Pediatric Bladder Health

Keeping a child’s bladder healthy and functioning with paralysis maintains urinary health for a lifetime. A bladder program maintains the natural bladder function as well as keeping the kidneys healthy. Neurogenic bladder function is an inability of the nerves to carry messages to and from the brain and body. It is found in issues such as brain injury or spinal cord injury either from disease or trauma, spina bifida, tethered cord, vascular insults, tumors, transverse myelitis, cerebral palsy, stroke, and tumors among others.

male child laughing in wheelchair with caregiver

Kidneys create urine by filtering blood. There is no room for storage of urine in the kidney, it is a processing organ. The bladder is the body organ that stores urine waiting to be excreted. Urine backing up into the kidney causes damage. Therefore, protecting the kidneys is critically important.

Bladder capacity varies by child. A formula for the general storing capacity of urine is:

In children less than two years: 2 X age (in years) + 2 = capacity (ounces)

In children two years and older: Age (years) divided by 2 + 6 = capacity (ounces)

For the lower urinary tract to work, the bladder and sphincter need to work together. The four most common issues with the bladder muscle and urinary sphincter are:

Bladder Sphincter Misalignment Symptoms
Bladder overactive/Sphincter overactive (Diagnosed as Detrusor/Sphincter Dyssynergia) Frequency, small volumes, incontinence, bladder elasticity loss, urine can back up into the kidneys resulting in damage, urinary tract infections.
Bladder overactive/Sphincter underactive Frequency, incontinence, urine can back up into the kidneys resulting in damage
Bladder underactive/Sphincter overactive Overflow incontinence (some urine is leaked but the bladder does not empty), bladder muscle becomes ineffective, urine can back up into the kidneys resulting in damage, urinary tract infections 
Bladder underactive/Sphincter underactive Constant incontinence, urinary tract infections


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A bladder program using intermittent catheterization is used to treat neurogenic bladder. For some children, a suprapubic indwelling catheter may be needed to avoid autonomic dysreflexia (AD) and other health issues. Children and parents may elect to have a surgical procedure called Mitrofanoff where a connection to the bladder is made through the belly button. This makes it easier to catheterize independently, especially for girls.

If a neurogenic bladder is present at birth, a bladder program is immediately established. Overflow incontinence should not be confused with emptying the bladder. Significant damage to the kidneys can occur with the postponement of initiating a bladder program. As children age, a plan should be put into place to transition catheterization responsibilities from the adult to the child. Begin by explaining what you are doing in simple terms. When able, have the child gather supplies, then have them watch what you are doing, followed by the child instructing you about the next step. When hand control is gained, have the child do the cleaning and removal of the catheter. Eventually, they should place the catheter themselves. Be flexible with the plan as you want your child to master a step before moving ahead. Some children will be able to catheterize by school age, others may not until ages eight or nine. It is not a goal of who gets their first but mastery of the process.

Other supports for bladder function may be recommended. Review fluid intake to avoid sugary drinks, caffeine, and alcohol. Be sure the bowel program is timely completed to allow complete bladder emptying. Medications may be used to assist with bladder and/or sphincter contraction or relaxation. Botox injections can help reduce tone/spasticity in the bladder and/or sphincter. Surgical augmentation to increase bladder and outlet resistance may be considered as needed.

It can be challenging for an adult to relinquish catheterizing duty to a child. However, this is a process that is normal for your child. Teaching them independence in toileting is a part of growing up. It will keep their kidneys in good function through adulthood. 

About the Author - Nurse Linda

Linda Schultz, Ph.D., CRRN is a leader, teacher, and provider of rehabilitation nursing for over 30 years. In fact, Nurse Linda worked closely with Christopher Reeve on his recovery and has been advocating for the Reeve Foundation ever since.

Nurse Linda

The opinions expressed in these blogs are the author's own and do not necessarily reflect the views of the Christopher & Dana Reeve Foundation.

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $10,000,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, ACL/HHS, or the U.S. Government.