Vaginal Bleeding in 7y/o

Nurses General Nursing

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Hello everyone!

I'm a first semester ADN student. My 7 y/o came home from school complaining of pain on urination, urge but inability to initiate a stream, and frequency. I immediately thought UTI and was told to bring her to the doc's office to leave a sample. The doc wasn't in, but later prescribed an antibiotic based on her symptoms, until lab results are in.

That night my daughter wet her bed and the urine was blood tinged. While bathing her the next morning I noticed blood on the washcloth and a little piece of tissue (like a piece of a clot), I also noticed some in the toilet, as she didn't flush after going. Later that evening we are out having dinner, my daughter says that she has to go to the bathroom, I take her. Well, there is a lot of blood on the tissue this time. I kind of hoist her up to take a look,and there is blood sort of pooled at the introitus and a little running down her leg! I take her to the emergency room (closest one, instead of the children's hospital) and tell the doc what happened. He basically regurgitates the info back and tells me to schedule a follow up with her pcp.

The next day (today) I call the pcp, who says that she would have told me to go to Children's because the hospital that I took her to, doesn't really serve peds. She said if it continues tomorrow to take her to Children's. Also says that on Monday, she will refer us to a pediatric urologist. It happened again tonight, I gave her a sitz bath, most of bleeding goes away still scant.

History

She was diagnosed with a prolapsed urethra in 99. There was some bleeding then, but was told to give her sitz baths and that everything would be fine. The bleeding went away, but I still see something peeking from the lady parts. I assumed it to be the urethra, but her new doc says that it is a skin tag. She said that if it isn't bothering her (it does from time to time) not to worry about it. She said that the only treatment for it would be to use an estrogen cream, but that the cream would cause her to grow hair under her arms and on lady parts. (Never really felt sure about that info)

I say all of that to ask if any of you have experience with prolapsed urethra's, or does it sound like precocious menarche. I have a terrible feeling that it's menarche. My daughter feels fine though, not a complaint at all. Just a little scared to be bleeding. If it is menarche do any of you know about treatments so that she continues to grow. I believe that the hormonal changes associated with menarche will cause her not to grow as tall as she could be. She's somewhat short now. Also isn't early menarche associated with breast cancer? My mom died of breast cancer at 48. I'm scared. Any info would be greatly appreciated.

Thanks.

Originally posted by KaroSnowQueen

Sixes, one of the things they relate as a breast Ca risk is menarche at age 11 or earlier. That's in most of the breast Ca risk lit.

But I am with the rest of you, this child needs a specialist at once.

And some kids do have odors very early. My two adopted kids and their cousin by blood have always had funky odors since they were quite young.

:) Thanks for the info guess you learn something new everyday. Guess I'll hit the books once again.

there's a pediatric gynecologist at johns hopkins. i can't think of his name. i'll try to find out what it is. a former co-worker of mine took her daughter to him. he was very kind to her.

his name is dr. john gearhart. look under hopkinschildren.org. he is under pediatric urology. this woman who i knew had a child w/ fused labia who she had under his care.

Hi Tobee,

First, let me say that I am so sorry that you and your daughter have to go through this experience. I can imagine how worried you must be and how scary this is for your daughter.

I am just a beginning nursing student like you and while I can't say what I think is causing this bleeding I did want to comment on your post because just a few months ago I watched a special on TLC regarding puberty in young women. They covered a segment on a young child who was adopted by a very kind couple and at around 6 or 7 she started puberty and menstruation.

Obviously, the parents were very worried and very upset by not only the physical implications of this but also by the emotional effects as well. They were very concerned about their young daughter feeling "different" and becoming an adolescent many years ahead of her peers.

The couple did find a specialist and he was able to diagnose early onset of puberty and menses by taking an X-Ray of her hand. The reason he did this is because the bones of the hands and feet begin to enlarge and fuse at the onset of puberty. He found that in the young girls X-Ray that this is what was happening and was able to rule that is was early puberty.

The girl was treated with hormones and they were able to successfully stop the menses and progression of puberty.

So, I guess, take it with a grain of salt as this story certainly is coming from and expert (me) but I thought it was interesting and could apply to your situation.

If you daughter has had problems before I would definately seek a specialist and perhaps if if is early puberty they will refer you to a good endocrinologist.

Good Luck and I hope that all works out well for you and your daughter,

Col

Thank you everyone.

I have been searching the web and gathering info all weekend. I found out, like colleen said that precocious puberty can be treated. I also found some pics and other info re: prolapsed urethrea. I called my pediatrician this morning and took my daughter in to see her. She ooked at her and said that it was a prolapsed urethra and that she would refer me to a urologist. I said well I would also like to have a referral to a endocrinologist as I am concerned about it being precocious puberty and would like to have her worked up for it (labs for FSH, LH, and estrogen) also the bone age tests.

She says no, it's not precocious puberty. I asked her why she was so sure. She said I can look at her and see that. I do workups for precocious puberty all the time. Doc says if it were pre. pub, she would have hair under her hairs, pubic hair, breast development. I said well she does have some fine hair under arms and on lady parts. SHe looked at it and said it was normal. I then reminded her of the amount of blood and asked if that much blood would be caused by the prolapsed urethra. She said I don't know. We went back and forth for a minute and she agreed to give me the endocrinologist's referral, but said she would do the lab work first. So I'm awaiting the results.

Meanwhile, before I went to see her I called Children's Hospital and was able to get an appointment with a ped. urologist today.

I took my daughter to see him this afternoon and he said that it was a prolapsed urethra. He said that the situation should resolve in 5-7 days and that I should call him if it doesn't. I showed him a pic I had printed from the web, that showed necrotic tissue on the urethra that I thought resembled what I see in my daughter. He said that there is no necrosis, and if there were it would just slough off and not be a problem. I expressed relief at it being pro. ure. and said that I thought it may have been precocious puberty (with all my web printouts in hand) He said the same thing as her pcp, that it wasn't precocious puberty, that he could tell by looking at her etc. He said that I had been reading to much. I said no, that's not possible when it comes to your children. He said parents who look up all that information, without a filter wind up more confused than anyone else (loosely paraphrased). I said I'm not confused at all, I just wanted to come in with some idea of what might be going on with my child. I said that wasn't trying to discount him, and that I certainly don't have his medical knowledge, but my research may be able to spark something in him that he overlooked, forget, etc and help my child. He said well hopefully we would look at everything, without needing to be sparked. I said yes, but doctor's aren't infallable. He was actually a little upset that I tried to educate myself about my daughter's health. So we will wait and see what happens in the next 7 days, and see the results of the labs.

Specializes in NICU, Infection Control.

You did good, Mom. Life would be easier for docs if nobody ??'d anything they said or did, but it's YOUR child! I'm an expert @ being the Mother From He** when it comes to my son, altho usually it's with his teachers, not his HCP's.

I'm very proud of you. follow through, ok?

I think you are right to research what you think might be wrong with your daughter. I too would leave no stone unturned. And as for the doctors----it would be different if it was THEIR child. Keep being the good mommy that you are!

Yes, can you imagine questioning a doctor on doctor's day, of all days (celebrated today at my hospital).

Glad to hear you're getting some answers nonetheless. Good luck to you and your daughter.

prmenrs, Rapheal, and NurseGirlKaren, thanks I needed those words of encouragement. You guys are cool.

Glad to hear everything is OK! :)

glad to hear she's ok!

glad to hear she's ok!

Glad things are looking up!!!

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