While many people think that urologic conditions only affect elderly individuals, they happen to people of all ages—including infants and young children. Since catheterization tends to be reserved for instances that would otherwise lead to health risks or complications, correctly performing the procedure is essential to longevity and bodily functions. While adults have a strong understanding of this and can perform self-catheterization on their own, that’s not necessarily the case with pediatric patients. Young children, especially infants, cannot perform catheterization on themselves for obvious reasons. Even as children begin to grow and understand the world around them, the aspect of catheterization requires precision and should be handled by an adult. To better understand how to perform pediatric catheterization, here’s how to help reduce discomfort in your child and succeed with care at home.
Why Would a Child Need a Catheter?
Pediatric urology is a specific subset of urology that focuses on urologic conditions in children. Most of these conditions are congenital, which mean that they are present at birth. When this occurs, diagnoses are made during infancy, but can sometimes be detected throughout the duration of the pregnancy itself. Due to advancements in screening and treatments, pediatric urologic conditions are usually treated early on in life. Sometimes, these treatments require surgery while others resolve on their own. There are also urologic conditions that can manifest during later childhood years.
Some of the most common pediatric urologic conditions include:
- Urinary Tract Infections
- Antenatal Hydronephrosis
- Hernia
- Hydrocele
- Hydronephrosis
- Hypospadias
- Neurogenic Bladder
- Nocturnal Enuresis
- Spina Bifida
- Undescended Testes
- Ureteropelvic Junction Obstruction
- Vesicoureteral Reflux
While not all these conditions will require catheterization, some do. Throughout the treatment of certain urologic conditions in children, catheters are used to help expedite healing and reduce the pain or discomfort a child feels. In instances deemed necessary, pediatric catheterization is used.
Pediatric catheterization is a way to safely address the build-up of urine in the bladder. It can also manage urinary incontinence associated with several different urologic conditions. When surgery is required to treat or absolve a urologic condition, a catheter is used until your child can use the bathroom on their own again. In other instances, pediatric catherization is done to measure urine output and diagnose infection, especially when voiding cannot be done on command.
Just as with adults, the details involved in pediatric catheterization depend on the circumstances. If your child is undergoing surgery, an indwelling (foley) catheter may be inserted. This is done at the hospital, by a trained doctor. In most instances, children will not need intermittent catheterization after the indwelling is removed. The indwelling catheter will be removed in the hospital by a doctor. Other conditions, or situations, may require pediatric catheterization at home.
When catheterization is performed on infants and young children, two people are needed for both insertion and removal to help avoid injury. It’s beneficial to have one or both parents present to help comfort the child during the procedure. In instances where the child is unable to be comforted, sedation is needed to avoid injury.
Pediatric Catheterization at Home
During infancy and early years, your child may not understand the concept of a catheter, but as children get older, they tend to grasp information better. If your child is old enough to understand basic concepts, it’s important to begin this process with a conversation. Your pediatric urologist can help with this, but you may need to continue the conversation at home throughout care. You do not want your child to rip out or try to remove the catheter.
As mentioned, while most instances of catherization in children occur in the hospital, sometimes a child needs to keep it in while they transition home. To make sure you’re fully prepared, your doctor or nurse will go over all the details regarding how to care for the catheter. They will also discuss what you’ll need to do if your child’s catheter accidentally comes out. Prior to leaving, you will have a management plan that discusses all of this and what to do in case of an emergency.
Some Key Points to Remember
Even if you’re not performing pediatric catherization, you must always wash your hands prior to touching or manipulating the catheter. Hand hygiene is essential in catheterization, especially in children whose immune systems are still developing. While it may be difficult to manage in some situations, keeping the catheter tubing straight and unkinked is important to avoid blockages. Always keep the drainage bag below the level of your child’s bladder so that the urine can be diverted out and away from the body.
You should check the color of the urine in the collection bag regularly to watch for any signs of dehydration. Aim for a clear or pale-yellow urine output and if it’s darker, make sure to increase your child’s liquid intake.
Taking Care of the Drainage Bag
Many parents find that the best way to care for the drainage bag is to use a strap to attach it to their child’s legs during the day. Infants may require alternate placement to adequately position the drainage bag below the level of the bladder. To avoid leaks throughout the night, it’s beneficial to utilize a second drainage bag, which can then be removed in the morning.
Every few hours, check the drainage bag. Always empty it when it’s about halfway full by opening the tap over the toilet. There are different pouching systems, but most are easy to use without disruption to the catheter itself. Keep a log of the urine output for your doctor.
If there are any holes or punctures on the drainage bag or tubing system, they need to be fixed. Make sure that you have plenty of extra supplies on hand to avoid delays or potential problems.
Reducing Your Child’s Discomfort During Catheterization
The main thing that parents worry about regarding pediatric catherization is their child’s comfort levels. To help, here are a few ways to reduce your child’s discomfort.
If your child’s catheter comes out while at home, contact your doctor. While it is possible to perform at home, catheterization in children is not as easy as adults and a caregiver will need to safely perform the procedure. The urethra is much smaller in developing children, which can increase the risks associated with catheterization by an unlicensed professional.
Potential Complications with Pediatric Catheters
In addition to infection, there are a few complications that can occur when dealing with pediatric catheters. Your doctor will discuss how to handle these ahead of time and if you are unable to correct them, call your doctor or head to an emergency room.
- Lack of Drainage – if the catheter isn’t draining, it could be due to several reasons. Check for any kinks or twists as well as the taping that keeps the catheter in place. Make sure the drainage bag is properly positioned and keep your child well hydrated. If the catheter is blocked and requires flushing, call your doctor.
- Leakage – sometimes, pediatric catheters leak. If you find this happening, try to determine the source of the leak. Oftentimes a change of tubing or bag can fix the problem. Make sure the tap is closed and the system is connected tightly. If you cannot fix the source of the leak, go to the doctor.
- Catheter Removal – if your child’s catheter falls out or is removed, follow the instructions given by your pediatric urologist. If you haven’t been given a management plan or are unsure as to how to reinsert the pediatric catheter, go to the hospital.
When to See Your Doctor
Whenever a question or concern arises, don’t be afraid to reach out to your doctor. If you think that it’s an emergency, go to a hospital or urgent care clinic so that it can be addressed as quickly as possible. Some reasons to go to an emergency room include cessation of drainage, change in urine (cloudy, smelling, hematuria), the presence of a fever, or any signs of infection such as pus, discharge, swelling, or skin that becomes hot to touch.
If your child’s urinary catheter comes out and you are unsure of what to do, call your doctor. To make sure that it’s safely reinserted, a team of two is needed alongside experience and understanding of pediatric anatomy. Finding the female urethral meatus can be more difficult in young girls as their anatomy is still developing. Inserting a catheter into a young male or female requires more precision and a specialized tubing to accommodate size differences.
Regardless of the age of your child, Byram Healthcare has a range of pediatric catheters and supporting supplies to help make pediatric catheterization at home as easy as possible.
