You are at the store with your five-year-old daughter when she says she needs to go to the bathroom. That’s odd, you think, she went right before we left. She tells you that her urine feels hot. Ten minutes later, she says she has to go again. Could she have a urinary tract infection (UTI)?
A urinary tract infection is a bacterial infection in the urine, bladder, or kidneys. They are quite common in children. Urine is normally sterile, meaning it does not have any bacteria (germs) in it. Infection can get into the bladder causing a urinary infection from the outside of the body. The most common germ that causes a UTI is Escherichia coli (E.coli).
Symptoms include dysuria (painful urination), which includes burning or stinging while urinating, urinary frequency (having to go often), and urgency (an immediate, urgent need to urinate). Sometimes children will have accidents. The urine can smell foul or be cloudy. You may see blood in the urine. The child may say that they feel like they need to urinate, but then have difficulty getting the urine out. In children older than infants, UTIs are more prevalent in females than males.
Infants with urinary tract infections cannot express these symptoms, so they may be fussy and cry (especially during urination). They may run a fever or vomit. They may refuse a bottle or breast, or feed less than usual. In infants, fever without other symptoms points to a possible UTI. Both male and female infants may get UTIs.
In teens, sexual activity increases the risk of UTIs. For this reason, it is common practice to check the urine for gonorrhea and chlamydia in teens with urinary symptoms. Teaching about condom use, urinating before and after intercourse, and wiping front to back may be helpful for the sexually active teen.
Diagnosis requires the collection of urine. If your child can urinate into a sterile cup, a “clean catch” urine collection may be simple, but younger children may struggle with this task. Options include using a pedi-bag to catch urine or catheterization. Pedi-bags are small plastic bags with adhesive that sticks to the skin to catch urine. The problem with them is that as the urine rolls around the outer skin, it often becomes contaminated with normal skin bacteria, which can affect the lab results. Using a small tube (a catheter) to obtain urine is a better option for getting a pure sample, but it is uncomfortable for both child and parent. Your pediatric healthcare provider will help you determine which sample technique is right for your child.
After the urine sample is collected, a urinalysis is run in the office (or lab). This gives a preliminary look at the urine sample. However, to accurately diagnose a UTI, there needs to be a urine culture which can take several days to grow.
Treatment may be started prior to getting the urine culture result. Treatment can eliminate the infection, as well as prevent future kidney damage. Treatment generally includes oral antibiotics, which may be dosed for 7 to 10 days. These are usually dosed twice a day and taken with food to ease any stomach upset. Have your child drink plenty of water to help to flush the urinary system. Taking probiotics (good bacteria) is helpful while children are on antibiotics. Antibiotics may cause loose stools (diarrhea), which probiotics can help to decrease.
Be certain to take the antibiotic medication exactly as it is prescribed and to finish the entire dose of antibiotic. Stopping the medication early may allow the urinary tract infection to return. Sometimes antibiotics may need to be changed based on the results of the urine culture. If your child is on an oral antibiotic, and you are not seeing improvement within 48 hours, call your pediatric healthcare provider.
Most children who have a urinary tract infection will not need follow-up testing as long as symptoms have resolved with the treatment. However, if your child’s symptoms do not resolve or if they return, call and follow up with your pediatric healthcare provider. Sometimes children who have repeated urinary tract infections will need additional testing including renal (kidney) ultrasounds and referral to a pediatric urologist (bladder doctor) or pediatric nephrologist (kidney doctor).
It is important to promptly recognize and treat urinary tract infections so that they do not worsen and spread to the kidneys. Signs of kidney infection (pyelonephritis) include fever, vomiting, and severe back sensitivity/pain. Untreated urinary tract infections can worsen and become more severe, leading to kidney infections and permanent scarring of the kidneys. This type of infection may require hospitalization and IV antibiotics.
If you are concerned that your child might have a urinary tract infection, please do not wait. Contact your pediatric healthcare provider for a same-day appointment. You can recognize the signs of UTI and allow for prompt treatment.
For more information, visit www.ncbi.nlm.nih.gov/pmc/articles/PMC4914380/