• Urinary Tract Infections in Childhood

    (UTI in Childhood)

    Definition

    The urinary tract carries urine from the kidneys to the outside of the body. It includes the kidneys, bladder, and tubes that connect them. The tubes from the kidney to bladder are called ureters. The tube from the bladder to the outside of the body is called the urethra. A urinary tract infection (UTI) is an infection in any of these structures. These infections can cause pain and burning when urinating.
    UTIs are easily treated. They can cause complications if they are not treated.
    The Urinary Tract
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

    Causes

    UTIs are caused by bacteria. The bacteria may enter the bladder or the kidneys. This can sometimes be caused by:
    • Holding urine for long periods of time
    • Not fully emptying the bladder
    • Females wiping themselves from back to front after a bowel movement
    • Clothing that is too tight, especially if it is not cotton

    Risk Factors

    Factors that may increase your child's chance of developing a urinary tract infection include:
      Abnormalities of the urinary tract, including:
      • Vesicoureteral reflux —urine flows backwards from the bladder up into the kidneys
      • Urinary obstruction—something is blocking or slowing the flow of urine
    • Poor hygiene and toilet habits
    • Family history of UTIs
    • Uncircumcised penis

    Symptoms

    Symptoms include:
    • Feeling the need to urinate frequently
    • Only producing a small amount of urine
    • Burning or painful urination
    • Fever
    • Diarrhea
    • Irritability
    • Lethargy
    • Stomachache
    • Foul-smelling urine
    • Blood in the urine
    • Potty-trained children wetting themselves

    Diagnosis

    The doctor will ask about your child's symptoms and medical history. A physical exam will be done. The doctor may also ask for a urine sample. Follow your doctor's directions on collecting your child's urine.
    Tests may include the following:
    • Urinalysis—a laboratory examination of a urine sample
    • Urine culture —to identify the specific bacteria that is involved
    • Complete blood count and other blood tests if your child has a fever
    Imaging tests may be ordered if your child is a boy with UTI or a girl after her second UTI. These infections may be due to problems in the urinary tract. The test may include ultrasound, CT scan, or specialized x-rays.

    Treatment

    Talk with your doctor about the best treatment plan for your child. Treatment options include:

    Antibiotics

    Antibiotics will help fight the bacteria that is causing the infection. Your child will most likely be given antibiotic pills or liquids to take by mouth. Make sure to finish all the medication as recommended. Finish the medication even if your child is feeling better.
    Some severe infections may need to have antibiotics delivered by IV or an injection.

    Fluids

    Encourage your child to drink plenty of fluids. This will help to flush the bacteria out of the system. It will also decrease the concentration of the urine. This may make it more comfortable to urinate.

    Pain and Fever Relief

    UTIs can be uncomfortable and may cause fever. Your doctor may recommend some over-the-counter medication for your child. They may include:
    • Acetaminophen (Tylenol)
    • Ibuprofen (Motrin)
    • Aspirin
    Follow the instructions on the package.
    Note : Aspirin is not recommended for children or teens with a current or recent viral infection. This is because of the risk of Reye's syndrome . Ask your doctor which other medicines are safe for your child.
    If your child is diagnosed with a UTI, follow your doctor's instructions .
    If your child is diagnosed with a UTI, follow your doctor's instructions .

    Prevention

    To help reduce your child's chances of developing a urinary tract infection, take the following steps:
    • Talk to your child's doctor if your child has an abnormality of the urinary system. Your child may need surgery.
    • Make sure that girls learn to wipe from front to back.
    • Encourage your child to go to the bathroom often. They should go several times a day.
    • Retract the foreskin of the penis on a regular basis. This will help to keep the area clean.
    • If your child has UTIs often, the doctor may prescribe antibiotics. This may help to prevent a new infection.

    RESOURCES

    Family Doctor http://familydoctor.org/

    National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov/

    CANADIAN RESOURCES

    About Kids Health http://www.aboutkidshealth.ca/

    Health Canada http://www.hc-sc.gc.ca/index-eng.php/

    References

    American Academy of Pediatrics (AAP) clinical practice guideline on diagnosis and management of initial UTI in febrile infants and children aged 2 to 24 months. Pediatrics. 2011 Sep;128(3):595 .

    Urinary tract infection (UTI) in children. Cincinnati Children's Hospital Medical Center website. Available at: http://www.cincinnatichildrens.org/health/u/uti-prevention/ . Accessed August 6, 2012.

    Urinary tract infection in children. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated May 24, 2012. Accessed August 6, 2012.

    Urinary tract infections in children. The Cleveland Clinic Health Information Center website. Available at: http://my.clevelandclinic.org/disorders/urinary%5Ftract%5Finfections/urology%5Foverview.aspx# . Accessed August 6, 2012.

    12/5/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Pohl A. Modes of administration of antibiotics for symptomatic severe urinary tract infections [review]. Cochrane Database of Systematic Reviews. 2007(4). DOI: 10.1002/14651858.CD003237.

    11/6/2009 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Craig JC, Simpson JM, Williams GJ, et al. Antibiotic prophylaxis and recurrent urinary tract infection in children. N Engl J Med. 2009;361(18):1748-1759.

    Revision Information

    • Reviewer: Michael Woods
    • Review Date: 09/2012
    • Update Date: 00/91/2012
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