central nervous system (metabolic-toxic encephalopathy), children are irritable, capricious, lagging behind in psychomotor development. To confirm the diagnosis of celiac disease, a provocative gluten test and a biopsy of the mucous membrane of the duodenum or jejunum are used.

The main method of treating celiac disease is diet therapy – exclusion from the diet of a sick child of all products containing gluten (bread, bakery, confectionery and pasta, semolina, oatmeal, pearl barley, wheat and barley groats and industrial cereals from these cereals).Since flour and other processed products of gluten-containing cereals are often added to sausages, sausages, small sausages, canned meat and fish (including those intended for baby food), they are also excluded from the child’s diet. In the acute period of the disease, enzymes, vitamins, and probiotics are also used.

In extremely severe forms of celiac disease and low effectiveness of diet therapy, glucocorticoids (hormones) are used in a short course with a gradual cancellation in the future.Parents should remember that a gluten-free diet should be followed for life, even if the signs of the disease completely disappear. Failure to comply with the diet can lead to a more severe relapse of the disease, and the resulting violations will be difficult to compensate.

Intestinal form of cystic fibrosis.

A genetic defect in this hereditary disease disrupts the reabsorption of sodium chloride by all exocrine glands, as a result of which their secret becomes viscous, thick, and its outflow is difficult.The secret stagnates in the excretory ducts of the glands, they expand, and cysts are formed. Death of glandular cells occurs. Most often, there are intestinal and pulmonary forms of cystic fibrosis, in which the glands of the intestines or bronchi are predominantly affected, respectively. Combined forms may occur. The defeat of the intestinal glands in cystic fibrosis leads to the fact that the processes of digestion and absorption of food components are significantly impaired (maldigestion and malabsorption syndromes). The digestion of fats suffers to a greater extent, which is associated with inhibition of the enzymatic activity of the pancreas, which also suffers from cystic fibrosis.

In newborns, the intestinal form of cystic fibrosis can manifest itself as meconium ileus – intestinal obstruction as a result of blockage of the intestinal lumen with thick and viscous meconium. Normally, in newborns, meconium should leave in the first day of life. If this does not happen, there should be alertness about cystic fibrosis, especially if the parents or close relatives of the child have signs of this disease. Complications of meconial ileus are perforation (hole formation) of the intestinal wall and the development of a serious condition – meconial peritonitis (inflammation of the peritoneum).

In the first year of life, a child with cystic fibrosis, despite good care, rational feeding and good appetite, does not gain weight well. Signs of cystic fibrosis are especially pronounced when switching from breastfeeding to mixed or artificial feeding. The appearance of children with cystic fibrosis is characteristic: a “doll” face, a deformed chest, a large swollen abdomen, and often an umbilical hernia. The limbs are thin, there is a deformation (thickening) of the terminal phalanges of the fingers in the form of drumsticks.The skin is dry, its color is grayish-earthy. The child’s stool is abundant, liquid, grayish in color, with a fetid, specific smell of rancid fat (“mouse smell”), greasy and shiny, poorly washed off the pot and diapers. A common symptom of “slippage” is when a baby has stool immediately after a feed. In some cases, there may be constipation, putty stools or the release of liquefied feces is preceded by the release of stool. Against the background of constipation, prolapse of the rectal mucosa often occurs (as a rule, surgical correction is not required in this case).Sometimes undigested fat flows out of the baby’s anus as an oily liquid, leaving a greasy mark on the diapers. If bowel movements and urination occur at the same time, fat floats on the surface of the urine in the form of oily films. Due to the constant long-term disturbance of the digestive processes, the child, against the background of a usually good or increased appetite, loses weight (up to the development of severe forms of exhaustion), signs of deficiency of various vitamins (polyhypovitaminosis) appear, metabolic processes suffer.Children are lagging behind in physical development. Diagnosis of cystic fibrosis is carried out by examining feces (determination of undigested food debris), determination of trypsin in feces, sweat samples (sodium and chlorine content in sweat fluid) and using a specific genetic study with the identification of a mutant gene. Treatment for the intestinal form of cystic fibrosis is aimed at improving the digestive processes. In a severe and moderately severe child’s condition, when malabsorption syndrome is combined with dehydration and severe toxicosis, the diet begins with a water-tea break.The child is soldered at the rate of 100-150 ml / kg of body weight per day with 5% glucose solution, rehydron, green tea, etc. In a serious condition, glucose-salt solutions are also administered intravenously. In the hospital in the acute period, hormonal therapy is prescribed in a short course, vitamins. After relieving the exacerbation, the child is transferred to a diet with a feeding frequency of 8-10 times a day. Babies in the first year of life continue to receive breast milk, which is the optimal type of food for them. For artificial feeding, preference should be given to formulas that contain fats in the form of medium chain triglycerides.These components of fats do not require the participation of pancreatic enzymes for their digestion and therefore are easily absorbed. After the introduction of complementary foods and in later life, the child’s diet should include a minimum amount of fat and a large amount of protein. Patients with cystic fibrosis need an increased amount of protein, as it is lost in a significant amount due to malabsorption syndrome. Therefore, it is necessary to include such high-protein foods as meat, fish, eggs and cottage cheese in the diet of a child from 7 months of age.In addition to the diet, individually selected dosages of enzyme preparations are prescribed. To normalize the intestinal biocenosis, preparations of normal intestinal flora are used in courses of 2-3 months or more. Vitamin therapy courses are being conducted. Parents should carefully monitor the child’s condition, and if the family has indications of the possible presence of the disease in relatives (the parents themselves may be healthy), inform the pediatrician about this.

