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There are many ways you can help children and their families get the care they need.
Knowing that your child is suffering from kidney stones can be extremely upsetting, but rest assured you're in the right place. At Boston Children's Hospital, we're known for our science-driven approach to care. We’re home to the most extensive research enterprise located in a pediatric hospital in the world, and we've partnered with a number of top biotech and health care organizations to provide the best care for your child.
The best treatment will depend on the size, location, number and composition of your child's stone(s). In many cases, stones can be passed spontaneously without any treatment—in fact, children can pass stones that are relatively large compared to those that adults can pass.
Your child's doctors may prescribe certain medications that have been shown to increase the chance of a stone passing spontaneously.
Sometimes it is necessary to remove the stones if warranted by your child's condition and symptoms. We may also consider removing a growing stone even if it is causing no symptoms, rather than waiting until it is very large.
The choice of technique depends upon the location, size and type of stone, as well as your child's anatomy. Methods include the following, which are further described below:
Extracorporeal shock wave lithotripsy (ESWL) is the most common and least invasive way of treating stones. ESWL uses a special machine called a “lithotripter” to send shock waves through the skin into your child's body.
The lithotripter focuses the shock waves at the precise point where the stone is located, in much the same way that a magnifying lens can focus sunlight to create intense heat. This causes the stone to break into small fragments. Many shock waves are applied slowly, often several thousand. This may take up to an hour. The pieces will then pass in the urine over the following days.
When the shock waves enter the skin, they are not focused, so they do no damage to the skin or internal organs. However, there can be some discomfort with this procedure, and it is very important that the child remain still during the procedure so that the shock waves can be accurately targeted. For this reason, general anesthesia is used.
After treatment, it may take up to three months for all fragments to pass, depending upon the position of the stone. The overall success rate of ESWL is about 85 percent. Stones in the lower pole of the kidney are less likely to pass. Very hard stones, such as those made of cystine or certain kinds of calcium stones, may not fragment very well.
This technique uses a small scope passed up through the urethra into your child's bladder, and from there up into one or both ureters (the tubes that connect the kidney with the bladder) and kidneys.
Digital cameras attached to the scope allow doctors to see the stones and remove them with a variety of specially designed instruments.
Ureteroscopy is done under general anesthesia. The success rate is very high, upwards of 95 percent. However, success rates are lower for large stones, which may require multiple treatments, and in children whose urinary anatomy makes it difficult to get the scope up to the stone.
Percutaneous nephrolithotomy (PCNL) is used to treat large kidney stones, and employs a needle that goes through the skin and into the kidney, under ultrasound or x-ray guidance.
An instrument is then passed into the kidney to allow direct examination, fragmentation and removal of the stone.
PCNL is done under general anesthesia. A kidney-drainage tube is usually left in place for two to four days. PCNL is particularly useful if your child has a hard or large stone that might not fragment with ESWL or has abnormal kidney anatomy.
A special, small-access sheath permits access to the kidney for stone removal in small children.
Years ago, almost all stones required open surgery for removal. However, with advances in technology, most stones can now be treated with a less invasive approach. Occasionally, open stone surgery is still needed in children with unusual anatomy or other specific conditions.
Effective prevention depends largely upon why the stones are forming. A metabolic evaluation of your child is necessary, in consultation with a pediatric nephrologist, to identify risk factors for stone formation.
This evaluation includes:
After this metabolic evaluation is completed, your doctor will better understand what is causing the stones — and how best to prevent your child from developing more stones. Sometimes, medications are required to help prevent future kidney stones.
Encourage your child to drink plenty of water, not only when he is thirsty, but also through the day. Keeping hydrated is extremely important. An excellent way to determine if your child is properly hydrated is by checking the color of the urine; if it's clear, he or she is adequately hydrated. If urine is yellow, he or she is dehydrated.
Many sport drinks have added sodium, so be sure to check the label before drinking them and avoid drinks with high amounts of sodium. Water is always the best way to stay hydrated and decrease your child's chances of developing stones. Citrate is generally good to have in the urine. We encourage children to drink lemonade (made with real lemon juice) because it may be a source of natural citrate.
Avoid salty foods like chips, French fries, processed meats, canned soups, prepackaged meals and high-fat items. To cut salt intake, leave the saltshaker off the kitchen table and do not add salt to food while cooking. Focus on providing a healthy diet high in fruits and vegetables, and be sure to include the recommended daily allowance of protein, calcium and vitamin D.
Exercise, exercise, exercise! Although fit children can develop kidney stones, many experts believe obesity may be related to higher incident rates. Make sure your child keeps hydrated while exercising. If there is a family history of kidney stones, pay extra attention to diet, exercise and water consumption.
Do NOT cut back on calcium in your child’s diet, unless your doctor recommends this. Many people assume that since kidney stones are made of calcium, they can reduce stone formation by reducing calcium in the diet. However, calcium is an essential nutrient (especially for children), and the body’s processing of calcium is extremely complicated, so reducing formation of calcium kidney stones is not as simple reducing calcium intake. We generally recommend our patients receive the RDA for calcium and Vitamin D in their diet. This should be discussed with your doctor.
Treatment plans are based on the cause of the stones, but your child's doctor may prescribe high fluid intake and a low-salt diet to reduce the chances of kidney stone recurrence. The nephrologist may prescribe medications to help prevent stones from forming, such as medications that lower the levels of calcium in the urine or other medications that help substances to dissolve in urine.
If your child has an inherited condition that leads to kidney stones, doctors will create an individualized plan of care based on the nature and symptoms of the disorder. These conditions include cystinuria, primary hyperoxaluria, Dent disease and other conditions that may increase stone risk.
After a child has his first stone and we've completed our initial evaluation, we like to see him twice a year. We check to see how he is drinking, monitor his symptoms and do follow-up urine and blood tests. We also check for development of new stones by follow-up ultrasound.
We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”