Uninhibited bladder contractions (“unstable bladder” syndrome) occur involuntarily in children who have failed to gain complete voluntary control over the voiding reflex, related to delayed nervous system maturation If the urethral sphincter is relatively weak, urinary frequency associated with urgency and enuresis may result Females may exhibit the so-called “curtsy” sign as the child squats and attempts to prevent leakage by compressing the perineum with the heel of one foot If performed, a screening ultrasound examination would reveal normal (minimal) residual urine volumes With maturity, spontaneous resolution of uninhibited contractions occurs in most cases In children with significant developmental delay or behavioral disorders, the infantile pattern of spontaneous bladder contraction may persist Abdominal Masses in the pelvis (including abdominal tumors, appendicitis, and ovarian torsion) that press on the bladder can cause frequency Generally, these diagnoses cause abdominal pain and/or other symptoms, and physical examination will elicit tenderness Constipation is a common cause of urinary frequency in schoolaged children It results in large fecal masses that cause mass effect with extrinsic bladder pressure, as well as stimulating bladder contraction or inhibiting the full bladder capacity Such frequency may then be small volume excretions There is noted association with constipation and UTI Pregnancy should always be considered as a cause of frequent urination in the adolescent female Metabolic and Endocrinopathies Diabetes mellitus (DM) causing osmotic diuresis from increased glucosuria is an emergent condition causing frequency Typically, new-onset diabetes presents with polydipsia, polyphagia, and polyuria; uncontrolled DM with or without diabetic ketoacidosis can present similarly Be alert for other concerning findings including altered mental status and respiratory changes Hypercalciuria has been reported as a significant noninfectious cause of the “frequency–dysuria syndrome” in pediatric patients Onset of symptoms generally ranges from to 14 years of age Occasionally, hypercalciuria can present in early infancy, where irritability is a hallmark symptom Symptoms often spontaneously resolve within months There may be a positive family history of calcium urolithiasis Dysuria may or may not be present Hematuria (generally microscopic) and/or crystalluria are often seen However, the urinalysis may be normal If the diagnosis is suspected and symptoms persist, studies of urinary calcium excretion and urologic consultation should be considered The salt-losing form of congenital