Blood in the urine: Urine may appear pink, red, or brown. Sometimes blood is visible only under laboratory examination.
Painful urination: A child may complain of burning or discomfort when passing urine.
Frequent or urgent urination: Stones near the bladder may cause a repeated urge to urinate.
Nausea and vomiting: Severe pain can trigger nausea, and some children may vomit repeatedly.
Fever or chills: These symptoms can indicate infection. When combined with suspected urinary obstruction, they require urgent medical assessment.
Difficulty passing urine: A significant reduction in urine output or inability to urinate may indicate obstruction or another serious problem.
Not every episode of abdominal pain indicates kidney stones. Constipation, gastrointestinal infections, appendicitis, and other conditions can cause similar symptoms.
Parents should not attempt to diagnose stones based solely on a child's description of pain.
Seek urgent medical care if a child has fever with severe side or back pain, persistent vomiting, visible blood in the urine with significant symptoms, difficulty urinating, or severe worsening abdominal pain.
A child who cannot keep fluids down or appears unusually sleepy, weak, or seriously unwell also needs prompt evaluation.
How Doctors Diagnose Kidney Stones in Children
The diagnostic process usually begins with a medical history and physical examination.
Doctors may ask when the symptoms began, where the pain occurs, whether the child has experienced previous episodes, and whether there is a family history of kidney stones.
They may also ask about daily fluid intake, dietary habits, medications, previous urinary infections, and other medical conditions.
Urine testing
Urinalysis can help identify blood, infection, crystals, and other abnormalities.
Depending on the findings, a urine culture may be performed to determine whether bacteria are present.
Some children also need more detailed urine testing to assess calcium, oxalate, citrate, uric acid, and other substances associated with stone formation.
For recurrent stones or suspected metabolic disorders, doctors may recommend a 24-hour urine collection when the child is old enough and it is practical to obtain a reliable sample.
Blood testing
Blood tests may evaluate kidney function, calcium levels, electrolytes, uric acid, and other indicators of metabolic health.
The exact tests depend on the child's symptoms and medical history.
Imaging
Ultrasound is often the preferred initial imaging examination for children because it does not involve ionizing radiation.
It can identify many kidney and bladder stones and may reveal swelling associated with urinary obstruction.
However, ultrasound does not detect every stone. If the results are inconclusive and clinical suspicion remains high, a doctor may consider additional imaging, sometimes including a low-dose CT scan when justified.
The choice depends on the child's circumstances and the need to balance diagnostic accuracy with radiation exposure.
Stone analysis
If a child passes a stone or a stone is removed during a procedure, laboratory analysis can help determine its composition.
This information is valuable because different stone types may require different prevention strategies.
For children with recurrent or multiple stones, identifying the underlying cause is often as important as treating the immediate episode.
How Are Kidney Stones Treated in Children?
Treatment depends on stone size, location, composition, symptoms, urinary obstruction, infection, and the child's overall health.
There is no single treatment appropriate for every child.
Observation and supportive care
Some small stones can pass naturally through the urinary tract.
When a doctor determines that observation is safe, treatment may include appropriate fluids, pain management, monitoring, and follow-up imaging.
Parents should follow the clinician's instructions rather than trying to force a child to drink excessive amounts of water in an attempt to push a stone out.
Pain medicines should be selected according to the child's age, weight, medical history, hydration status, and kidney function. Not every over-the-counter medicine is suitable for every child.
Medical expulsive therapy
In selected cases, doctors may prescribe medication intended to help a stone pass more easily.
The decision depends on the stone's location and size, the child's age, and the potential benefits and risks.
These medicines should never be given to a child without professional guidance.
Shock wave lithotripsy
Extracorporeal shock wave lithotripsy uses externally generated shock waves to break certain stones into smaller fragments.
The fragments can then pass through the urinary tract.
Whether this approach is suitable depends on factors such as stone size, location, composition, and the child's anatomy.
Not all stones respond equally well, and some children require additional treatment.
Ureteroscopy
Ureteroscopy involves passing a small instrument through the urinary tract to locate and treat a stone.
Depending on the situation, the stone may be removed with specialized instruments or fragmented using a laser.
The procedure may be considered when a stone is unlikely to pass naturally, causes significant symptoms, or requires intervention for another reason.
Percutaneous procedures and surgery
Large or complex stones may require a procedure that accesses the kidney through a small incision in the back.
Open surgery is now less common for routine kidney stone treatment, but surgical approaches may occasionally be necessary in unusual or complicated cases.
If a stone is associated with an infected, obstructed urinary system, urgent treatment may be needed to drain the kidney and control the infection before definitive stone removal.
The priority is always to protect the child's health and preserve kidney function.
What Happens After a Child Passes or Has a Stone Removed?
Treatment does not always end when the stone is gone.
Children who develop urinary stones may have a higher risk of recurrence, particularly if the underlying cause remains unidentified or untreated.
Follow-up allows doctors to assess whether the urinary tract has recovered, whether additional stones remain, and whether preventive treatment is working.
Depending on the circumstances, follow-up may include repeat ultrasound, urine tests, blood tests, and a review of the child's fluid intake and diet.
If stone analysis identifies a particular composition, a pediatric specialist or dietitian may recommend targeted changes.
For example, a child with excessive urinary calcium may benefit from reducing excessive sodium while maintaining appropriate dietary calcium.
A child with low urinary citrate may need further assessment and, in selected cases, medication.
Children with inherited metabolic conditions may require long-term monitoring and more individualized management.