Weird pee comes in basically three varieties: looks weird, smells weird, and hurts-when-I-pee. These can come in various combinations and at various ages, and it can cause a bit of bewilderment when you are called on to interpret what it all means, what you should do about it, and whether or not your child requires immediate medical evaluation – generally right around the same time that you are trying to figure out how to make tonight’s dinner vegetable more appealing if your house is anything like mine.
If your child already has a history of urinary tract infections, congenital urinary tract anomalies, kidney stones, or other medical problems that affect the kidneys, urinary tract, and/or urine, this guide likely doesn’t provide you much additional insight. Instead, you should follow the plan that you and your child’s physician have previously discussed.
Otherwise, here is a handy primer for first-timers.
My kid’s pee looks weird
Pee that looks weird can be: too dark, bloody-looking, looks like iced tea or Coca-Cola, frothy/bubbly, or pinkish orangish stuff in the diaper.
Dark urine is most often caused simply by inadequate fluid intake. It is the sign of a healthy kidney doing its job by sensing that the body doesn’t have as much water as it needs to function optimally and then taking steps to hold onto the water that would otherwise be peed out. Health professionals like to make it sound fancy by referring to the process as “generating a concentrated urine.” Whatever. Kidneys are smart, so they hold on to the things the body needs when it needs them and pees them out when it doesn’t, and that includes water. As an interesting point of trivia, did you know that the healthy adult kidney conserves about 144 liters of water every day, even under states of optimal hydration?!? Dark urine means your kidney is working extra hard to conserve water, so do it a favor and drink water! Dark urine can have a strong smell to it, so if what you’re seeing is dark urine that smells strongly like urine but doesn’t hurt coming out, try having your child drinking some water and see if it gets better. If it doesn’t get better, give your pediatrician a call. Ideally, urine should look like pale lemonade; anything darker is a signal to increase the amount of water you’re drinking.
Urine that looks bloody or like iced tea or cola, on the other hand, is a sign of blood or other pigments in the urine, and it should prompt some evaluation to find the cause. For peripubertal-age girls (around the age of puberty, 10-15), the first step is to be sure that they aren’t just starting a menstrual cycle. Otherwise, there are several possible causes of blood or pigment in the urine that you should be aware of and that should prompt a visit with a doctor. The most common causes of blood in the urine are urinary tract infections (UTIs) and kidney stones or crystals. Both of these are usually associated with at least some discomfort with urination; both can be exquisitely painful. If your child is experiencing bloody-looking urine and pain, immediate medical evaluation is recommended, either by your pediatrician or – if your pediatrician is unavailable – in an urgent care or emergency room setting. This is especially important if your child is also experiencing fever or difficulty urinating. Less common but still important causes of bloody-looking urine can include intrinsic kidney diseases, including some that can appear after recent viral or strep infections, recent trauma to the kidney or urinary tract, red blood cell break down (known as “hemolysis”) in the blood vessels with the hemoglobin from inside the cells coming out in the pee, or muscle breakdown pigments that can also be seen in the urine in this way, which may happen with certain viral infections or after extremely strenuous exercise. These types of causes should also be promptly evaluated by your pediatrician or in an urgent care/emergency room.
Frothy or bubbly-looking urine can sometimes be seen and should be evaluated by your doctor, though this can generally be done in a semi-urgent fashion in your doctor’s office rather than in an urgent care or emergency room setting. The bubbly appearance is often due to excessive protein in the urine and may be an indication of a nephrotic syndrome, which is a family of kidney diseases characterized by excessive protein loss in the urine. Occasionally, if the frothiness is only present in the morning and your child is an otherwise healthy and active teen or tween, the protein loss is not concerning, but this can only be determined by a medical professional. If your pediatrician confirms an abnormal amount of protein in the urine, he or she will likely refer your child to a pediatric nephrologist – a specialist in kidney diseases in children – to determine the cause of the problem. You should seek earlier medical attention if you notice that your child’s face, eyelids, or belly seem very swollen/puffy or if your child complains of feeling unwell.
Pinkish or orangish urine
Many parents have been alarmed upon finding a pinkish or orangish color in their baby’s diaper. Good news! This usually represents the very common finding of urate crystals in the urine, which are a product of high uric acid levels in the urine of newborn infants and are not problematic. As long as your baby is well-appearing, eating well, and making a normal number of wet diapers, these need not be a cause for concern. You can discuss them with your pediatrician over the phone or at your child’s next checkup just to be sure.
My kid’s pee smells weird
Pee that smells weird generally refers just to foul-smelling or very strong-smelling urine. Occasionally it can refer to a musty smell or overtly sweet-smelling urine, both of which should prompt immediate consultation with your pediatrician.
As previously noted, the most frequent cause of foul-smelling urine that should prompt evaluation by a medical professional is a UTI. UTIs also usually come with pain (“dysuria”), urinary frequency and/or urgency – often with a feeling of not being able to completely empty the bladder with attempts to go – and bloody-looking urine, which is often quite red. If fever is also present, this constitutes a medical emergency and should be evaluated immediately, especially in infants or very young children.
Sweet-smelling urine, on the other hand, may be related to high concentrations of sugar in the urine, which may be a sign of developing diabetes, and this should also be evaluated immediately, especially if you notice that your child seems to be going to the bathroom much more frequently than usual or is newly having accidents when he/she was previously fully toilet trained.
Musty-smelling urine is extremely rare but can be found in some genetic syndromes; it is not typically the first thing that people notice that prompts an evaluation, but if it is, an evaluation that starts with your pediatrician is warranted.
My kid says it “hurts when I pee”
Hurts-when-I-pee: when accompanied by looks weird and smells weird, generally can be attributed to a UTI and should prompt immediate evaluation, as above. The evaluation may reveal not a UTI but urinary stones or crystals; your doctor will be able to advise you on proper further evaluation and treatment, but it almost certainly will include drinking a lot more water. Similarly, a child can report that they have pain/discomfort with urination without other findings that may reflect microscopic crystal formation in the urine and should be treated with increased water intake and scheduling an evaluation with your pediatrician within the next few days.
One final challenge that deserves mention: what if you don’t know what your child’s pee looks like/smells like/feels like when they pee? That’s okay!! I don’t do regular pee checks on my 8-year-old either! However, other than frothy/bubbly urine, I find that most children will be a bit unnerved by looks weird or hurts-when-I-pee, and they are likely to report this problem to you in one way or another, which is going to catch the vast majority of problems at a pretty early time point.
I hope you found this useful. Good luck with those vegetables, and keep drinking water! Lots and lots of water!!