Smelly urine in toddler

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

Stinky urine in a feverish child should be a red flag for doctors. Swilmor/ hide caption

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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.

Symptoms & Causes of Bladder Infection in Children

What are the symptoms of a bladder infection?

Don’t assume that you’ll know when your child has a bladder infection, even if you’ve had one yourself. Symptoms can be very different in children than in adults, especially for infants and preschoolers. If your child is not well, contact your child’s pediatrician or health clinic.

Fussiness or a general ill feeling can be symptoms of a bladder or kidney infection in a child younger than age 2.

Young children

It’s not always obvious when an infant or child younger than age 2 has a bladder infection. Sometimes there are no symptoms. Or, your child may be too young to be able to explain what feels wrong. A urine test is the only way to know for certain whether your child has a bladder or kidney infection.

When a young child has symptoms of a UTI, they may include

  • fever, which may be the only sign
  • vomiting or diarrhea
  • irritability or fussiness
  • poor feeding or appetite; poor weight gain

Older children

Symptoms of a bladder or kidney infection in a child ages 2 and older can include

  • pain or burning when urinating
  • cloudy, dark, bloody, or foul-smelling urine
  • frequent or intense urges to urinate
  • pain in the lower belly area or back
  • fever
  • wetting after a child has been toilet trained

Seek care right away

If you think your child has a bladder infection, take him or her to a health care professional within 24 hours. A child who has a high fever and is sick for more than a day without a runny nose, earache, or other obvious cause should also be checked for a bladder infection. Quick treatment is important to prevent the infection from getting more dangerous.

What causes a bladder infection?

Most often a bladder infection is caused by bacteria that are normally found in the bowel. The bladder has several systems to prevent infection. For example, urinating most often flushes out bacteria before it reaches the bladder. Sometimes, your child’s body can’t fight the bacteria and the bacteria cause an infection. Certain health conditions can put children at risk for bladder infections.

Urinary Tract Infection in Children: Know the Signs

UTIs in children are very common and very treatable. To prevent complications, it’s best to call your child’s doctor to get treatment as soon as you notice symptoms.

What are the symptoms of UTI in children?

Urethra infection and bladder infection are the most common forms of UTI in children, but these infections can also affect the ureters and kidneys. If your child has a UTI, you may notice:

  • Bedwetting
  • Fever (occasionally the only symptom in babies)
  • Foul-smelling, cloudy or blood-tinged urine
  • Frequent urination, although very little urine may be produced
  • Fussiness
  • Nausea, vomiting or loss of appetite
  • Pain below your child’s belly button
  • Pain or burning sensation when your child urinates
  • Waking at night to urinate

How are UTIs in children diagnosed?

It’s important to know that UTI symptoms are similar to symptoms of other conditions and infections. Always contact your child’s primary care doctor when symptoms appear. He or she will ask about your child’s symptoms to determine if an examination is necessary.

To confirm a UTI and identify the type of bacteria causing it, the doctor may need a urine sample. Older children will be asked to urinate in a cup at the doctor’s office. To diagnose a baby or young child, the doctor may need to:

  • Insert a catheter through his or her urethra and into the bladder to collect urine.
  • Collect urine by attaching a bag around his or her genitals, within a diaper, until the child urinates. This method carries a risk of urine contamination by normal skin bacteria.

How is a UTI treated?

The doctor will send your child’s urine sample to the lab, but analysis may take a couple of days. In the meantime, he or she will prescribe your child an antibiotic that treats the most common bacteria that cause UTIs. If your child’s urine culture identifies bacteria that may be causing symptoms, but is not treated by that antibiotic, the doctor may prescribe a new antibiotic.

Be sure to give your child the antibiotic in the prescribed dosage at the prescribed times each day. Your child must finish the full antibiotic course to ensure the infection doesn’t return. You should also encourage your child to drink plenty of water.

With proper treatment of a UTI, most kids will feel better in two to three days. Your doctor may need to perform further tests if your child has repeated infections. It is important to treat your child’s infection promptly because untreated infections can cause kidney damage or, in rare cases, a bacterial infection of the bloodstream known as sepsis.

What causes a UTI?

Bacteria, often the intestinal bacteria E. coli, can easily enter the urinary tract from the skin around the anus. UTIs are more common in girls, especially during potty training, because a girl’s urethra is shorter and closer to the anus. Uncircumcised baby boys also have a slightly elevated risk. Some risk factors for UTI are not preventable, including:

  • A structural or functional abnormality in the urinary tract (like a blockage).
  • An abnormal backward flow of urine from the bladder up the ureters and toward the kidneys, known as vesicoureteral reflux, which is very common in kids with UTIs.

In some cases, additional tests such as ultrasound or bladder x-rays may be recommended to look for these conditions and to determine the most effective treatment.

