Urinary tract infection - children
Definition
A urinary tract infection (UTI) is a bacterial infection of the urinary tract. This article discusses UTIs in children.
The urinary tract includes the:
- Bladder
- Kidneys
- Ureters -- the tubes that take urine from each kidney to the bladder
- Urethra -- the tube that empties urine from the bladder to the outside
See also:
- Catheter-associated UTI
- Urinary tract infection - adults
Causes
Urinary tract infections (UTIs) can occur when bacteria find their way into the bladder or the kidneys. These bacteria are normally found on the skin around the anus or sometimes around the vagina.
Normally, there are no bacteria in the urinary tract itself. However, certain things can make it easier for bacteria to enter or stay in the urinary tract. These include:
- A problem in the urinary tract, called vesicoureteral reflux, which is usually present at birth. This condition allows urine to flow back up into the ureters and kidneys
- Brain or nervous system illnesses (such as myelomeningocele, spinal cord injury, hyrocephalus) that make it harder to completely empty the bladder
- Bubble baths or tight fitting clothes (girls)
- Changes or birth defects in the structure of the urinary tract
- Not urinating (peeing) often enough during the day
- Wiping from back (near the anus) to front after going to the bathroom. In girls, this can bring bacteria to the opening where the urine comes out
UTIs are more common in girls, especially around age 3 when they first begin toilet training. In boys who are not circumcised, the risk for UTIs is slightly higher before the first birthday.
Symptoms
Young children with UTIs may only have a fever, poor appetite, vomiting, or no symptoms at all.
Most urinary tract infections in children only involve the bladder. If the infection spreads to the kidneys, it is called pyelonephritis and may be more serious.
Symptoms of a bladder infection in children include:
- Blood in the urine
- Cloudy urine
- Foul or strong urine odor
- Frequent or urgent need to urinate
- General ill feeling (malaise)
- Pain or burning with urination
- Pressure or pain in the lower pelvis or lower back
- Wetting problems after the child has been toilet trained
Symptoms that the infection may have spread to the kidneys include:
- Chills with shaking
- Fever
- Flushed, warm, or reddened skin
- Nausea
- Pain in the side (flank) or back
- Severe pain in the belly area
- Vomiting
Treatment
In children, UTIs should be treated quickly with antibiotics to protect the developing kidneys. Any child under 6 months old or who has other complications should see a specialist immediately.
Younger infants will usually stay in the hospital and be given antibiotics through a vein. Older infants and children are treated with antibiotics by mouth. If this is not possible, they are admitted to the hospital where they are given antibiotics through a vein.
It is important that your child drink plenty of fluids during the time they have a urinary tract infection.
Some children may be treated with antibiotics for long periods of time (as long as 6 months - 2 years), or they may be prescribed stronger antibiotics.
The health care provider may also recommend low-dose antibiotics after the first symptoms have gone away. This type of treatment is less common now than it once was.
Antibiotics commonly used in children include:
- Amoxicillin or amoxicillin/clavulanic acid (Augmentin)
- Cephalosporins
- Doxycycline (should not be used in children under age 8)
- Nitrofurantoin
- Trimethoprim-sulfamethoxazole
Follow-up urine cultures may be needed to make sure that bacteria are no longer in the bladder.
Prognosis
Most children are cured with proper treatment. The treatment may continue over a long period of time.
The long-term consequences of repeated UTIs in children can be serious. However, these infections can usually be prevented.
Prevention
- Avoid giving your child bubble baths
- Have your child wear loose-fitting underpants and clothing
- Increase your child's intake of fluids
- Keep your child's genital area clean to prevent bacteria from entering through the urethra
- Teach your child to go the bathroom several times every day
- Teach your child to wipe the genital area from front to back to reduce the chance of spreading bacteria from the anus to the urethra
Long-term use of preventive (prophylactic) antibiotics may be recommended for some children who are prone to chronic UTIs.