Symptoms | Phenylketonuria | Help: non-disabled person.ru

Children with phenylketonuria (PKU) are born without any signs of illness.

However, already in the second month, you can notice some physical signs: lightening of hair, irises of the eyes, which is especially noticeable in children born with dark hair. Many children gain weight very quickly and excessively, but remain loose, lethargic. In most of them, a large fontanelle grows early. Most often, obvious signs of the disease are found at 4-6 months of life, when children stop responding with joy to appealing to them, stop recognizing their mother, do not fix their gaze and do not react to bright toys, do not turn over on their stomach, do not sit.

For many years, the reaction between phenylpyruvic acid, which is excreted in the urine of a child, and ferric chloride has been an appropriate diagnostic test. If the reaction is positive, a typical green color appears. In addition, other abnormal metabolites such as phenyl lactic acid and phenylacetic acid are formed and excreted in the urine.

The latter compound smells like mice, so the disease can be easily diagnosed by smell; this is how it was first discovered.

As the disease progresses, epileptiform seizures can be observed – extensive convulsive and non-convulsive types of nods, bows, flinches, short-term blackouts. Hypertension of certain muscle groups is manifested in a kind of “tailor’s pose” (tucked legs and bent arms). Hyperkinesis, ataxia, hand tremors, and sometimes central paresis can be observed. Children are often blond with fair skin and blue eyes, they often have eczema, dermatitis.
There is a tendency to arterial hypotension.

The first manifestations of the disease are:

– lethargy of the child, lack of interest in the environment;
– increased irritability, anxiety;
– regurgitation, vomiting;
– convulsive equivalents: spontaneous Moro reflex, spontaneous Babinsky reflex, sucking automatisms, priapism in boys, athetosis movements;
– convulsive syndrome;
– Musty, mousey, wolfish smell of urine and sweat.

In the absence of treatment, a delay in static-motor and psycho-speech development is formed, mental retardation, as a rule, reaches a deep degree (idiocy or imbecility, deep mental disability).

Despite many scientific studies, the pathogenesis of brain dysfunction is still not fully understood. It is assumed that damage to the nervous system in PKU is the result of the influence of a number of unfavorable factors, in particular, the direct toxic effect on the central nervous system of phenylalanine and its derivatives, disorders in the metabolism of proteins, lipo- and glycoproteins, disorders of membrane transport of amino acids, disorders of hormone metabolism.

Recently, more and more importance in the pathogenesis of PKU is given to metabolic disorders of monoamine neurotransmitters (catecholamines and serotonin), which play an extremely important role in the maturation and functioning of the central nervous system.

Diagnostics of phenylketonuria – pass the analysis to SZCDM

Phenylketonuria (PKU) is a hereditary disorder of the metabolism of amino acids, primarily phenylalanine (FA), which is part of proteins.The substance is involved in protein folding and stabilization of protein structures.

