Kidney stones are possible even in very young children
You might not expect to see kidney stones in an 8-year-old, but Stephanie Sallee, RN, CPEN, an ED nurse at St. Louis Children's Hospital says to "never say never."
Children are coming to EDs with kidney stones at younger ages, says Sallee, who recently cared for a 9-year-old with a recurrence of kidney stones. "She came to us because her pain got so severe," says Sallee. "When she arrived, she was moving back and forth on the bed moaning. Over the course of a couple hours and a couple doses of morphine, she was much better and was admitted for pain management."
At Children's Hospital of Pittsburgh's ED, Michael C. Ost, MD, reports, "We are seeing a tremendous rise in the incidence and prevalence of pediatric stone disease." Ost is an associate professor of urology at the University of Pittsburgh School of Medicine.
According to Susan Byrd, RN, BSN, nurse manager of the emergency/trauma center at St. Joseph's Children's Hospital in Tampa, FL, "we have seen a small increase in the number of school-age children with kidney stones. The definitive reason for this increase is unknown. We suspect it may be related to the increase in soft drink consumption and the decrease in water consumption in children."
What is the cause?
Ost says while a direct etiology has not been found or proven, most experts believe the trend is due to high-salt diets and processed foods. "The negative effect of these foods is compounded by the high sugar content in many of the popular beverages that are consumed by children," he says.
A big red flag is a child who can't be distracted, says Sallee. "Most kids can handle aches and pains. With kidney stones, often the pain is so different and significant that they really can't cope. Their discomfort is obvious," she says. "Is the child more focused on the cartoon on TV than the pain? Can they run around after they rate their pain a level of 10, or are they walking around bent over?"
Look for hematuria, abdominal or back pain, pallor, fever, or just severe discomfort, says Sallee. "Kids are notorious for having random episodes of abdominal pain, frequently without cause," says Sallee. "Most kids point to their belly button as the source of pain. When it starts moving to other areas of the abdomen is when I start getting curious about other causes like appendicitis or kidney stones."
Symptoms may differ from adults
Children with kidney stores may not have "classic" signs and symptoms seen in adults, such as severe colicky flank pain, says Elaine Beardsley, MN, RN, CPEN, ED clinical nurse specialist at Seattle Children's Hospital. "It can present as vague abdominal pain, or signs of a urinary tract infection," she says.
Ask these questions at triage, she says: When did the symptoms begin? What is the location, intensity, and duration of the pain? Has there been blood in the urine? Does the child have any previous history of urinary tract infection or kidney stones? Does the child have fever or dysuria? Has anything been done at home to relieve the pain?
Beardsley recently cared for a 14-year-old with crampy, intermittent abdominal pain that radiated to the side, with nausea and vomiting. She did not fit the classic presentation of appendicitis or pyelonephritis because she had no fever, so kidney stones were considered as a differential. "We gave her morphine for pain, which helped for about one hour," says Beardsley. "Her urinalysis showed hematuria, and she had an ultrasound initially, then a CT. She was diagnosed with kidney stones."
Beardsley also cared for a school-age child who presented with generalized abdominal pain, dysuria, and nausea and vomiting with hematuria. "Pain was constant," says Beardsley. "The ED resident ordered labs to rule out appendicitis. The urinalysis showed hematuria, and a CT diagnosed kidney stones."
Sources
For more information on caring for children with kidney stones, contact:
- Elaine Beardsley, MN, RN, CPEN, Clinical Nurse Specialist, Emergency Department, Seattle (WA) Children's Hospital. Phone: (206) 987-4590. E-mail: [email protected].
- Michael C. Ost, MD, Division of Pediatric Urology, The Children's Hospital of Pittsburgh (PA). Phone: (412) 692-7932. Fax: (412) 692-7939. E-mail: [email protected].
- Stephanie Sallee, RN, CPEN, Emergency Unit, St. Louis Children's Hospital. Phone: (314) 454-2280. Fax: (314) 454-2110. E-mail: [email protected].
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