Aleece Fosnight, PA-C, discusses bladder control issues and associations with food

Aleece Fosnight, PA-C

According to Johns Hopkins Medicine, urinary incontinence, or enuresis, is a normal occurrence in children aged 3 years and younger. As a child gets older, they become more able to control their bladder, though problems can arise if wetting persists as girls reach age 5 years and older, and boys reach age 6 years and older, when enuresis is typically diagnosed in each sex.¹

Enuresis can be caused by multiple factors, such as anxiety, ADHD, diabetes, constipation, and more. There are factors that can worsen incontinence issues, such as certain foods, the subject of this Q+A interview.

Below, Aleece Fosnight, PA-C, an urology specialist at Aeroflow Urology—a provider of incontinence supplies via insurance—breaks down what typical childhood foods may lead to further incontinence issues as well as what foods can be more bladder-friendly.²

Contemporary Pediatrics:

Can you provide some prevention information related to the pediatric population when it comes to bladder issues and bladder control, especially as we get into a new school year and as children consider certain foods for lunches? What can providers relay to parents of children with bladder issues?

Aleece Fosnight, PA-C:

Great question! Hydration is always my go to when thinking about bladder support especially during the school year when access to water or a water break may be limited. Bringing a water bottle (20-24oz) to school and encouraging regular water intake throughout the day - small sips on the hour vs large amounts all at once - is a better strategy. Encourage the child to fill up that water bottle at least once during the day. Invite teachers into the conversation so that they can support your child as well. Think about a morning hydration boost. Start the day with a glass of water (8oz) to prevent concentrated urine. Limit bladder irritants such as sodas, energy drinks, artificially flavored waters, tea, coffee, and juices (especially citrus like orange juice). Avoid caffeinated beverages as well.

For bathroom routines, consider timed voiding every 2-3 hours and not rushing during their bathroom break. Bring in school advocacy and remind the school administration that children should be allowed bathroom breaks outside of scheduled times. Communication is key here with every teacher that your child has. Remember that constipation can worsen bladder symptoms so include fiber-rich foods in lunches. This can include whole grain bread/wraps, fresh vegetables, low-acid fruits, cheese or yogurt, and lean proteins, like turkey, chicken, or hummus. Limit foods high in acid content (pineapple, citrus, tomatoes), any foods with added spicy flavoring, processed meats or other foods, and artificial sweeteners. Movement is another great way to avoid constipation so ensure that your child has access to recess or physical education daily.

Contemporary Pediatrics:

What are some common child foods that are associated with bladder issues in children that providers can tell their patients or parents to watch out for?

Fosnight:

Foods that are ultra-processed and have a high-salt content (potato chips, pretzels, crackers, lunch meats, jerky, pepperoni). Again, avoid caffeinated foods and beverages such as chocolate, tea, sodas. Carbonated beverages can also irritate the bladder. Highly acidic foods and beverages such as citrus (lemons, limes, oranges, grapefruit - this also includes juice or lemonade), tomato-based foods (pizza sauce, spaghetti sauce, ketchup, salsa) can also irritate the bladder. Avoid artificial sweeteners - think about aspartame, sucralose, and saccharin. Remember that not all children will have bladder irritation with these foods. Consider keeping a food and symptom diary for a few weeks to determine if certain foods or beverages consistently trigger bladder symptoms. I also like to consider moderation rather than elimination unless symptoms are very severe with an associated food or beverage.

Contemporary Pediatrics:

What clinical pearls would you like providers to walk away with when it comes to bladder control in the primary setting, and are there certain foods parents should avoid altogether?

Fosnight:

Constipation is the major driver of pediatric urinary urgency, frequency, and incontinence. You have to treat the bowel alongside bladder symptoms in order to have a holistic impact on pelvic health for the child. Consider a referral to a pediatric/adolescent pelvic floor therapist. Remember the importance of hydration quality over quantity. Many children skip water/beverages during the day in order to skip bathroom breaks and then "power drink" after school. This pattern increases concentrated urine during the day leading to bladder irritation.

Please encourage steady sipping throughout the day. Unfortunately, many school bathroom policies restrict access to using the restroom on an intuitive schedule. This can cause dysfunctional voiding, even for bowel movements. Counsel parents to advocate on timed voiding every 2-3 hours during school hours and more often for individual bladder needs. Don't forget to screen for comorbidities such as ADHD, anxiety, sleep apnea, learning differences, and other mental health concerns as these are often associated with urinary conditions.

Bladder diaries are also a simple way to record symptoms and food/beverage triggers. Record 2-3 days of information to see if there are any patterns or trends. Normalize the conversation and reduce shame by framing bladder control as a body-signal regulation skill, not a behavioral failure. School routines should include morning voiding, packing a reusable water bottle, and pre-recess bathroom breaks.

Contemporary Pediatrics:

It is well known that food and diet can have a direct input on the day to day, but what direct associations are there between food choices and outcomes whether related to school, attitude, or confidence?

Fosnight:

Another great question! Blood sugar stability is key. Remember to have a balanced meal with protein, complex carbohydrates, and healthy fats to support steady glucose throughout the day. This will help with sustained attention, memory recall, and problem solving. High-sugar or refined carbohydrate meals or snacks cause rapid glucose spikes and crashes leading to fatigue, distractibility, irritability, and other behavioral concerns. Consider iron-rich foods, like lean meats, beans, and spinach, which are essential for oxygen delivery to the brain. Interesting fact, low iron is linked to decreased attention and processing speed. Omega-3-fatty acids improve neural signaling and may support reading and behavior. Again, hydration is important as dehydration can cause headaches, fatigue and a "grumpy" attitude.

Children with regular, comfortable bathroom habits are also more likely to participate in recess, sports, and group activities without bladder worry. They are also more likely to build supportive peer relationships and boost self-esteem with lunches packed with bladder-friendly, energy-sustaining foods.

Contemporary Pediatrics:

Is there anything you would like to include?

Fosnight:

Balance over perfection. Being overly restrictive with diets can create food anxiety, social isolation at lunch, nutritional gaps, and can even lead to disordered eating. The goal is to identify and minimize triggers while still allowing children to enjoy a variety of foods and still participate in social eating situations. Empower your children to speak up when they have bladder and/or bowel needs and encourage parents to advocate for their children.

References:

1. Urinary Incontinence in Children. Johns Hopkins Medicine. Accessed August 15, 2025. https://www.hopkinsmedicine.org/health/conditions-and-diseases/urinary-incontinence/urinary-incontinence-in-children
2. About us. Aeroflow Urology. Accessed August 15, 2025. https://aeroflowurology.com/about-aeroflow-urology