The first symptoms: frequent regurgitation, vomiting, eczema, cramps, moldy smell emanating from urine and skin. The child may have been lethargic or, conversely, hyperactive. Lags behind in psychomotor development, there are signs of oligophrenia. The diagnosis can be made at the maternity hospital. All children with phenylketonuria will certainly receive the status of a disabled child.

Treatment of the disease consists in adherence to a special low-protein diet that does not contain foods with FA.

Definition of disease

Phenylketonuria is a congenital, genetic abnormality implying abnormalities in the hydroxylation of phenylalanine. It is characterized by the accumulation of amino acids and products of its metabolism in the body, which leads to severe damage to the central nervous system. The disease was first described by the Norwegian physician I.A.Felling in 1934.

Studying the disease, experts have established that the only gene of phenylalanine hydroxylase is responsible for the presence of the disease.The first successful treatment was developed and carried out in 1950 in England.

There is no clinic in the neonatal period. Pathology manifests itself in the first six months of a child’s life. Subsequently, the accumulation of the substance leads to severe developmental disorders. Therefore, it is extremely important to identify the defect immediately after birth and prevent the use of products containing phenylalanine. Later adherence to the diet will not eliminate the resulting violations, but will not allow the development of new ones.

Pathology is equally common among both sexes. No racial characteristics were identified. A large number of patients in countries such as China, Turkey, Ireland. On average in Russia, every 7,000th child is born with phenylketonuria.

Causes of phenylketonuria

There are three types of genetic disorder, the first is considered classic, as it is diagnosed in more than 90% of cases. The second and third are a rarer form of pathology.Symptoms are similar in all types, the disease leads to mental retardation. In the classical form of phenylketonuria, this can be avoided with diet therapy, but unfortunately atypical options cannot be corrected.

• Classical phenylketonuria (type I) is a low production of phenylalanine hydroxylase (PAH), which leads to the collection of phenylalanine and its breakdown products in natural body fluids. The pathology is caused by a mutated RAS gene.

• Phenylketonuria type II is a lack of dihydropteridine reductase, which prevents the conversion of phenylalanine to tyrosine.Pathology due to mutation of the QDPR gene.

• Phenylketonuria type III is a lack of 6-pyruvoyltetrahydropterine synthase, which is necessary for the synthesis of tetrahydrobiopterin. The pathology is caused by a mutated PTS gene.

All forms of the disease are inherited in an autosomal recessive manner. This means that a genetic defect can be inherited from one of the parents. The gender of the parent and child is irrelevant.

Classification

Phenylketonuria currently does not have a generally recognized world classification. Debates are underway on this issue, along with the study of the disease. Earlier, before the decoding of genes, it was believed that the degree of damage to intellectual abilities depends on the degree of enzyme activity. Therefore, the current qualifications are considered obsolete. She also does not take into account other symptomatic factors.

When diagnosing, they put:

• Type I (PAH deficiency) – PA concentration is more than 20 mg / dL.

• The average form of PKU is FA from 8.1 to 20 mg / dl.

• Mild HFA-level – PA from 2.1 to 8.0 mg / dL.

At levels up to 8.0 mg / dL, phenylketonuria is considered benign. It does not require special treatment, but supervision is necessary for the first year of a child’s life. The condition is monitored by a pediatrician, neurologist, geneticist.

There is also another form of phenylketonuria that does not require correction.It is a transient form of HFA during the neonatal period. It occurs, as a rule, with prematurity, which is due to the functional immaturity of the body. Transient phenylketonuria is a temporary increase in the PA level that can rise to critical values. At the same time, the clinic is absent or the manifestations are very insignificant. After a few months, the biochemical parameters returned to normal.

Pathogenesis

The mechanism of the origin and development of phenylketonuria is associated with a violation of the exchange of an organic compound – the amino acid phenylalanine.The metabolic block interferes with the conversion of phenylalanine to tyrosine. The amino acid is not only not converted, but accumulates in the form of toxic metabolites:

• phenyl lactic acid;

• phenylpyruvic acid;

• phenylacetic acid;

• phenylethylamine and others.

The accumulation of phenyl substances has a toxic effect on the central nervous system. At the moment, the mechanism has not yet been fully understood, doctors do not know the pathogenesis of brain dysfunction.

