Facts on UTIs in Children

There are three basic forms of Urinary tract Infection (UTI). Pyelonephritis (upper UTI) is an infection involving the upper urinary tract. Cystitis (lower UTI) is an infection of the urinary bladder. While, asymptomatic bacteriuria shows no associated clinical findings but have positive urine culture.

The fecal flora, especially coliform bacteria i:e E.coli, klebsiella, and Proteus ascends  up from the urethra to the urinary bladder and causes the Urinary tract infection. Cystitis is also caused by viral infections such as adenovirus. In both male and females Staphylococcus saprophyticus may also cause UTIs.  Urinary tract infections are more common in boys as infants, however after the age of 2-3 UTIs is more common in girls. The risk for UTI is high among girls when they first begin toilet training, because after going to bathroom when they wipe from back (near the anus) to front this can carry bacteria to the opening from where the urine flows. On the other hand, the risk for UTI among boys is slightly higher among uncircumcised infants.

The symptoms of cystitis (bladder infection) in children includes presence of blood in urine, cloudy urine, foul or strong urine odor, urgency to urinate, malaise, painful or burning urination and wetting problems in already toilet trained children. However, classic symptoms of cystitis – painful urination, urgency, increased frequency - are often absent in children therefore, it is difficult to identify infection. UTIs may also present with unexpected fever, failure to thrive, weight loss, and vomiting and diarrhea in other infants. An infant or child with pyelonephritis (upper UTI) may not have the classic symptoms of flank pain or shaking chills. Asymptomatic bacteriuria which is more persistent in girls shows no symptoms but has positive urine culture.

The diagnosis of UTI in children is done by urinalysis and urine culture. The urine sample is collected and sent to the laboratory for investigation.

The neonates are hospitalized and treated with intravenous antibiotics. Older children who need hospitalization are also treated with intravenous antibiotics. Children with dehydration, emesis, or possible sepsis should also be admitted to the hospital for re-hydration and intravenous antibiotics. Urinalysis should be repeated one week after completion of therapy of any UTIs. Most children are cured with proper treatment. The treatment may continue over a long period of time. Some children who get repeated UTIs may be recommended with long-term use of prophylactic antibiotics. Repeated UTIs in children can be serious and has a higher risk for developing renal diseases. Therefore, follow-up urine cultures may be needed to make sure that bacteria are no longer in the bladder with UTI. The work up should include renal ultrasound.

UTIs in children can usually be prevented. Children’s health solely depends on the hands of their caretakers. Children’s should wear loose-fitting underpants and clothing, refrained from bubble bath and taught to go to the bathroom several times a day. Children’s are to be encouraged to increase their fluid intake. The caretaker needs to teach children’s to keep their genital area clean and wipe the genital area from front to back to reduce the chance of spreading of bacteria from anus to the urethra.