How can UTIs be prevented in kids?

  • Encourage your child to use the bathroom when he or she has to go, rather than holding it.
  • Teach your child how to properly wipe, front to back, after using the toilet.
  • Buy your potty-trained child cotton underwear, which allows the area to dry properly.
  • Dress your child in loose-fitting clothes, because tight clothes can trap moisture.
  • Make sure your child drinks enough fluids each day, preferably water. Ask your doctor how many ounces your child needs. Babies consume what they need through breastmilk or formula.

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Strong-smelling Urine Not Necessarily Cause for Concern

April 16, 2010

Dear Mayo Clinic:

What could be causing my husband’s urine to have a very strong odor? Is it cause for concern? He is 74 years old.


Strong-smelling urine has several possible causes. One possibility, diabetes, is a serious medical concern. Other reasons can range from diet — specifically asparagus — to a urinary tract infection, which requires treatment.

Causes for strong urine odor include:

Urine concentration: It’s normal for urine to have a stronger odor first thing in the morning. After a night’s sleep, urine is more concentrated and odorous as well as brighter yellow in color.

Dehydration also increases urine concentration, causing stronger smelling urine. Have your husband try drinking more water to see if the odor lessens. Hot weather or intense physical activities can contribute to dehydration, too. Concentrated urine, without any other symptoms, generally isn’t harmful.

Diet: For some people, eating asparagus causes urine to produce a sulfur-like smell. There are no health concerns associated with this odor.

Urinary tract infection: Foul-smelling urine is a symptom of a urinary tract infection. Other symptoms are cloudy urine, an urgent need to urinate, or a burning sensation while urinating. The foul smell may be the only symptom of a urinary tract infection. With a persistent foul smell from the urine, your husband should see a physician for a urinalysis and diagnosis. A urinary tract infection needs to be treated with antibiotics to prevent kidney infection and kidney damage.

Diabetes: Strong sweet-smelling urine is a sign of advanced diabetes, which can be diagnosed with urinalysis. With advanced diabetes, sugar and ketones, which are normally absent, can accumulate in the urine and create a strong odor. According to the American Diabetes Association, an estimated 5.7 million people have undiagnosed diabetes. If the odor in your husband’s urine persists, I’d suggest he see a physician for a simple urine test.

One other consideration is urine leakage/incontinence. When this occurs, the smell may seem stronger than usual because it clings to clothing. Temporary or chronic incontinence has many possible causes.

Temporary causes can be too much fluid in the bladder. Coffee and alcohol especially can cause a sudden need to urinate and urine leakage. Dehydration and other sources of bladder irritation — carbonated drinks and spicy, sugary or acid foods — can irritate the bladder and cause leakage of urine.

Causes of chronic incontinence can involve prostate and bladder disorders, including enlargement of the prostate and a weakened bladder. If incontinence is contributing to the smell, your husband should talk with his primary care doctor to determine the cause and develop a treatment plan.

— Amy Krambeck, M.D., Urology, Mayo Clinic, Rochester, Minn.

Why does my urine smell like ammonia?

Most of the time, this occurrence is nothing to cause alarm. There are times, however, where ammonia-smelling urine indicates a health problem.


Share on PinterestDehydration from not drinking enough water can cause urine to smell like ammonia.

Dehydration can cause an ammonia smell. Dehydration occurs when someone fails to drink enough fluids or has a significant fluid loss, due to vomiting or diarrhea. Ammonia odor happens when chemicals in urine are concentrated due to a lack of water.

In addition to an ammonia-like odor, another telltale sign of dehydration is bubbles in a person’s urine. And if someone is dehydrated, their urine is dark honey or brown color, rather than a pale yellow or gold.

Urinary tract infections

According to research from Washington University School of Medicine in St. Louis, Missouri, urinary tract infections or UTIs are the most common bacterial infections worldwide, affecting up to 150 million people each year.

Additional figures for the United States include 10.5 million doctor visits and up to 3 million emergency room visits for UTI symptoms.

UTIs tend to affect women and girls more, but men and boys can also develop UTIs. These infections are the result of bacteria entering the urinary tract. The bacteria make urine smell unpleasant and cause it to be cloudy or bloody.


Share on PinterestPregnancy can sometimes cause ammonia-smelling urine.

Pregnant women have a higher risk than others for UTIs, which increases their chances of having ammonia-smelling urine. One report from the U.S. Centers for Disease Control and Prevention (CDC) finds up to 8 percent of pregnant women experience UTIs.

UTIs can cause serious pregnancy complications, including premature labor, low birth weight, and sepsis infections. Hence, pregnant women should let their doctors know if they experience unpleasant-smelling urine, especially if the smell resembles ammonia.