There are suggestions that the damage to the nervous system is the result of a number of factors. Among them are both the direct toxic effect of phenylalanine and the disruption of the metabolism of proteins, lipoproteins and glycoproteins, the failure of homonal metabolism and membrane transport of amino acids.All this in combination is essential for the maturation and proper functioning of the central nervous system.

Symptoms

I type. The first signs in a child appear at the age of 2 months to six months.

• Apathy or, conversely, increased irritability.

• Lack of interest in the environment, people, objects, environment.

• Frequent regurgitation.

• Allergic dermatitis.

• Violation of muscle tone.

• Low pressure.

• Convulsions.

• Sometimes microcephaly (the small size of the skull relative to other parts of the body) and hydrocephalus (excess fluid that washes the brain) develop.

Characteristic symptoms include hypopigmentation of the skin, hair, and iris. Urine has a specific moldy odor, or it is also called “mouse” odor. Epileptic seizures are observed in half of patients, often being the first pronounced clinical symptom. The seizure is characterized by “salaam” seizures resembling nods. They occur frequently and do not respond well to anticonvulsant treatment.

If the concentration of PA is not adjusted, the disease progresses.As a rule, the IQ level in such children does not exceed 20, with a norm of 85. Mental retardation is so strong that there are no emotional reactions, psychopathies and schizophrenic disorders are observed.

II type. The first symptoms appear in the first year of life.

• Increased excitability.

• Delayed development.

• Profuse salivation.

• Reduced blood pressure.

• Frequent increase in body temperature.

• Tendon hyperreflexia (increased reflexes) or spastic tetraparesis (weakening of all four limbs).

• Myoclonic epilepsy (generalized seizures, mainly occurring after awakening).

• Microcephaly.

A distinctive feature of the second type is neuronal death, impaired folate metabolism, and calcification in various parts of the brain. The disease progresses rapidly and can lead to the death of a child within 2 to 3 years.

III type. Symptoms of pyruvoyltetrahydropterin synthetase deficiency are similar to those of Parkinson’s disease:

• Postural instability and gait difficulties.It is difficult or impossible to maintain a certain position of the whole body or limbs.

• Hypokinesia (low physical activity, limited tempo and range of motion).

• Hypersalivation (increased salivation).

• Swallowing disorders.

• Oculogynous crises (symmetrical deviation of both eyes, usually upward).

In 80% of cases, this type of disease is accompanied by a decrease in the amount of biogenic amines in the cerebrospinal fluid. Treatment is complicated by the fact that an early decrease in the concentration of FA can cause serious pathological changes. Failure to follow diet therapy will lead to a slowdown in the development of speech, low intelligence, and memory problems.

Diagnostics

Phenylketonuria can be detected in the first days after birth before any symptoms appear.To determine the concentration of phenylamine in the blood, carry out:

• microbiological test;

• chromatography;

• fluorimetry;

• mass spectrometry.

In all cases, dry spots of the infant’s capillary blood act as biological material.

Recently, the analysis for phenylketonuria has been included in the neonatal screening program. It is carried out for all newborns, the study is especially important for premature babies. The diagnostic criterion is an increased concentration of phenylalanine at a rate of 0 – 2 mg / dl. The increased level requires a clarifying diagnosis. It will be necessary to establish the very fact of the presence of phenylketonuria and identify its cause.

• If the screening test showed high results of the PA level, in addition, the following may be prescribed:

• Phenylalanine-load diagnostics to identify the nosological form of the disease.

• Molecular genetic analysis to determine the shape: classical, II or III type.

• Sequencing of the RAS gene, if molecular genetic diagnostics gave a negative result for the PAH gene.

• Analysis for pterins in urine to exclude pterin-dependent forms.

Differential diagnosis of phenylketonuria is carried out with pathologies such as impaired liver function, galactosemia and other diseases.

Treatment

Symptomatic therapy for any form of phenylketonuria is ineffective. There is only one way to prevent the negative consequences of the disease – diet therapy. High-protein and phenylalanine-containing foods are excluded from the diet. The missing amount of protein is replenished with specialized therapeutic nutrition, with the lowest possible content of the FA amino acid or completely devoid of it. It should be borne in mind that the effectiveness of therapy directly depends on the time of the beginning of the correction and the pathological changes that have already occurred.

