Urinary Tract Infection in children

By Assoc.PhD Nguyen Thi Quynh Huong*

1. What is urinary tract infection (UTI)?

A UTI happens when bacteria get into the urinary tract, multiplies there, and causes inflammation. The germs most often come from the gut and feces which can get into the urethra.

The urinary tract is made up of the kidneys, which produce urine; the ureters, the tubes through which the urine travels from the kidneys to the bladder; and the bladder, which stores the urine. Bacteria can affect any part of the urinary tract. A UTI is called a pyelonephritis if it affects the kidneys and cystitis or lower UTI if it affects the bladder. Pyelonephritis is a serious condition in children and can lead to kidney scarring and hypertension and may cause end-stage renal disease later in life.

2. What are the risk factors?

UTIs are more common in girls because a girl’s urethra is shorter and closer to the anus, so it is easier for bacteria to get into the urethra. There are other factors which may increase your child’s risk of getting a UTI, such as:

• an anatomical problem in the urinary tract (i.e. a blockage somewhere along the ureter)
• dysfunctional elimination syndrome - a condition where children “hold” their pee, even though they need to pee
• an abnormal backward flow of urine from the bladder up the ureters and toward the kidneys also called vesicoureteral reflux
• constipation, which can put pressure on the bladder preventing it from emptying normally
• bladder or bowel incontinence
• poor toilet and hygiene habits
• What can cause a UTI?

The most common germs that cause UTIs reside naturally in the gut’s flora such as E.Coli, Klebsiella, Pseudomonas aeruginosa, and Enterococci.

4. When should you suspect your child has a UTI?

In all infants and children, an unexplained fever of over 38.5C can be a sign of a UTI.

Signs and symptoms of UTIs vary with age. In older children, the symptoms are relatively easy to spot. Your child may feel pain in the lower belly or back and an urgent need to pee while only producing little urine. They may pee more often and/or feel a burning pain when doing so. Sometimes the child may experience fever, malaise, vomiting and have either cloudy or foul-smelling pee or blood in urine (hematuria).

With younger children it can be a bit trickier as symptoms are more general. In infants younger than three months the most common signs are fever. There may also be abdominal pain, vomiting and poor feeding. In rarer cases there may be signs of lethargy, irritability, failure to thrive and hematuria.

In very small infants younger than three months, the most common symptoms are fever, vomiting, lethargy, and irritability. Poor feeding and failure to thrive may occur but less frequently and in rare cases there may be hematuria and jaundice.

5. Are UTIs dangerous for my child?

UTIs are easy to treat, but it is important to diagnose and treat them early. Undiagnosed, untreated and recurrent UTIs can lead to kidney damage such as renal scarring (15%), hypertension (38%) and risk for end stage renal disease.

6. How will a doctor diagnose a UTI?

Your pediatrician will ask questions, do a physical examination and take a urine sample for tests such as urine culture.

Sometimes your pediatrician may prescribe additional tests to determine the reason for infection and to prevent recurrence.

7. How can we treat a UTI?

UTIs are usually treated with antibiotics taken by the mouth (orally). After finishing the prescribed course of treatment, your doctor may repeat the urine tests to confirm that the infection has completely cleared. This is important to prevent recurrence and spreading.

Strictly follow your pediatrician’s directions and give your child the correct amount of antibiotics for the full course your doctor has prescribed. Observe your child and his bathroom habits. His condition should improve after 48 hours. In order to help the bacteria to be flushed out, encourage your child to drink plenty of fluids. Preferably water with a little orange or lime juice as it will make the urine more acidic, something bacteria do not like.

      8. What is the treatment for a severe UTI?

Children who have a severe infection may need antibiotics delivered intravenously (through a vein directly into the blood stream) and require admission to a hospital.

This may be needed if:

• the child has pyelonephritis (kidney infection)
• the child has high fever, looks very ill and /or has a pyelonephritis (kidney infection)
• the child is younger than three months of age
• the child does not feed well, cannot swallow medication and/or is dehydrated
• the bacteria causing the UTIs are resistant to oral antibiotics
• the bacteria have spread to the blood stream (called a septicemia)
• the child does not improve after 48 hours of oral antibiotic treatment
• the child has severe dilating vesicoureteral reflux.

      9. Can UTIs be prevented?

UTIs are very common and it is impossible to prevent all of them. There are however several measures that can help reduce the risk of your child catching one:

• Try to breastfeed your baby for the first six months of life. This will overall benefit the development of his immune system and reduce the risk for UTIs.
• Encourage your child to drink plenty of water and stay well hydrated. This helps flush out bacteria from the urinary tract and also reduces the risk of constipation.
• Encourage your child to use the bathroom as soon as he needs to pee and not to ‘hold it back’. Holding the urine back makes it easier for bacteria to grow.
• Teach your daughter good bathroom habits and to wipe her bottom from front to back. This minimises the risk of bacteria spreading from the anus and entering into the urethra.
• Provide your child with loose fitting, cotton underwear and avoid synthetic materials. Synthetic materials promote a perfect environment for bacteria to grow.
• In infants and toddlers, change diapers regularly to prevent bacteria from growing.
• Your pediatrician may recommend other measure to minimie the risk of UTIs such as treatment of phimosis in boys or labial adherence in girls. — Hanoi French Hospital

* Assoc.PhD. Nguyen Thi Quynh Huong is a pediatrician with years of international training and experience in treating little ones.

For more information on your child’s health and vaccination, please contact us at 84 – 24.3577.1100, access www.hfh.com.vn, or email us at contact@hfh.com.vn. Address: 1 Phuong Mai, Dong Da, Ha Noi.