Pregnancy vitamins can also create a smell of ammonia in the urine. Smelly urine from taking vitamins usually goes away after a short time.

In the absence of other symptoms, such as pain with urination, cloudy or dark urine color, or unusual frequency of urination, there is usually little reason for concern. But reccurring ammonia odor in pregnancy should still be brought to a doctor’s attention.


Menopause can also increase a woman’s risk for UTIs and ammonia-smelling odor, resulting from drops in the female hormone estrogen and loss of vaginal flora, which are the normal and healthy bacteria living in the vagina. Both these changes may cause ammonia-smelling urine.

A further possibility is diet changes during menopause, which can cause an ammonia odor.


Diet is the most common cause of ammonia-smelling urine in all people. Certain foods, medications, and vitamins can cause changes in urine smell and color.

Asparagus is commonly linked with an ammonia smell, as are large amounts of vitamin B-6. Similarly, foods high in protein can increase urine’s acidic properties and cause it to have an ammonia smell.

When diet is the cause of ammonia-smelling urine, the odor disappears once a person eliminates food triggers from their diet. Odor caused by something a person has eaten is usually nothing to worry about.

Kidney or bladder stones

Anyone who develops kidney or bladder stones may experience ammonia-smelling urine.

When stones pass through the urinary tract, the risk for UTIs increases and they can cause urine to have an ammonia smell.

Kidney disease

Kidney disease causes chemicals in urine to become concentrated and to cause a smell resembling ammonia. Kidney dysfunction can also cause high bacteria and protein levels in the urine, which will contribute to a foul, ammonia smell.

Liver disease

The liver, similarly to the kidneys, is responsible for removing toxins from the body and helping it to digest food. Infections and diseases of the liver can produce high levels of ammonia in the urine and the accompanying pungent odor.

Ammonia levels in blood and urine will increase when the liver is not working the way it should. Any continued ammonia odor in urine should be checked by a doctor.


Your child’s stinky urine may be more than just unpleasant: A new study suggests kids with terrible smelling urine should be checked for a urinary tract infection.

According to researchers, only a handful of studies have looked at stinky urine and whether it was a symptom of a urinary tract infection (UTI), but the results were mixed.

“I didn’t believe it was that reliable,” said Dr. Marie Gauthier, the study’s lead author from CHU Sainte-Justine in Montreal.

According to the results of Gauthier’s study, it may not be.

The new study is based on 331 children between the ages of one and 36 months, who were suspected of having a UTI and had a urine test at the emergency room between August 2009 and April 2011.

The parents or people who brought the child into the ER filled out a questionnaire about the child’s medical history and questions about what happened over the previous two days, such as if the child took antibiotics and if their urine smelled “offensive” or “stronger than usual.”

Overall, 51 kids — about 15 percent — were diagnosed with a UTI. The parents of about 57 percent of those said their children had stinky urine over the previous two days — enough to show a link.

But, 32 percent of the parents of children who didn’t have UTIs also reported stinky urine.

“It is associated with a urine infection, but the association isn’t that strong,” Gauthier told Reuters Health. “To have stinky urine in itself isn’t proof of urine infection. Not at all.”

The researchers write in the journal Pediatrics it could still be useful for doctors and nurses to ask about a child’s urine odor if they suspect a UTI.

The researchers also found that girls were more likely to have UTIs, as were kids who suffered from a condition in which urine flowed backward from their bladder into their upper urinary tract.

Even after accounting for those kids, the researchers said stinky urine was still linked to being diagnosed with a UTI.

While the study could not say why the urine of those with a UTI was stinky, the researchers write that it might be from bacteria.

As for the stinky urine of children without a UTI, Gauthier said it could be from dehydrated kids whose urine is concentrated even though they did not find a link between the two.

Watch out for a fever

The researchers note that their study did have some limitations. Specifically, the presence of stinky urine was reported by the parents and “offensive” or “stronger” smells may mean different things to different people. The number of kids with a UTI was also small, and the study lacked a control group.

Dr. Nader Shaikh, a professor in the department of pediatrics at University of Pittsburgh School of Medicine in Pennsylvania, told Reuters Health that parents should watch if their children have a fever.

“The main thing to watch out for is a fever. That can be the only sign of a urinary tract infection,” said Shaikh, who was not involved with the new study. He added that children with stinky urine should also be checked.

As Gauthier pointed out, although they determined the evidence is not strong enough to use urine smell as a way to diagnose UTIs, “If the urine is stinky, the risk of having a urine infection is a little bit higher.”

Smelly Urine a Red Flag for Kids’ UTI

MONDAY, April 2, 2012 (HealthDay News) — When parents say their child’s urine smells bad, doctors should test for a urinary tract infection, Canadian researchers report.