The purpose of nutritional therapy in the classic form of the disease is to prevent the development of disorders of the central nervous system, physical and mental development. The mild form of HFA allows the expansion of the diet under the strict supervision of a doctor over the child’s condition and biochemical parameters. Banned: meat, fish, nuts, chocolate and legumes, all types of eggs, cottage cheese and cheeses. You should also exclude foods containing the artificial sweetener aspartame.

The criterion for the effectiveness of treatment is the level of PA in the blood.

Forecast and prevention

Conducting mass screening in maternity hospitals allows timely identification of a genetic abnormality. Start adherence to diet therapy in time and, as a result, prevent serious consequences. Otherwise, the prognosis for mental development is unfavorable.

Classical PKU has a favorable prognosis if it is diagnosed in the first weeks of a child’s life and all the requirements of doctors are observed.Such children go to regular schools, are able to get higher education and lead a normal life.

During preparation for pregnancy, the couple must undergo preliminary genetic testing for the presence of mutations in the RAS gene. If one of the parents has a defective gene, the chance of having a child with PKU is 1: 4 and 100% if both parents are sick.

Women with established PKU during pregnancy and breastfeeding should follow a strict diet.The high concentration of the amino acid in the blood and amniotic fluid has a serious teratogenic effect on the fetus.

Advantages of SZTsDM JSC

You can pass the analysis to the FA level in the subdivisions of SZTsDM JSC. Here you will find:

• qualified and friendly staff;

• the latest equipment, sending research results by email.mail;

• several options for obtaining analysis data;

• convenient location of terminals;

• no queues, confidentiality conditions.

Laboratories are located in St. Petersburg and other cities of the Leningrad region, as well as in Veliky Novgorod, Novgorod region., Pskov, Kaliningrad.

go to analyzes

A sharp smell of urine in a child and baby up to a year (with ammonia, acetone, fish)

The smell of a child’s urine is an indicator of the state of his body. Normally, it should be weak or absent altogether. If you notice a change – strange discharge, a pungent smell of acetone, fish or other foreign substances, you should think about the possible reasons. Every parent should know what changes in urine can tell and what needs to be done to prevent a worsening of the baby’s condition.

What urine smell should a child have?

Urine in children should smell weak, without impurities, and the smell of urine in babies may be completely absent. Expansion of the children’s diet leads to the appearance of a subtle, mild, unobtrusive odor. As a rule, urine begins to smell from 5-6 months, with artificial feeding – earlier. Until the child can independently report what is bothering him, you need to especially carefully monitor any deviations.

If you notice that urine smells harsh and unpleasant, you should immediately contact your pediatrician, even if there are no other symptoms. At the initial stage, this may be the only manifestation of pathology. Timely diagnosis of the disease will avoid expensive treatment and potent drugs. Do not hesitate to tell the doctor such things – when it comes to the health of the child, it is better to play it safe.

Why can the smell of urine change?

The baby’s urine smells like ammonia.Normally, when it enters the pot, the “aroma” is weak and intensifies as it is in the open air. If a pungent smell appeared immediately after getting into a pot or diaper, there may be several reasons:

• the appearance of new products in the diet;
• long-term medication intake;
• pathologies of a different nature.

Introducing new foods to complementary foods can cause changes in urine odor

Before you sound the alarm, you need to think about which factor was present in your situation.If food is the culprit, adjust your diet. You can find out if the pungent smell of urine in a child has become a side effect of taking medication in the official instructions for the drug. The absence of the first two factors indicates that you are faced with a disease.

With the development of pathologies, urine may smell:

In infants

In infants, urine is colorless and odorless. As the crumbs grow and complementary foods are introduced, ammonia accumulates, and urine more and more resembles an adult.

The pungent odor of ammonia in infancy signals danger. The cause of the pathology may be a violation of a special diet by the nursing mother, heredity or the development of acquired diseases.

From all of the above, it follows that the child’s urine starts to smell for various reasons, and parents need to find out why. Follow the baby’s behavior: does he feel discomfort, is he capricious? A specialist consultation will not be superfluous. If fever, loss of appetite and soreness are added to the unpleasant smell, call an ambulance.

