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My Child Has:
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Urinary Tract Infection
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Urinary tract infections describe a health problem that results from a bacterial infection along the urinary tract.
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UTI is uncommon in children who are not yet toilet trained. Therefore urinary tract infection in this age group requires full evaluation. Most urinary tract infections occur during toilet training or beyond as a result of voiding pattern abnormalities or hygiene problems. They are most common in girls, because girls have a shorter urethra. Although they are unlikely in boys at any age unless an obstruction is present, uncircumcised males are more likely to develop a UTI than circumcised males. Children with a complete or partial blockage in the urinary tract are more likely to develop UTI.
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Normal urine is sterile and contains fluids, salts, and waste products. It is free of bacteria, viruses, and fungi. An infection occurs when microorganisms, usually bacteria from the digestive tract, cling to the opening of the urethra, the hollow tube that carries urine from the bladder to the outside of the body, and travel back into the bladder where they begin to multiply. Most infections arise from Escherichia coli (E. coli) bacteria, which normally are found in the colon.
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A urinary tract infection may involve different portions of the urinary tract including the following:
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- urethritis - an infection of the urethra, the hollow tube that drains urine from the bladder to the outside of the body.
- cystitis - a bacterial infection in the bladder that often has moved up from the urethra.
- pyelonephritis - a urinary infection of the kidneys that is usually a result of an infection that has spread up the tract, or from an obstruction in the urinary tract. An obstruction in the urinary tract causes urine to flow back into the ureters and up to the kidneys.
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The following are the most common symptoms of UTI. However, each child may experience symptoms differently. Symptoms may include:
In babies:
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- fever
- abdominal pain; colic
- abdominal fullness
- foul smelling urine
- poor growth
- weight loss or failure to gain weight
- irritability
- vomiting
- poor feeding
- diarrhea
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Older children:
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- urgency to urinate
- incontinence during day and/or night
- frequent urination
- painful or difficult urination
- discomfort above the pubic bone
- blood in the urine
- foul smelling urine
- nausea and/or vomiting
- fever
- chills
- pain in the back or side below the ribs
- fatigue
- small amount of urine while voiding despite feeling of urgency
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The symptoms of a UTI may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.
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Your child's physician may diagnose a urinary tract infection based on a description of symptoms and a physical examination. Other studies may include a urinalysis (a laboratory examination of urine for various cells and chemicals, such as red blood cells, white blood cells, infection, or excessive protein) and culture that will detect the presence of an infection.
Children with a confirmed urinary tract infection may require further diagnostic testing with a renal and bladder ultrasound. This is a diagnostic imaging technique that uses high-frequency sound waves and a computer to image the urinary tract.
In some children with a fever and a urinary tract infection one of the following tests is needed to evaluate the bladder and urethra and to detect possible vesico-ureteral reflux (in which urine backs up to the kidneys instead of flowing out through the urethra):
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- Voiding Cysto-Urethrogram (VCUG) : A VCUG is a bladder x-ray that takes moving pictures. A specially trained x-ray technologist or radiologist performs the test. A small tube called a catheter is inserted into the bladder through the urethral opening (the place where urine leaves the body). A special fluid is passed into the bladder through the tube. Then x-rays are taken to see if the fluid backs up from the bladder into the ureters and kidney when the bladder is full or when the child urinates.
- Radionuclide cystogram (RNC) : An RNC is similar to a VCUG except a different fluid is used. Like a VCUG, this test is used to determine if urine is going from the bladder back to the kidney, where it is produced, rather than entirely out of the body except different fluid is passed through the tube
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Specific treatment for a urinary tract infection will be determined by your child's physician based on:
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- your child's age, overall health, and medical history
- the extent of the condition
- your child's tolerance for specific medications, procedures, or therapies
- expectations for the course of the condition
- your opinion or preference
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Treatment may include:
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- antibiotics
- a heating pad or medications (to relieve pain)
- increased fluid intake (especially water)
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Your child's physician may ask you to bring your child back into the office a few days after treatment starts to reevaluate your child.
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The following may help to prevent your child from developing urinary tract infections:
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- Ensure that your child is voiding regularly (every 2-3 hours) and takes the time necessary to completely empty the bladder.
- Teach your child to wipe his/her bottom from front to back. If your son is uncircumcised, he should be taught how to retract the foreskin on his penis and clean himself. The foreskin should never be retracted forcibly. Do not allow the foreskin to stay retracted for long periods as this may shut off the blood supply to the head of the penis causing pain and possible injury.
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