Urinary Reflux In Children

Key points about urinary reflux

• urinary reflux is also called vesico-ureteric reflux
• it is the abnormal flow of urine from the bladder back up the tubes (ureters) to the kidneys
• if a baby or child has urinary reflux, they are at risk of urinary tract infections (UTIs)
• repeated UTIs may cause scarring and damage to the kidneys
• it is important to watch out for the signs of a UTI in your child with urinary reflux
• if you think your child may have a UTI, go to a health professional for a urine test
• in most tamariki (children), urinary reflux gets better as they grow

It may help to read this together with the following pages.

Urinary Tract Infection In Children

Urine Tests

The urinary tract and how it works

The urinary tract includes the kidneys, ureters, bladder, and urethra.

The kidneys filter and remove waste and water from the blood to produce urine. The urine travels from the kidneys down 2 narrow tubes called the ureters. Urine is then stored in the bladder.

When your child does a wee, urine flows out of the body through the urethra, a tube at the bottom of the bladder. The opening of the urethra is at the end of the penis in boys and in front of the vagina in girls.

What is urinary reflux?

Urinary reflux is the abnormal flow of urine from the bladder back up the ureters towards the kidneys. This can happen because the ureters may not close off when urine is being squeezed out of the bladder when your child does a wee. Normally when the bladder empties, all the urine flows out of the bladder through the urethra.

Urinary reflux can be from grades 1 to 5. Grade 1 is the mildest form, while grade 5 is the most severe.

Check some diagrams showing the different grades of urinary reflux.

Urinary Reflux Diagrams

Signs and symptoms of urinary reflux

Urinary reflux does not cause any symptoms in affected pēpi (babies) or tamariki. The most common sign of urinary reflux is a UTI.

If your child has urinary reflux, it is important to watch out for signs of a UTI. Signs of a UTI include:

• fever
• vomiting
• feeling generally unwell, often with loss of appetite
• tummy pain
• pain when weeing
• wanting to wee frequently
• bedwetting or wetting during the day, if previously dry
• blood in the wee

If you think your child may have a UTI, go to a health professional for a urine test.

Another sign of urinary reflux is a stretched (dilated) urinary tract. An ultrasound scan can show this. Sometimes a pregnancy ultrasound can show this before a baby is born. 

Diagnosing urinary reflux

There are a variety of tests your health professional may request to diagnose urinary reflux and look at the condition of your child's kidneys and drainage tubes. 

See the following pages for information about these tests.

Micturating Cysto-Urethrogram (MCU)

Renal Ultrasound In Children

Nuclear Medicine Kidney Scans In Children

Possible complications of urinary reflux

Urinary reflux may increase the chance of your child getting UTIs because of the incomplete drainage of urine.

Urinary reflux alone does not usually cause kidney damage. But, recurrent UTIs in tamariki with urinary reflux may cause kidney damage and scarring and can affect how well the kidneys work in the future.

Only a few tamariki with urinary reflux develop significant kidney problems. In most tamariki, the problem is easily managed with treatment and monitoring.

Managing urinary reflux

Urinary reflux usually gets better by itself as your child grows, especially if it is mild.

Treatment focuses on preventing UTIs while your child is young, when they can cause damage to the kidneys. Sometimes, health professionals may prescribe a small dose of antibiotics to prevent UTIs until the urinary reflux improves or gets better by itself.  

In most tamariki, no treatment is necessary for urinary reflux. Your child's health professional will monitor the growth and health of your child's kidneys with scans as needed. This will depend on how severe your child's reflux is.

Regular urine tests may be needed to make sure there is no infection present. If your child develops any symptoms of a UTI while on antibiotics, take them to a health professional urgently for a urine test.

Healthy toileting habits

It is very important to encourage healthy toileting habits to reduce your child's chance of UTIs. This includes:

• emptying the bladder every 2 to 3 hours during the day and not holding on to wee
• making sure your child takes the time to empty all of the wee from their bladder when they go toilet
• treating any constipation your child may have
• checking in that they are wiping with toilet paper front to back 

Will my child need long-term follow up for urinary reflux?

In most tamariki, urinary reflux gets completely better later in childhood and they have no future problems.

Urinary reflux sometimes happens due to abnormal development of the kidneys resulting in a condition known as dysplasia. Kidney dysplasia causes reduced function in the affected kidney. If your child has urinary reflux and dysplasia, their health professional will measure their kidney health every year. This includes checking their blood pressure and urine protein tests. 

Tamariki who have severe reflux and repeated UTIs may also develop kidney damage and need further monitoring for this.

More information