When Your Child Needs Clean Intermittent Catheterization (CIC)

Children with urinary tract problems may require clean intermittent catheterization (CIC). This is the temporary placement of a tube (catheter) to help drain the bladder. A parent or another adult does CIC until the child learns how to do it. Children as young as 5 years old can do their own CICs.

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Children with urinary tract problems may need clean intermittent catheterization (CIC). This is the short-term (temporary) placement of a hollow tube (catheter) to help drain the bladder. After the urine is drained, the catheter is removed. A new sterile catheter is used whenever CIC needs to be done. A parent or another adult does CIC until the child learns how to do it themselves. Children as young as 5 years old can do their own CICs.

How is CIC done?

CIC is done by passing a catheter into the urethra. This is the tube that carries urine from the bladder out of the body. When the tube reaches the bladder, urine starts to drain. CIC allows the bladder to empty completely. When the bladder is empty, the catheter is removed.

Why is CIC needed?

CIC helps your child empty their bladder. It can reduce bladder pressure and drain out any urine that remains in the bladder. So, if done correctly and regularly, CIC also helps prevent:

  • Urinary tract infections.

  • Kidney and bladder damage.

  • Wetting accidents (incontinence).

Feeling nervous is normal

At first, inserting the catheter into your child’s urethra may seem scary for both you and your child. But you will have help from your child’s health care team. They will teach you how to do CIC. And as children become more independent, they can start to help with CICs. CIC is done under clean conditions to reduce the number of germs. This includes thorough handwashing, using nonsterile gloves, having a clean area, and using clean or sterile supplies and equipment. Start by letting your child wash their hands and gather the catheter and other supplies. When your child feels ready, the doctor or nurse can teach them how to do CIC.

How often is CIC done?

Do CIC as often as instructed. Typically this will be every 3 to 4 hours during the day. Your child's doctor will let you know if you need to wake your child during sleeping hours to do CIC.

Your child’s catheter

Catheters are made of soft, flexible plastic or silicone material. They come in many shapes and sizes. Some are disposable and are used once and thrown away. Others may be used multiple times if cleaned correctly. Some are uncoated catheters. These require a lubricant or water to aid insertion. Some are coated catheters that have a slippery coating. They are either ready to use or require the addition of water. Your child’s doctor will choose the best catheter for your child. If your child uses reusable catheters, ask how often they should be replaced. Follow the doctor’s instructions carefully.

Using a catheter

Follow these steps when doing a CIC:

Step 1: Get ready

  • Gather your supplies. You’ll need:

    • A catheter.

    • Water-soluble lubricated gel or sterile water.

    • Disposable, alcohol-free, and scent-free wipes or a washcloth.

    • A container to drain urine into (unless draining into the toilet).

    • A container to put the used catheter in.

  • Wash your hands. Use soap and warm water. Talk with your child's doctor to find out if you should use sterile or disposable gloves.

  • Open the catheter package halfway. Be very careful not to touch the tip of the catheter.

Step 2: Lubricate the catheter

Squeeze water-soluble lubricant onto a paper towel, and roll the first 6 to 8 inches of the catheter in the lubricant.

Step 3: Insert the catheter

For boys:

External genitals of male child, showing urethral opening on penis.

  • Have your child stand over the toilet, sit in a chair across from the toilet, or sit upright in bed.

  • If your child isn't circumcised, gently pull back the foreskin and keep it back during the catheterization. Clean the tip of the penis, and work outward in a circular motion with an alcohol-free disposable wipe or washcloth.

  • Hold the penis on both sides, upright, and away from the body.

  • Gently insert the tube until urine starts to drain into the toilet. Then keep inserting the catheter about 1 inch more. When urine starts to flow, point the penis and catheter downward, draining into a container or the toilet.

  • Hold the tube in place until the urine stops draining. Remove the catheter after the urine flow stops completely. If your child isn't circumcised, pull the foreskin gently back over the penis.

For girls:

External genitals of female child, showing urethral opening inside the labia, between the clitoris and vagina.

  • Have your child sit on the toilet, sit in a chair across from the toilet, stand with one foot on the toilet rim, or lie in bed.

  • Find the two folds of skin that surround the vagina (called the labia). Separate them with your dominant hand. Find the urethral opening. It is located below the clitoris and above the vagina.

  • After the urethral opening is found, clean the area with a disposable wipe or washcloth. Wipe from the urethral opening toward the vagina.

  • Keep the labia separated, and gently insert the tube until urine begins to drain. Then keep inserting the catheter about 1 inch more.

  • Hold the tube in place until the urine stops draining.

Step 4: Remove the catheter

  • Remove the catheter slowly. There may be some urine that will drain as you remove the catheter. Wait until this stops again, then remove the catheter. This makes sure that the bladder is completely empty.

Step 5: After the CIC

  • Wipe the area between your child's legs, and wash your hands.

  • If your child used a disposable catheter, throw it away.

  • If your child used a reusable catheter, wash it with soap and water, rinse it, and dry it off. Then put it into a container, such as a plastic bag that seals at the top.

  • Wash your hands with soap and warm water.

Tips for successful CICs

  • Place two plastic bags that seal at the top in your child’s backpack. Label one “Clean” and the other “Dirty” so your child can store reusable catheters in the correct bag.

  • Children capable of doing so should learn to do CIC starting in kindergarten. Then your child won’t have to rely on the nurse for help with CICs.

  • Girls should not rely on mirrors to find the urethra, if possible.

  • Keep in mind that your child may have some mild pain at first. This often lasts about 3 days for boys and 1 to 2 days for girls. But it depends on the child.

  • Stick closely to the catheterization schedule.

  • Make sure your child drinks plenty of liquids. Make sure they don't stop drinking liquids as a way to not have to do catheterization. The schedule needs to be followed no matter how little fluid the child drinks.

Coping

The thought of having to regularly catheterize your child can be overwhelming. You may be feeling angry or sad about your child’s need for CIC. You may view it as a loss of freedom or normalcy for your child and your family. This is to be expected. But as you start doing CICs, you will likely be more comfortable with it. And for your child, CICs will become a normal part of their daily activities. Also keep in mind that you’re not alone. Your child’s doctor or nurse will teach you how to do CICs. When your child feels ready, they will be taught how to do their own CICs. In the meantime, it’s very important that you be supportive and patient. Encourage your child’s success by making sure that they follow the voiding schedule.

When to call the doctor

Contact your child's doctor right away if your child has:

  • A fever, typically at or above 100.4 degrees, or as directed by your child's doctor.

  • Blood in the urine. (A small trace of blood can be normal.)

  • Foul-smelling urine.

  • Sand-like material (sediment) in the urine.

  • Pain in the lower back or lower abdomen.

  • Trouble inserting the catheter.

  • Increased pain when inserting the catheter.