Treatment & Care
Knowing that your child is suffering from kidney stones can be upsetting. But you can rest assured that you’re in the right place. At Children’s Hospital Boston, we’re known for our science-driven approach—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—but our physicians never forget that your child is a child, and not just another patient.
How are kidney stones treated?
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.
What if my child can’t pass the stone himself?
Sometimes it is necessary to remove the stones if warranted by your child's condition and symptoms. It also makes sense sometimes to remove 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)
- percutaneous nephrolithotomy (PCNL)
- open stone surgery
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, over about 20 minutes. 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. In older children, sedation can be used to control discomfort, but in small children, 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. 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.
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.
Open stone surgery
Years ago, almost all stones required open surgery for removal. With advances in technology, however, most stones can now be treated with a less invasive approach, but open stone surgery is still needed occasionally in children with unusual anatomy or other specific conditions.
How do I make sure my child doesn't get more stones?
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:
- detailed questions about your child's medical history, diet and fluid intake
review of current prescribed and over-the-counter medications
- Please be sure to bring a detailed list of all of your child’s medications, including over-the-counter medications. If it’s more convenient, you may bring the medications themselves instead of making a list.
- physical exam
- a urine test to look for factors that contribute to stone formation, such as increased levels of calcium in the urine
- blood tests to look for other risk factors
analysis of the stone (once it is passed or removed) to identify its composition, which can provide important clues about why it formed.
- If your child passes a stone, try to recover it, place it in a plastic bag and bring it to your appointment so that we can send it out for chemical analysis.
- questions about family history, since some inherited disorders can increase the risk of kidney stones
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.
Here’s a list of some basic things you can do to decrease your child’s chances of developing kidney stones:
Encourage your child to drink plenty of water, not only when he is thirsty, but 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 his urine; if it’s clear, he’s adequately hydrated, but if it’s yellow, he’s 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 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.
What kind of treatment plan will the doctor prescribe?
It varies based on the cause of the stones, but some common ingredients are listed below:
- Your child's doctor will 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.
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.
After a child has his first stone and we've completed our initial evaluation, we like to see her twice a year. We check to see how she's drinking, monitor her symptoms and do follow-up urine and blood tests. We also check for development of new stones by follow-up ultrasound.
Coping and support
We understand that you may have a lot of questions when your child is diagnosed with kidney stones. Will these stones go away on their own? What do we do next? We’ve tried to provide some answers to those questions in the following pages, but there are also a number of other resources to help you and your family through this time.
Patient education: From your first office visit through the entire diagnosis and treatment process, our nurses will be available to help answer any questions you may have. They will also reach out to you by phone, continuing the care and support you received while at Children’s.
Parent to parent: Want to talk with someone whose child has been treated for kidney stones? We may be able to put you in touch with other families whose children have been treated at Children’s.
Social work: Our clinical social workers have helped many other families in your situation. Your social worker can offer counseling and assistance with issues such as coping with your child’s diagnosis, stresses relating to coping with illness and dealing with financial difficulties.
Visit our For Patients and Families site for all you need to know about:
- Getting to Children’s
- Navigating the hospital experience
- Other resources that are available for your family
|Center for Patients and Families|
When you’re at the hospital, we encourage you to visit our Children’s Center for Families, which is dedicated to helping families locate the information and resources they need to better understand their child’s particular condition and take part in their care. All patients, families and health professionals are welcome to use the Center’s services at no extra cost. The center is open Monday through Friday from 8 a.m. to 7 p.m., and on Saturdays from 9 a.m. to 1 p.m. Please call 617-355-6279 for more information.