To examine the link between smelly urine and urinary tract infections (UTIs), researchers from Sainte-Justine University Hospital Center at the University of Montreal surveyed the parents of 331 children ranging in age from 1 month to 3 years who were tested in the emergency room for a suspected UTI.

The study revealed smelly urine was the risk factor most strongly linked to UTI — 57 percent of the children who tested positive for a UTI had smelly urine, while only 32 percent of children who tested negative did.

Although stinky urine increases the likelihood that a child has a UTI, the researchers admitted that this symptom alone isn’t enough to make a diagnosis.

The findings were published online April 2 in the May 2012 issue of the journal Pediatrics.

Pediatricians agreed that stinky urine may be one of the few signs that a young child has a UTI.

“UTIs in children can present in several different ways depending on the age of the child,” said Dr. Estevan Garcia, director of pediatric emergency medicine at Maimonides Medical Center in New York City. “Young children do not often complain of pain or burning when they urinate. UTIs are especially difficult to diagnose in very young infants, where fever may be the only symptom.”

Dr. Roya Samuels, a pediatrician at Cohen Children’s Medical Center in New Hyde Park, N.Y., said: “Although associated with UTIs in this study, malodorous urine may also be associated with an array of noninfectious causes, including dehydration or the consumption of certain foods, medications or vitamins.

“Clinical decision-making rules regarding UTIs in children do not include taking into account parental reports regarding the smell of a child’s urine,” Samuels added. “This study suggests that perhaps urine odor be included in the diagnostic algorithm for UTIs in young children with fever of unknown source.”

UTIs in Children: How Can I Tell if My Child Has a Urinary Tract Infection?

According to, about 8 percent of girls and 2 percent of boys will have at least one UTI, or urinary tract infection, during childhood. UTIs happen when bacteria gets in the urine by way of bloodstream or skin around the genitals. This can create an infection and inflammation of the urinary tract.

If your kids are older than 4-years old, they can probably describe what they are feeling when they’re in pain or uncomfortable. But for babies that cannot talk or toddlers who are just learning to put sentences together, how can you very well pinpoint what is wrong with them when it can be so many different things? And if you’ve never dealt with a urinary tract infection (UTI) before, you probably don’t know what signs to look out for.

So here’s what you should check for to determine if your child should see a doctor:

Most Obvious Symptoms of Urinary Tract Infections (UTIs) in Babies or Toddlers

  1. Most Obvious Symptoms of a Urinary Tract Infection in Babies or Toddlers
    1. Odd-smelling Urine: The most obvious symptom of a UTI is odd-smelling urine. The foul odor comes from the bacteria that has entered into the urinary tract. For babies and toddlers, do a smell check of their diaper to see if the urine smells different than normal. Not all babies or children will have odd-smelling urine during a urinary tract infection but you can’t miss it if it happens to them.
    1. Cloudy or Bloody Urine: Hematuria, or blood in the urine, is fairly common and UTIs and typically doesn’t signify anything serious unless an infection has gone untreated for an extended amount of time. Bloody urine will be a lot easier to spot on a diaper than cloudy urine but sometimes the blood is so microscopic that only a urine test will detect it.

    Other Telltale Symptoms of Urinary Tract Infections

    1. Fever: Not all babies with a UTI have a fever, and for some babies, fever is the only symptom they’ll show with a UTI. The rule of thumb is that if the fever reaches above 100.4 for a baby under 3 months, 101 for a 3-6 month old, or 103 for babies and children 6 months or older, you should seek medical advice. Even if your baby or toddler has a low-grade fever that won’t go away, you should take them to see a doctor for testing. Vomiting, loss of appetite, and diarrhea may also accompany a UTI but these symptoms can be mistaken for a variety of illnesses.
    1. Crying or Unexplained Irritability: Babies cry for many reasons so it’s hard to tell sometimes why they are crying especially for first time moms. Are they just wanting to be held? Or are they in pain from colic, constipation, or a urinary tract infection? When you’ve covered all the possibilities within your control – fed them, changed them, burped them, made sure they’re not too hot or cold – watch to see how often they have bouts of irritability. The good news is that UTIs are usually easy to treat but can cause permanent kidney failure and damage if left untreated. So if your child has any of the above symptoms or other unusual symptoms, it’s best to have them seen and tested by a medical professional. You can take your child to an ER clinic for urgent care and attention, especially if it’s after hours, and you cannot see your pediatrician.A UTI is most painful during urination. If you notice sporadic fussiness and irritability, monitor your child while they urinate. Some toddlers can respond if you ask them if it hurts when they go potty. For babies, it’ll be a little harder and may take a little longer to assess. Take their diaper off, and watch for their next urination. If they cry or look like they are in pain, take them to the doctor immediately.

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