Urinary Tract Infections in Children

A urinary tract infection (UTI) is caused by bacteria that get into the bladder. UTI's are very common in children, particularly in little girls, and tend to keep coming back. Some children are prone to get UTI's because of a tendency that runs in the family. The infections recur because the bacteria stick to the skin around the opening to the bladder (the urethra) in some people, and then get into the bladder. All UTI's start as a bladder infection, and then may spread to the kidney.

Symptoms.
The symptoms of UTI may include some of the following: fever, back (flank) pain, lower abdominal pain, burning with urination, blood in the urine, frequent or urgent urination, wetting pants or bed, or foul-smelling urine. Infants may have only fever, irritability and/or poor feeding. Older children may complain of problems with urination. Many of these signs can be seen with other types of problems, therefore, it is very important that a urine specimen be obtained for culture to grow and identify any bacteria that are present and to find out what medicine is best to treat the infection.

Collecting urine for a urinalysis and culture
In babies who are not potty trained, urine is collected by using a bag that covers the genitals, by passing a catheter (tube) into the bladder or by passing a needle through the skin into the bladder. Older children urinate into a sterile cup. When urinating into a cup, it is most helpful if the child starts urinating first into the toilet, then finishes in the cup. Also, girls should spread their legs and, if possible or with help, spread the lips around the urethral opening.

Problems that can make UTI's worse.
Children who have blockage (obstruction) of the urinary tract may be more likely to get severe infections that can damage the kidney(s). Also, children who do not empty their bladder completely or who have reflux, a condition in which urine from the bladder goes back up into the kidney, are more likely to have the infection spread to the kidney and cause kidney damage. That's why any child with a history of UTI should have a kidney ultrasound and bladder X-ray (VCUG, see below) to identify these problems.

Studies in the Radiology Department
An ultrasound of the kidney is a painless procedure which is done by passing a probe over the skin overlying the kidneys and bladder. The ultrasound tells us if both kidneys are present, if a kidney may be obstructed and if the bladder empties normally. A second test, the bladder X-ray or voiding cystourethrogram (VCUG) involves putting a catheter (tube) into the bladder, filling it with dye and taking X-rays. This test tells us if urine goes back up into the kidneys (reflux). This test is important since reflux cannot be seen on an ultrasound. However, passing the catheter may cause momentary pain or a strong urge to urinate. If these 2 tests show a problem with your child's urinary tract, a kidney scan may be perfomed to test how well the kidney works and/or drains. A scan involves injecting a small amount of a radionuclide tracer into a vein and taking pictures of the kidneys for up to several hours. If necessary, a medicine called lasix which help the kidneys drain faster will be injected. This test is done in the Nuclear Medicine department. The tracer is harmless and bad reactions have not been reported.

Treatment of UTI's
When we suspect a UTI is present, we will start your child on an antibiotic until the final urine culture result is ready about 2 days later. We may treat your child for 3-14 days, depending on the type and severity of the infection. After your child finishes all the antibiotic, a repeat urine specimen should be sent to make sure that treatment worked. If the X-rays are abnormal, we may recommend either long term preventative treatment (a low dose of antibiotic at bedtime) or surgery. However, we generally do not recommend looking into the bladder (cystoscopy) or dilating the urethra. When the X-rays are normal, the risk of kidney infection and damage is usually very low and we will treat each new UTI as it occurs. It is important to remember that bladder infections may be annoying but in general do not result in long term problems for your child. However when UTI's are frequent and/or with fever we will probably recommend once a day antibiotics for several months to allow the bladder to fully recover.

How to prevent UTI's
Some children will continue to get UTI's no matter what we do, but others may benefit from a few tips. First, children should be encouraged to drink a reasonable amount of fluid during the day and go to the bathroom at least every 3-4 hours-even if they do not feel the need to void this often. When constipation is present, it should be treated by changing to a high fiber diet or with fiber supplements or other treatments, if severe.