Overview of Urinary Tract Infection (UTI) in Children
A urinary tract infection (UTI) in children is a fairly common condition. According to the National Kidney and Urologic Diseases Information Clearing House (NKUDIC), approximately three percent of children in the United States get a UTI each year (NKUDIC, 2011).
Normally, germs that enter the urethra are promptly flushed out through urination. However, when bacteria are not expelled this way, they may grow within the urinary tract, causing an infection. The urinary tract consists of the parts of the body that are involved in urine production. They are:
- a bladder that stores your urine until it is removed from your body
- two kidneys that filter your blood and extra water to produce urine
- two ureters, or tubes, that take urine to your kidneys from your bladder
- a urethra, or a tube, that empties urine from your bladder to outside your body
Your child can develop a UTI when bacteria enter the urinary tract and travel up the urethra and into the body. The two types of UTIs most likely to affect children are bladder infections and kidney infections. When a UTI affects the bladder, it is called cystitis. When the infection travels from the bladder to the kidneys, it is called pyelonephritis. Both can be successfully treated with antibiotics; however a kidney infection can lead to more serious health complications if left untreated.
Causes of Urinary Tract Infection in Children
UTIs may be caused by a variety of germs, but are most commonly caused by bacteria, which may enter the urinary tract from the skin around the anus or the vagina. The most common cause of UTIs is Escherichia coli (E. coli), which originates in the intestines. Most UTIs are caused when this type of bacteria spread from the anus to the urethra.
Risk Factors for Urinary Tract Infection in Children
UTIs occur more often in girls, especially when toilet training begins. Girls are more susceptible because their urethra is shorter and closer to the anus. This makes it easier for the bacteria to enter the urethra. Uncircumcised boys under one year also have a slightly higher risk of UTI. The overall risk of your child developing a UTI during childhood is two percent for boys and eight percent for girls (NKUDIC, 2011).
The urethra does not normally harbor germs, but certain circumstances can make it easier for bacteria to enter or remain in your child’s urinary tract. The following factors can put your child at a higher risk for a UTI:
- a structural deformity or blockage in one of the organs of the urinary tract
- abnormal function of the urinary tract
- vesicoureteral reflux: a birth defect that results in the abnormal backward flow of urine
- the use of bubble baths (for girls)
- tight-fitting clothes (for girls)
- wiping from back to front after a bowel movement
- poor toilet and hygiene habits
- infrequent urination or delaying urination for long periods of time
Symptoms of Urinary Tract Infection in Children
Symptoms of a UTI can vary depending on the degree of infection and your child’s age. Infants and very young children may not experience any symptoms. When they do occur in younger children, symptoms can be very general. They may include:
- poor appetite
- overall feeling of illness
Additional symptoms vary depending on the part of the urinary tract that is infected. If your child has a bladder infection, symptoms include:
- blood in the urine
- cloudy urine
- foul-smelling urine
- pain, stinging, or burning with urination
- pressure or pain in the lower pelvis or lower back, below the navel
- frequent urination
- waking from sleep to urinate
- feeling the need to urinate with minimal urine output
- urine accidents after the age of toilet training
If the infection has traveled to the kidneys, the condition is more serious. Your child may experience more intense symptoms, such as:
- chills with shaking
- high fever
- skin that is flushed or warm
- nausea and vomiting
- side or back pain
- severe abdominal pain
- severe fatigue
The initial signs of a UTI in children can be easily overlooked. Younger children may have a difficult time describing the source of their distress. If your child looks sick and has a high fever without a runny nose, earache, or other obvious reasons for illness, consult your physician to determine if your child has a UTI.
Complications of Urinary Tract Infection in Children
Prompt diagnosis and treatment of a UTI in your child can prevent serious, long-term medical complications. Untreated, a UTI can result in a kidney infection that may lead to more serious conditions such as:
- kidney abscess
- reduced kidney function or kidney failure
- hydronephrosis, or swelling of the kidneys
Diagnosis of Urinary Tract Infection in Children
Contact your physician immediately if your child has symptoms related to a UTI. A urine sample is required for accurate diagnosis. The sample may be used for:
- urinalysis: A microscope is used to examine the sample for bacteria or pus.
- urine culture: A laboratory test, usually taking 24 to 48 hours, in which the sample is analyzed to identify the type of bacteria causing the UTI, how much of it exists, and appropriate antibiotic treatment.