In children over one year old and adolescents

In the process of growing up (at 1-2 years old), the baby gets acquainted with a variety of products, and parents immediately begin to notice that the child’s urine becomes yellower from the age of one year and acquires a specific smell, especially noticeable when ingested on the fabric. The reasons for the ammoniacal odor of baby urine can be:

• excessive consumption of carbohydrate or protein products;
• lack of useful macronutrients in the daily diet;
• dehydration;
• eating foods containing chemical components (enhancers of taste and odor, preservatives, etc.)).

During adolescence, urine can become smelly during hormonal changes, with severe physical overwork. Parents need to teach their child to thorough intimate hygiene. In the case when urine smells like acetone or there is a temperature, there is a burning sensation in the urinary tract, you should immediately go for diagnosis.

If other unpleasant symptoms are added to the unpleasant smell of urine, the child should be shown to the attending physician

What diseases does the unpleasant smell indicate?

To understand the causes of an unpleasant symptom, our table will help:

liver failure

The nature of the smell	Reasons	Possible diagnoses
Acetone	Due to an increase in the blood of acetone bodies with an insufficient amount of carbohydrates in the body.In the absence of pathology, diabetes mellitus passes independently after adjusting the diet	; stenosis of the digestive system; heavy metal poisoning
Ammonia	High concentration of ammonia due to pathology of the urinary system	pyelonephritis; dehydration; urethritis; cystitis; cancerous tumor; systemic diseases
Rotten eggs (hydrogen sulfide)	The consequence of heartburn occurs with excessive consumption of spicy or alcoholic products	pyelonephritis; liver failure; inflammation of the urinary system
Chemical	Increased concentration of chemical elements in the blood	poisoning with household chemicals; drug overdose; diabetes mellitus
Mouse	Poor blood clotting	Phenylketonuria
Fish	Intestinal fermentation		trimethylaminuria
Purulent	Presence of pus	acute urethritis; acute cystitis; fistula.
Feces	Poor hygiene	–

Diagnosis of pathology in a child

In order to find out the causes of bad urine odor, you need to seek help from a medical institution. Diagnostics can be of two types: laboratory and instrumental. The first type of check means the study of biological body fluids for the presence of specific signs of pathologies in them.

Ultrasound examination of the kidneys allows you to make an accurate diagnosis.

The second type of diagnosis allows you to look at the clinical picture “from the inside”: with the help of special devices, the doctor determines which organ is affected and how badly.Instrumental research for the final diagnosis includes:

• biochemical analysis of urine;
• Ultrasound or tomography of the kidneys.

Treatment options

Standard treatment regimens for diseases that cause an unpleasant odor of urine in a child:

9088 It is incurable. Symptoms are minimized by controlling blood phenylalanine

Not only prevented

to 910 diseases, but also after – in order to avoid re-infection.The prevention of relapse consists in increasing immunity and stimulating the work of the organs of the urinary system. If your baby is sick, try to follow all the doctor’s instructions to avoid complications.

Pediatrician of the 2nd category, allergist-immunologist, graduated from BSMU of the Federal Agency for Healthcare and Social Development. Read more »

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norm, how many times a day, color

So many worries are associated with how a newborn baby “walks in a big way.”Moms are worried about the frequency of the stool, its color, consistency. So how to determine if everything is in order with the crumbs with digestion? Perhaps he needs help?

Many mothers know that it is very important to monitor the baby’s stool, and during the examination, the pediatrician is always interested in how the baby walks in a big way. This information is one of the most important points in diagnosing a baby’s health status. Unfortunately, quite often mothers mistakenly interpret the completely natural and safe conditions of the baby. And because of these mistakes, they can start unnecessary treatment and worry about the baby for no good reason.So let’s figure out how a baby’s chair should look like and when to worry and when not.

Immediately after childbirth

When the baby is in the mother’s tummy, he receives all the necessary substances and trace elements through the umbilical cord. The baby’s digestive system does not work, but his stomach is not empty. The baby sucks his fingers, opens his mouth and thus swallows a small amount of amniotic fluid. When a baby is born, this substance will be in its intestines and will gradually be released as the baby is applied to the breast and its digestive system begins its work.

So, the first stool of the crumbs is meconium: a dark, plasticine-like stool mass. This is how the baby recovers for the first day or two. Sometimes it gives him unpleasant sensations: the baby worries, cries, pushes before he can go in a big way. However, this is not always the case – many children recover easily, only slightly pushing.

