Beth is a two and a half-year-old toddler brought to the office by mom with a suspected bladder infection. For the past two days the child has complained of a “burning” when she urinates, and mom says there is strong odor to the urine. Whereas Beth usually voids a few times a day, now she is having to go two-to-three times an hour. Sometimes she will frantically run to the bathroom and sit on the toilet, yet only a dribble of urine will trickle out. Beth has not had a fever throughout all of this, nor has she been particularly ill.
“All I know is that I have had my share of bladder infections, and Beth is having the exact symptoms I get every time I get cystitis,” mom added with great conviction. She went on, “I actually had some antibiotics left over from her last ear infection. I almost gave them to her, but I figured you might want to do a culture or something, so I didn’t.” I thanked her for not doing so. A urine culture is a very important part of sorting out what is wrong with Beth. Even one dose of antibiotics would make a urine culture invalid. I commended her for making the correct choice.
Beth seemed in good spirits, and did not look acutely ill. Her temperature was normal as were her vital signs. Although she complained of frequent and painful urination, I looked for all possible sources for infection. Her ears were clear; her throat was not red; her heart and lungs were normal and her abdomen was soft and non-tender. She did not have any tenderness in the flanks, the area where the kidneys are located. Nor was she tender above the pubic bone, an area that may be tender with a bladder infection. The only thing I found on the examination was quite a bit of redness of the vaginal area. There was no discharge, nor was there any suggestion of trauma to the area. It appeared like a redness one would expect from irritation as opposed to infection. It certainly did not look like a yeast infection. When I showed the area to Beth’s mom, she did a double take because she had no idea it was there.
Just as I began my questioning the nurse knocked on the door, handing me the results of the urine sample they had collected from Beth before she entered the examining room. Nodding my head as I read the results, Beth’s mom anxiously asked, “Is it really bad, Doc?” I smiled and said, “No, as a matter of fact, it is completely normal. And that’s good news.”
I went on to tell her that Beth had vaginitis, a non-specific inflammation of the vaginal area that is common in girls Beth’s age, and that it is not at all serious. I did send the urine to the hospital lab for a culture to be absolutely sure there was no infection, but her urinalysis could not have been any clearer.
Vaginitis is the result of irritation and inflammation from various causes. One of the most common cause for female children and toddlers is bubble baths. Many of the bubble bath soaps are very fragrant and perfumy. They can set up a chemical irritation of the sensitive vaginal lining. Another common cause in female toddlers is incorrect wiping after going potty. They may wipe from back to front. This usually happens when first being toilet trained and, in exerting their independence, want to do it themselves.
Another cause that is very common in young females is masturbation, or exploring. This is completely normal, and should in no way be made into something that is bad. It seems that toddler girls have an uncanny knack of practicing this at the most awkward time, i.e. when the boss and his wife are over for dinner. But it is not a big deal. All one might do is, in a subtle manner, try to divert her attention by engaging her or asking for her help. “Could you please help Mommy by throwing this in the trash?”
Vaginitis is commonly seen in the summer months. This is due in great part because of the bathing suits toddles wear. A baby girl will wear her two-piece bathing suit and go in the water at the beach or in a pool. After awhile she gets out and often lies on a towel to dry off and get warm. Then she may get up and run around, playing with her friends. Back into the water. She repeats this cycle countless times a day, and this sets up a mechanical irritation of the vagina that results in the vaginitis.
Lastly, in discussing causes of vaginitis, one must always mention pinworms which is probably the most common parasite in the United States. The life cycle of the pinworm involves a stage whereby at night, the adult female worm crawls from the lower colon onto the anal area to deposit her eggs. Some of the worms may accidentally crawl near the vaginal vault and serve as a source of irritation.
In Beth’s case it turned out that she loved bubble baths and got one almost every night. Also she was in the process of being potty trained. As she is a very independent child, she did NOT want mom to help after going potty. Mom thought this might lead to a problem. When she was able to check Beth’s bottom after the “wiping”, only half of the time did she do a good job.
Beth did not have an infection and would not need antibiotics. All that was needed was a soak in a sitz bath, a tub of warm water, for ten minutes, twice a day. Then mom must be sure that she was good and dry. One might even use a hair dryer with a cool setting to blow dry her bottom. Following this procedure mom was to apply an antibiotic ointment such as Neosporin to the reddened and inflamed areas. If everything had not resolved completely by the third day I would need to see Beth back because something would not be right. She should call the office with a report and an update in two days as the results of the urine culture would be back by then.
Again, we talked about the causes of vaginitis, and how these things could be prevented. Obviously, bubble baths are a notorious cause and, in susceptible females, these should be avoided. Children should be taught to wipe from front to back, which may often take patience and frequent reminding. It is important that this be reinforced at day care or pre-school. During the summer months when kids virtually live in their bathing suits, it would be a good idea to have a spare dry one. When the child gets out of the water she can dry off and put on another bathing suit. The wet one can be hung to dry and the two can be rotated. As for masturbation, this is very normal in young children, and should not be made into something bad or dirty. It is very easy for a parent to nonchalantly divert the child’s attention from masturbating without making it a big deal. This is the best approach. If a child has vaginitis, and the causes are not readily obvious, the doctor may want to investigate for pinworms as this surely can be the culprit, and it is easy enough to treat.
Beth’s mom was relieved that she did not have a urinary tract infection and was anxious to try the things that we had talked about. I saw the child on a Monday afternoon. By Tuesday evening Beth was completely back to normal. Her skin was perfectly clear, and her urine output was back to baseline.