Collecting a clean urine sample can be a challenge for children who are not toilet trained. A usable sample can’t be obtained from a wet diaper. Your physician may use one of the following techniques to get your child’s urine sample:
- urine collection bag: A plastic bag is taped over your child’s genitals to collect the urine, though contact with the skin can contaminate the sample.
- catheterized urine collection: A plastic tube, or catheter, is inserted into the tip of a boy’s penis or into a girl’s urethra and into the bladder to collect urine.
Your physician may recommend additional diagnostic tests to determine whether the source of the UTI is an abnormality of your child’s urinary tract. If your child has a kidney infection, tests also may be required to look for kidney damage. The following imaging tests may be used:
- kidney and bladder ultrasound
- voiding cystourethrogram (VCUG): An X-ray that is taken while your child’s bladder is full. The doctor will inject a contrast dye and then have your child urinate (typically through a catheter) to observe how the urine flows out of the body. This can help detect any structural abnormalities that may be causing a UTI.
- nuclear medicine renal scan (DMSA): A nuclear test in which pictures of the kidneys are taken after the intravenous (IV) injection of a radioactive material called an isotope
- computed tomography (CT) scan or magnetic resonance imaging (MRI) of the kidneys and bladder
The tests may be done while your child has the infection. Often, they are done weeks or months after treatment to determine if there is any residual damage.
Treatment of Urinary Tract Infection in Children
Your child’s UTI will require prompt antibiotic treatment to prevent kidney damage. The type of bacteria causing your child’s UTI and the severity of your child’s infection will determine the type of antibiotic used and the length of treatment.
The most common antibiotics used for treatment of UTIs in children are:
- amoxicillin and clavulanic acid
- doxycycline (only in children over age 8)
If your child has a UTI that is diagnosed as a simple bladder infection, it is likely that treatment will consist of oral antibiotics at home. However, more severe infections may require hospitalization and intravenous (IV) fluids or antibiotics.
If your child has a UTI, hospitalization is often necessary in cases where:
- your child is less than six months old
- your child has a high fever
- your child likely has a kidney infection
- your child’s blood is infected by the bacteria
- your child is dehydrated, vomiting, or unable to take oral medications for any other reason
Pain medication to alleviate severe discomfort during urination also may be prescribed.
If your child is receiving antibiotic treatment at home, you can help to ensure a positive outcome by:
- giving your child the prescribed medications for as long as your physician advises, even if your child begins to feel healthy
- taking your child’s temperature in the morning and evening
- monitoring your child’s urination frequency
- asking your child about the presence of pain or burning during urination
- ensuring that your child drinks plenty of fluids
During your child’s treatment, contact your physician if symptoms persist or worsen, or if your child has a fever higher than 101 degrees Fahrenheit (38.3 degrees Celsius), or 100.4 degrees Fahrenheit (38 degrees Celsius) for infants. You should also seek medical advice if your child develops new symptoms of pain or changes in urine output.
Long-Term Outlook for Urinary Tract Infection in Children
With prompt diagnosis and treatment, you can expect your child to fully recover from a UTI. However, some children may require treatment for periods lasting from six months up to two years.
Long-term antibiotic treatment is more likely if your child is diagnosed with vesicoureteral reflex, or VUR, a birth defect that results in the abnormal backward flow of urine from the bladder up the ureters, moving urine toward the kidneys instead of out the urethra. According to KidsHealth.org, this disorder is found in 30 to 50 percent of children with a UTI (KidsHealth, 2012). VUR can cause chronic UTIs in children, which create an increased risk of kidney damage and ultimately, kidney failure. Surgery is an option used in severe cases. Typically, children with VUR outgrow the condition, though kidney damage or kidney failure may occur into adulthood.
How to Prevent a Urinary Tract Infection in Children
You can help prevent the possibility of your child developing a UTI with proven techniques such as the following:
- Do not give female children bubble baths, which can allow bacteria and soap to enter the urethra.
- Avoid tight-fitting clothing and underwear for your child, especially for girls.
- Ensure that your child drinks enough fluids.
- Avoid allowing your child to have caffeine, which can cause bladder irritation.
- Change diapers frequently on younger children.
- Teach older children proper hygiene for maintaining a clean genital area.
- Encourage your child to use the bathroom frequently rather than holding in urine.
- Teach your child safe wiping techniques, especially after bowel movements. Wiping from front to back reduces the likelihood that bacteria from the anus will get transferred into the urethra.
If your child gets repeated UTIs, your physician may advise preventive antibiotics. Be sure to follow instructions for continuing therapy even if your child does not have symptoms of a UTI.