1 Does your child find passing urine painful?

2 Does your child's penis or vulva look red and/or sore?

3 Does your child have any of the following, with or without a fever?

• Frequent passing of small amounts of urine
• Bedwetting or daytime accidents after being dry
• Offensive-smelling or cloudy urine

4 Is your child passing more urine than usual?

5 Does your child have one or more of the following?

• Unexplained weight loss
• Increased thirst
• Excessive tiredness

6 Is your child a boy, and does his foreskin balloon when he passes urine?

7 Is your child's urine discoloured?

8 Does your child have problems with bladder control?

9 Does your child regularly wet himself or herself during the day and/or at night?

10 Is your child reluctant or unable to pass urine?

11 Is your child excited, anxious, or cold?

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Possible causes Any condition that causes inflamed skin in the genital area can result in pain when passing urine. The pain is due to urine coming into contact with the inflamed skin. In babies and children who are not yet toilet trained, nappy rash is the commonest cause of inflamed skin. In older children, a fungal skin infection or, in girls, a vulval infection with thrush, may be the cause.

Action Try self-help measures for relieving nappy rash if your child has not yet been toilet trained. If passing urine is still painful once the skin has healed or if your child is toilet trained, consult your doctor.

13 See your doctor within 24 hours

Possible cause Your child may have a urinary tract infection.

Action If possible, collect a sample of your child's urine in a clean container, and take it to your doctor for him or her to test. If the result indicates that an infection is likely, a urine sample will be sent to a laboratory for analysis to confirm the diagnosis. Meanwhile, your child will be started on antibiotics. In some cases, further tests, such as ultrasound scanning (see Investigating the urinary tract in children), may be needed to look for any associated problems.

14 See your doctor within 24 hours

Possible cause Diabetes mellitus is a possible cause of these symptoms. It is caused by insufficient production of the hormone insulin, which is needed by the body to get energy from sugar and carbohydrate foods.

Action Your doctor will take a blood sample to check your child's blood sugar level. If the diagnosis of diabetes is confirmed, you will be given advice on your child's diet and lifestyle (see Diabetes mellitus). Your child will also need to have drug treatment with insulin injections for the rest of his or her life.

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Possible cause Your child may have phimosis, in which the opening in the foreskin is too small.

go to Genital problems in boys

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Possible causes and action Some foods, such as beetroot, and some drugs may change the colour of your child's urine. Rarely, however, a change in urine colour is a sign of liver or kidney disease or is due to blood in the urine. If you cannot identify a dietary cause for the change, consult your doctor, taking a urine sample with you. Your doctor will test the urine for the presence of abnormal substances, including blood.

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18 Call your doctor now

Possible causes Local soreness or severe constipation are possible causes. In some cases, a urinary infection may be causing pain on passing urine, and your child may be reluctant to try to pass urine again. A child who feels a strong urge to pass urine but is unable to do so needs urgent medical help.

Action Your doctor will examine your child to try to establish the cause of the problem. He or she may suggest painkillers and suggest you encourage your child to pass urine while he or she is in a warm bath. If this fails, your child may need hospital admission.

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Possible cause and action It is normal to need to pass urine more frequently in times of excitement or anxiety or when exposed to cold temperatures. If your child continues to pass urine frequently after his or her situation returns to normal, consult your doctor.

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Consult your doctor if you are unable to make a diagnosis from this chart.

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Consult your doctor if you are unable to make a diagnosis from this chart.

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Consult your doctor if you are unable to make a diagnosis from this chart.