Lower grades of reflux resolve without surgery in most children.  This usually occurs as the bladder and its ureteral valve undergo growth. If children with lower grades remain free of recurring infections, new kidney injury is uncommon. The chance of the reflux resolving depends somewhat on how old your child is when he or she is diagnosed. The longer the child has had reflux, the less likely that it will resolve on its own. The intensity of the reflux is described as a ‘grade’, with grade 1 being the least intense, and most likely to resolve without surgery  The overall likelihood of the reflux eventually resolving without surgery is roughly:  Grade 1: 80 to 90%. Grade 2: 70 to 80%. Grade 3: 50 to 60%. Grade 4: 10 to 20%. Grade 5: 5 to 10%. Voiding dysfunction refers to several common conditions in which children have abnormal urination patterns with and without moderate to severe constipation. Some common signs that your child is dealing with dysfunctional voiding include:  Frequent urination with urgent running to the bathroom or daytime wetting. Urination may be infrequent, perhaps two to three times a day or less. Keep in mind that parents may be unaware of constipation if their child does not recognize or admit to it. Treatment of voiding dysfunction usually requires some combination of bladder retraining, behavior modification, medications, and pelvic floor biofeedback therapy. Most large pediatric medical institutions have specialists or programs that can assist in developing a treatment program specifically for your child. You can also read about treatments for voiding dysfunction  here. Children, mostly girls, with dysfunctional voiding are prone to recurrent UTIs. In general, after age one, girls have UTIs more frequently than boys.The risk of a girl getting a UTI, in general, can be diminished by good hygiene in the genital area (keeping clean and dry, wiping front to back, and wearing cotton underwear all help), and drinking enough water to void a dilute urine 5 to 7 times a day. Common symptoms of UTIs include:  A burning sensation when urinating. Unusual-smelling urine. Fever. Nausea, vomiting, and diarrhea. When a UTI is suspected, an antibiotic with broad effectiveness against most of the usual bacteria is selected until the urine culture result is available (urine cultures will be discussed in the next step). The usually takes 24 to 48 hours.  Most uncomplicated UTIs in children are treated for about 7 days.  For more serious infections, treatment should be for 10 to 14 days or more. Common antibiotics include: Amoxicillin, Trimethoprim, sulfamethoxazole, and Nitrofurantoin. Take your child to a doctor to have a culture taken to see if the child has bad bacteria, which can cause the infection, in his or her urinary tract. The culture may take a few days to a week to be processed.  If the culture is negative,  any antibiotic treatment can be discontinued. If the culture is positive, the choice of antibiotic may be changed to select the one with the most specific effectiveness.  Your provider will receive this information with the urine culture result. Children with frequent UTIs, especially those with reflux, can receive long-term (months to years) treatment with “low dose” antibiotics; this is called antibiotic prophylaxis. The rationale is that daily small doses of antibiotics will “suppress” bacterial growth in the urine and prevent the UTI from developing. During observation or medical management, periodic kidney and bladder sonograms can document normal kidney growth and can make sure that no new kidney scars have formed. If the sonogram is not sufficient or inconclusive, a kidney scan test called a DMSA renal scan has a very high sensitivity for kidney scars.
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One-sentence summary -- Observe and carefully monitor your child’s health. Be aware of the chances that each grade of reflux has of resolving without surgery. Determine if dysfunctional voiding is a part of the problem. Treat the dysfunctional voiding to combat the reflux. Understand that urinary tract infections (UTIs) are also a condition that can lead to reflux. Treat your child’s UTI with antibiotics. Have a culture taken to determine if your child really has a UTI. Talk to your doctor about continuous antibiotics to treat recurrent UTIs. Schedule regular sonogram appointments for your child.


Show that you mean business by arriving five to ten minutes early for any meeting or appointment you might have.  This shows that you respect your time and the time of others. This applies to professional settings.  It is typically okay to be a few minutes late to parties and other social events. Stay up on the current events in your city, state, country and the world.  Don’t just know about the latest pop culture, know about the politics that are affecting you.  This will give you serious topics to discuss with others. Download news apps to your phone and take fifteen minutes daily to read articles every morning.  You can even sign up for news alerts. Should you be assigned a task at work or school, work diligently on it.  Do your research so you can do it to the best of you ability.  If there is a presentation portion, practice beforehand until you have mastered it.  This will show that you take your work seriously. For instance, if you have a presentation coming up, prepare a powerpoint.  Use a simplistic format and include visuals or charts.  Check for typos and practice presenting in the mirror. Take care of your appearance by showering and keeping your hair and clothes presentable. This will keep you looking sharp, neat and clean. You don't have to look ready for a board meeting (unless you're actually going to a board meeting), but you should always look nice.  Iron your clothes the night before so you don’t have to rush in the mornings. Use your clothes to tell people what you want them to think about you. If you want to be taken seriously, don't do things that make people think less of you. Avoid public intoxication, drugs, crime, and other poor decisions.  Instead, involve yourself in positive activities like volunteering. Be mindful of what you post on social media, too.  Avoid posts that glorify drugs, violence or other negative behaviors. If you tell someone that you will do something, you should follow through on that. If they see you as someone that just makes empty promises, they will be very unlikely to take you seriously. Perhaps you promised a coworker that you would pick them up the following morning for work.  Be sure to set a reminder on your phone and wake up early so you can keep the promise. If you are lying often, you can’t really expect people to believe you. They aren't going to trust you to tell them the right information. Always be truthful with others, even when it’s difficult.  They will begin to take you seriously if they know you will be honest with them. People value honesty and genuineness in others. For example, if you don't know something, say, "I'm not familiar with that, but I'll look it up." If someone is being rude to others or suggest something that is wrong, speak up for what you believe.  Do so in a respectful and kind manner.  This will show to others that you have integrity and that you’re willing to fight for what’s right. For instance, your boss might suggest paying the new female coworker less than the male staff because of her gender.  Let him know that this is not okay and that she deserves equal pay to do equal work.
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One-sentence summary --
Arrive early. Read the news. Prepare for your assignments or projects. Dress for success. Set up a good reputation. Follow through on your promises. Tell the truth. Speak up when you disagree.