Urinary Tract Infection in Children (UTI)

Urinary tract infection in children caused by bacteria include cystitis, affecting the urinary bladder as well as pyelonephritis, affecting the kidneys.

  • Fever may be the only symptom of a urinary tract infection in newborns and babies.
  •  Older children may complain of a burning sensation or pain while urinating, wanting to pass urine more frequently, and sometimes, pain in lower abdomen.
  • Bacteria are the cause of urinary tract infections.
  • A urine test help diagnose the infection.
  • Urinary tract infections are treated by antibiotic therapy.
  • Maintaining good hygiene is important in preventing urinary tract infections.

Urinary tract infections of bacterial origin are a common occurrence in childhood. The bacteria causing the infection usually enter through the opening of the urethra, and move upwards, reaching the urinary bladder. From there they may spread to the kidneys too. In some rare cases, the infection in the kidneys may reach the blood and cause a widespread blood infection called sepsis. It can affect other organs too.

Among infants, boys are found to be more prone to urinary tract infections, but later on, girls have them more frequently. Girls are at a higher risk of contracting urinary tract infections because their urethras are short, and the bacteria can spread to other parts of the urinary tract faster. In boys, the bacteria which accumulate below the foreskin make those who are uncircumcised to be at greater risk of UTIs. Children who frequently have constipation may have urinary tract infections more often.

Infants and young children who develop urinary tract infections may be having certain structural defects in their urinary tract which make them vulnerable to infections. For example, vesicoureteral reflux, which is caused when a defect in the ureters which carry the urine from the kidneys to the bladder allow backward flow of urine, can take the bacteria from the bladder to the kidneys. Blockages in the urinary tract can result in the stagnation of urine that causes the bacteria to multiply. It has been found that half of the newborns and babies who have urinary tract infections have some structural defects too. In young schoolchildren also, up to 30% of those who have UTIs are found to be having some kind of abnormality in their urinary system. However, older children as well as adolescents have UTIs similar to that of adults.

In about half the infants and young children who have urinary tract infections, especially if they have fever, the kidneys are affected besides the urinary bladder. Infections in the kidneys may cause scarring of the tissues, which can lead to high blood pressure in adulthood. Scarring can impair kidney function later in life too. Severe vesicoureteral reflux can also cause scarring.

Symptoms and Diagnosis

Most of the newborns and babies with urinary tract infections may not have any symptoms except fever. A few may have vomiting or diarrhea. Lethargy and poor feeding are the other common signs.

Burning sensation and pain during urination is the most common symptom in older children. They may have an urgent need to pass urine, and urinate more frequently, but sometimes, they may find it hard to pass urine, and may feel a pain in the lower abdomen. Incontinence, or lack of control over urination, is another symptom. The smell of the urine may change to either too strong or foul. If the kidneys are affected, there is usually pain at the back, or at the sides, in addition to fever, malaise, and chills.

A urine test can detect urinary tract infections. The urine sample for testing should be collected carefully to avoid contamination. The urethral opening should be cleaned well before asking the child to urinate into a sterile cup. Children who are too young to urinate on request may require catheterization to collect a urine sample. A thin plastic tube is inserted into the bladder through the urethral opening to draw out a sample. Urine sample may be collected from newborns and babies by inserting a needle into the bladder through the skin, as samples collected by taping a plastic bag to the genital area are usually too contaminated for testing.

When the urine sample is examined under the microscope, bacteria and white blood cells may be detected, if infection is present. Chemical analysis of the urine is also done. Urine sample is then cultured to identify the type of bacteria that is causing the infection. The result of urine culture is very important in the treatment of UTI.

When an infant or a child has UTI, detecting the bacteria causing the infection, and eliminating it, is not sufficient. Girls below 2 years of age, and boys irrespective of their age, need to undergo further investigations to detect structural defects in their urinary tract that may have made them prone to the infection. In older girls with recurring infections also, the underlying cause needs to be identified. An ultrasound scan can detect structural defects and obstructions in the urinary tract.

Voiding cystourethrography is a test in which a dye is introduced through a catheter which is passed into the bladder via the urethra. X-rays taken before urinating, and after passing the urine, can identify abnormalities of the urinary tract as well as the occurrence of partial reverse flow of urine. In a test called radionuclide cystourethrography, a radioactive material is introduced into the bladder, and a nuclear scanner is used to obtain images. The advantage of this test is that radiation exposure of testes or ovaries can be minimized when compared to voiding cystourethrography. However, images obtained by radionuclide cystourethrography are not as sharp as those produced by x-rays taken during voiding cystourethrography. If the child is diagnosed with pyelonephritis, a special nuclear scanning is often employed to determine the extent of scarring of the tissues.

Prevention and Treatment

Maintaining high standards of hygiene may help prevent urinary tract infection in children. Girls should learn to wipe their bottoms from front to back after bowel movements, and not the other way, so that the fecal bacteria are not introduced into the urethral opening. Bubble baths may irritate the tender skin surrounding the urethral opening and make it vulnerable to infections. Both boys and girls should avoid frequent bubble baths to reduce the risk of urinary tract infections. Circumcision or removal of the loose foreskin in boys is found to lower the risk of UTIs by10 times, but it is not clear whether this procedure has any significant advantage over keeping the area under the foreskin clean by regular washing. Urination and bowel movements at regular intervals, and proper cleaning afterwards, may help reduce the occurrence of UTIs.

Antibiotic therapy is used for treating urinary tract infection in children. When the culture results have identified the particular type of bacteria causing the infection, the doctors can treat it more effectively with specific antibiotics. However, if a child who is diagnosed with UTI by preliminary testing is severely ill, the treatment is started immediately with a general antibiotic, without waiting for the results of the urine culture. The drugs are given intramuscularly or intravenously in cases of severe infection. For milder infections, oral antibiotic therapy may be sufficient. Antibiotics are continued for one to two weeks to ensure complete elimination of the infection. If the child is undergoing further testing to identify structural defects, lower maintenance doses are given till those tests are completed.

Some mild defects do not require any treatment as they may eventually get resolved without any medical or surgical intervention. In some cases, surgical correction of the structural defects may be necessary to avoid infections recurring. Some children may need a daily dose of antibiotic to protect them from repeated infections.

Watch this Video About Urinary Tract Infection in Children (UTI):

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Yasser Elnahas

MD, PHD, Professor Of CardioVascular Surgery
Dr. Yasser Elnahas, Is an associate Professor of Cardiovascular Surgery. Dr. Elnahas was trained as a fellow At Texas Heart Institute And Mayo Clinic Foundation.Dr. Elnahas is dedicated to educating the general public about different disease conditions and simplifying the medical knowledge in an easy to understand terminology.

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