If everything is in order with the baby, he was put to the breast on time and fed on demand, then gradually his stool changes. On the third or fifth day, the baby has a so-called “transitional stool”, partly consisting of meconium, which is still in the gastrointestinal tract, partly from digested colostrum and milk.As a rule, first, veins appear in the meconium mass, then the feces gradually turn yellow. By the end of the first week, the stool of the crumbs usually takes on the features of a normal infant: yellow, rather liquid.

When should you worry? If the baby did not go out in a big way in the first two days, you need to consult a doctor. There are children with individual characteristics who will continue to do this less often than most babies. However, the cause of the stool retention must be determined by the doctor.If the crumbs have any problem with intestinal permeability, help will be required immediately, but you should not diagnose your baby without a doctor.

We are at home

On the third or fifth day, the mother receives milk, and by the end of the first week, the baby has a fairly stable stool. In the literature, it is sometimes said that the stool of newborns is “creamy”, and this confuses mothers who begin to suspect that not everything is in order with the baby. In reality, the stool of a healthy baby is liquid and not always uniform.The normal color of stool is yellow and its shades. You may notice lumps, a little mucus – that’s okay. Do not be afraid even if the baby’s feces have a greenish tint up to three months due to the immaturity of the liver enzyme systems and the peculiarities of bilirubin metabolism, such a condition has the right to be and also does not require treatment.

Many mothers sometimes have anxiety due to the fact that the baby’s stool “suddenly” becomes watery and the child walks in a big way with copious gas and a sharp sound.Doctors in this case often suspect lactase deficiency. In reality, this is usually the case. In the period from 3 weeks to one and a half months, the baby has frequent growth surges, so at certain moments the baby literally “hangs on the chest” to help the mother develop more milk. During a day or several, the baby needs breast more often and longer than before, and the mother begins to suspect that there is not enough milk. As a result, she often begins to shift the baby from one breast to another, and the baby receives mainly “front” milk, which comes at the beginning of feeding from each breast.This milk is rich in carbohydrates and proteins, the crumb is actively growing from it, however, the stool because of this milk is liquid and with gasses (sometimes the “result” looks foaming if the baby is held over a pot or basin when he needs to empty himself, and the mother can observe the consistency chair). In this situation, there is no need to panic – it is just that the baby does not need to be constantly shifted from one breast to another, fearing that he is starving. Give the baby the opportunity to get “back” milk, rich in fats, which will not cause flatulence and will stay in the intestines longer.

In this situation (when the baby suddenly begins to clearly suck more milk), the mother may feel insecure and start drinking lactogonic teas. From this, more carbohydrates again begin to flow into her milk and the baby’s stool becomes more liquid and with gas.

Similar problems due to “front” milk occur in the case of improper attachment to the breast, as a result of which the baby drowns out the air and interrupts feeding itself, or simply cannot get the “back” milk.The best way out in this situation is to consult with a breastfeeding specialist in order to correct the technique of attachment and stop panicking that the baby “does not have enough milk”.

In short, do not worry if your baby has problems with this kind of stool. Of course, the flora of his intestines is unstable, it is just beginning to establish itself – this takes at least three to four months. Your task is simply to feed the baby on demand and correctly and not rush to treat him from imaginary diseases.

Stool retention

Moms worry not only about the appearance of the chair, but also about its frequency. How often should a baby “do things”? Normally, the baby walks a lot several times a day, usually after feeding. However, some children may have a normal bowel movement once a day, and even once every few days. Usually, such children have an anatomically weak anterior abdominal wall and intestinal motility. Such a frequency of stool can be considered the norm, if the baby still walks in a large way regularly, the stool is of normal consistency and, in general, the baby is cheerful and cheerful and does not suffer from colic.Don’t worry. However, if the baby is allergic, then you need to do everything possible so that he goes to the toilet at least once a day. Atopic dermatitis is much more severe if the baby does not empty the intestines often enough – consult your doctor about this.

Children also experience physiological stool retention at the age of one and a half to five months. It is important to monitor the baby’s condition here. If he is experiencing discomfort, you need to consult a doctor. Children can retain stool for psychological reasons, just as adults sometimes cannot go to the toilet when they are nervous.Do not panic over a one-time problem, but if the problem lasts or recurs, consult your doctor.

