Urinary Tract Infections in Children

What are the symptoms of Urinary Tract Infections in Children?

Knowing your child has a UTI is tricky. The symptoms are not always obvious to parents, and younger children are usually unable to describe how they feel.

In babies, look for:

• Fever
• Fussiness
• Poor feeding or appetite
• Vomiting
• Strong smelling urine

In older children, look for:

• Fever
• Painful urination
• Frequent need to urinate, but very little urine
• Fear of urinating
• Wetting accidents
• Blood in urine

What causes Urinary Tract Infections in Children?

UTIs occur when bacteria get into the urinary tract. They are much more common in girls because a girl’s urethra is shorter and closer to the rectum. Uncircumcised boys younger than one year also have a slightly higher risk for a UTI.

Other causes could be:

• A problem in the urinary tract (for example, a malformed kidney or a blockage somewhere along the tract of normal urine flow)
• Poor toilet habits
• Infrequent diaper changes
• Family history of UTIs
• Constipation

Many children who get urinary tract infections have normal kidneys and bladders. But there are some abnormalities that could cause UTIs. They include:

• Vesicoureteral reflux (VUR): Urine normally flows from the kidneys down the ureters to the bladder in one direction. With VUR, when the bladder fills, the urine may also flow backward from the bladder up the ureters to the kidneys. This abnormality is common in children with urinary infections.
• Urinary obstruction: Blockages to urinary flow can occur in many places in the urinary tract. The ureter or urethra may be too narrow, or a kidney stone stops the urinary flow. Occasionally, the ureter may join the kidney or bladder at the wrong place and prevent urine from leaving the kidney in the normal way, resulting in infection.
• Dysfunctional voiding: Some children develop a habit of delaying a trip to the bathroom because they don’t want to leave their play. They may work so hard at keeping the sphincter muscle tight that they forget how to relax it at the right time. These children may be unable to empty the bladder completely. Some children may strain during urination, causing pressure in the bladder that sends urine flowing back up the ureters. Dysfunctional voiding can lead to vesicoureteral reflux, accidental leaking, and UTIs.

How are Urinary Tract Infections in Children diagnosed?

Only by consulting a healthcare provider can you find out for certain whether your child has a urinary tract infection. At Michigan Institute of Urology in Southeast Michigan we frequently diagnose and treat UTIs in children. Here’s what you can expect:

Some of your child’s urine will be collected and examined.

• If the child is not yet toilet trained, the healthcare provider may place a plastic collection bag over your child’s genital area. In other cases, a small catheter may be inserted to collect sterile urine for analysis.
• An older child may be asked to urinate into a container. The sample needs to come as directly into the container as possible to avoid picking up bacteria from the skin or rectal area.
• If needed, we can insert a small tube into the urethra to allow urine to drain directly from the bladder into a container.

The collected urine will be examined under a microscope. If an infection is present, bacteria and sometimes pus will be found in the urine. If the bacteria from the sample are hard to see, the healthcare provider may place the sample in a tube or dish with a substance that encourages any bacteria present to grow. Once the germs have multiplied, they can then be identified and tested to see which medications will provide the most effective treatment. The process of growing bacteria in the laboratory is known as performing a culture and often takes a day or more to complete.

If you collect your child’s urine at home, refrigerate it as soon as it is collected and carry the container to the healthcare provider or lab in a plastic bag filled with ice.

How are Urinary Tract Infections in Children treated?

UTIs are treated with antibiotics. Be sure to give your child the antibiotics exactly as prescribed to ensure the infection clears and does not reoccur. Treatment usually lasts about a week.

If a child has severe pain when they urinate, your doctor can also prescribe numbing medicine to make it more comfortable.

Your child should drink plenty of fluids without caffeine during and after treatment.

Once cleared, additional tests may be recommended to check for abnormalities in the urinary tract. Repeated infections may cause kidney damage. These tests may include:

• Kidney and bladder ultrasound: An ultrasound test examines the kidney and bladder using sound waves. This test shows shadows of the kidney and bladder that may point out certain abnormalities.
• Voiding cystourethrogram (VCUG): Although not commonly done, this test examines the urethra and bladder while the bladder fills and empties. A liquid that can be seen on x-rays is placed into the bladder through a catheter. The bladder is filled until the child urinates. This test can reveal abnormalities of the inside of the urethra and bladder. The test can also determine whether the flow of urine is normal when the bladder empties.
• Abdominal X-ray: May be used to get an accurate picture of the child’s stool burden.
• Nuclear scans: These tests use radioactive materials that are usually injected into a vein to show how well the kidneys work, the shape of the kidneys, and whether urine empties from the kidneys in a normal way. Each kind of nuclear scan gives different information about the kidneys and bladder. Nuclear scans expose a child to about the same amount of radiation as a conventional x-ray. At times, it can even be less.
• Computed tomography (CT) scans and magnetic resonance imaging (MRI): These tests provide 3-D images and cross-section views of the bladder and kidneys. With a typical CT scan or MRI machine, the child lies on a table that slides inside a tunnel where the images are taken. If the child’s infection is complicated or difficult to see in other image tests, a CT scan or MRI can provide clearer, more detailed images to help the doctor understand the problem.
• Pelvic floor physical therapy: This may be used in the appropriate setting to “re-train” the child to void correctly.