However, babies have not only stool “delays”, but also real constipation. Constipation is called not only when the baby does not go to the toilet at all, but also “pea” feces, overdried, when bowel movements are difficult. What could be the reason?

Regular constipation is usually caused by improper feeding of the baby. However, this condition can also occur if the mother does everything right, but she has her own health problems, for example, with the thyroid gland.Medication can also cause constipation. For example, intestinal weakness is provoked by all kinds of sedative potions and medications that neurologists often prescribe to children at an early age. Even cough medicine or dental gels can cause constipation. In any case, the doctor must deal with this. You should not give the baby medicines and laxatives on your own, or act on it mechanically with an enema or a gas tube. It is better to discuss with the doctor the issues of feeding, medication and the baby’s lifestyle – this way you can understand the problem.

Complementary feeding time

Of course, when you start introducing complementary foods, your baby’s stool pattern changes. First of all, you need to remember that the task of the first complementary feeding (at 5, 6 months) is not to feed, but to help adapt to new tastes, to new food. Give your baby a lick of complementary foods and only gradually move on to doses of “from a nail” or “half a teaspoon”. Recall that one product is needed to introduce crumbs into the diet so that you can understand how and what the baby reacts to.Quite often, as soon as we give the baby some kind of food “off the nail”, it is not digested – we find the product in the feces almost in its original form. Within one or two days, this is normal, the baby’s body has not figured out the new component in the stomach, but if this continues on the third day, the product must be removed from the diet, since it is obvious that the baby is not yet ready to accept it. You need to take a break for a week or two, without offering the baby anything but breast, then try again, with a different product.

The body of the crumbs can react more violently, for example, with liquefied stools and abdominal pain, and sometimes allergies. In this case, you also need to cancel the product and keep the baby breastfed so that the gastrointestinal tract calms down.

When you introduce your baby to protein foods, he may react with constipation. To avoid this, you need to remember simple rules. Protein requires more fluid, so if this is your baby’s first food (such as cottage cheese), give him more breast milk.If you start introducing proteins when the baby is already drinking liquid, provide him with a drink. Do not worry that the introduction of new products has to be postponed – nothing bad will happen to your baby. And be especially calm about the opinion that at 6-7 months the child needs to be given meat products so that he grows well. Not all children are able to assimilate such a protein; for many, even a homogenized meat product at this age will lead to constipation and overload the kidneys. Let the baby eat breast milk for a longer time and receive vegetables and fruits as complementary foods – this way you will avoid many problems with stool.

In general, the concern of mothers about the stool of babies is quite justified: after all, this is an important diagnostic symptom that allows you to understand a lot about the state of the baby. However, it must be remembered that not all situations require intervention, and most problems can be solved simply by correcting feeding errors. Do not rush to treat the baby and resort to medications, start with a diet.

Text: Anna Babina
Consultant: Olga Ivanovna Tkach, pediatrician of the Center for Traditional Obstetrics

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Disease	Treatment regimen	Prophylaxis
Diabetes mellitus	Blood glucose control , in severe cases – insulin therapy	Minimize the consumption of foods containing a large amount of fast carbohydrates, refusal of fast food
Stenosis of the digestive system	In the early stages – anti-symptomatic drugs, in the later stages – surgery	Balanced three meals a day + light snacks between meals
Pyelonephritis	Antibiotic therapy – the drug is selected after bacterial culture of urine.In combination with an antibiotic, prebiotics and probiotics are recommended	Avoid severe hypothermia, consume enough fluids per day, respond promptly to urge to urinate
Urethritis	Azithromycin, Ceftriaxone, Doxycycline. For external use Miramistin is used. After treatment, immunomodulators are prescribed	Compliance with the rules of personal hygiene, minimizing the consumption of fatty, spicy foods, excluding hypothermia
Cystitis	Antibiotics, anti-inflammatory, diuretics, analgesics.Bed rest and physiotherapy measures, compresses	Similar to the prevention of urethritis
Liver failure	Cephalosporins, hypoammonaemic drugs, mild laxatives, vitamins	Timely treatment of infectious diseases, avoiding excessive consumption of protein	–
Trimethylaminuria	Diet that excludes foods containing choline and lecithin and antibiotic therapy	Compliance with personal hygiene rules