About urinary tract infections (utis) in children

What is urinary tract infections (utis) in children?

Urinary tract infections are a fairly common problem in childhood and may have either a benign course responding to simple antibiotic therapy or be associated with significant disruption in either the anatomy or function of a child's urinary system. This article will focus on UTIs affecting children, with an emphasis on those less than 2 years of age. Because of their more unique and complicated nature, neonatal (less than 28 days of age) UTIs will not be addressed as a specific issue. The principles discussed below, however, are applicable to that age group.

The urinary tract is commonly divided into two areas. The upper urinary tract consists of the kidneys and the delicate tubular structure (ureter) that runs from the kidney to the bladder. The lower tract includes the bladder and the urethra (the tube from the bladder to the outside of the body).

Urinary tract infection (UTI) facts

  • Childhood urinary tract infections are fairly common and are generally caused by bacteria. Routine antibiotic therapy is successful in resolving these infections.
  • Recurrent UTIs in children may be indicative of malformation or malfunction of the urinary tract.
  • Common symptoms and signs of UTIs in children include pain and urgency with urination, blood in the urine, abdominal/pelvic pain, fever, flank pain, and vomiting.
  • Some selected children who experience a UTI should have diagnostic studies performed. These children include children less than 2 years of age, any male child, any child who has had more than one UTI or any child who has had pyelonephritis.
  • Several recommendations exist to help lessen the likelihood of a child developing a UTI.

What is a urinary tract infection (UTI)?

A urinary tract infection is an infection of the bladder (cystitis) or kidney(s) (pyelonephritis). Cystitis is considerably more common than the more severe and more serious pyelonephritis.

What are the symptoms for urinary tract infections (utis) in children?

Symptoms of a Uti can vary depending on the degree of infection and your child’s age. Infants and very young children may not experience any symptoms. When they do occur in younger children, symptoms can be very general. They may include:

  • fever
  • poor appetite
  • vomiting
  • diarrhea
  • irritability
  • overall feeling of illness

Additional symptoms vary depending on the part of the urinary tract that’s infected. If your child has a bladder infection, symptoms may include:

  • blood in the urine
  • cloudy urine
  • foul-smelling urine
  • pain, stinging, or burning with urination
  • pressure or Pain in the lower pelvis or lower back, below the navel
  • frequent urination
  • waking from sleep to urinate
  • feeling the need to urinate with minimal urine output
  • urine accidents after the age of toilet training

If the infection has traveled to the kidneys, the condition is more serious. Your child may experience more intense symptoms, such as:

  • irritability
  • chills with shaking
  • high fever
  • skin that’s flushed or warm
  • Nausea and vomiting
  • side or back pain
  • severe abdominal pain
  • severe fatigue

The initial signs of a Uti in children can be easily overlooked. Younger children may have a difficult time describing the source of their distress. If your child looks sick and has a high Fever without a runny nose, earache, or other obvious reasons for illness, consult their doctor to determine if your child has a UTI.

What are the causes for urinary tract infections (utis) in children?

UTIs are most commonly caused by bacteria, which may enter the urinary tract from the skin around the anus or vagina. The most common cause of UTIs is E. coli, which originates in the intestines. Most UTIs are caused when this type of bacteria or other bacteria spread from the anus to the urethra.

What are the treatments for urinary tract infections (utis) in children?

Antibiotic therapy for UTIs is based upon the sensitivity profile obtained from the urine-culture results. Cystitis (infection limited to the bladder) should respond quickly to routine oral antibiotics. Pyelonephritis may need hospitalization for intravenous administration of antibiotics along with fluid therapy if the patient is experiencing associated vomiting and dehydration. Oral antibiotic therapy, however, may be appropriate if these complications are not present.

The American Academy of Pediatrics has issued a position statement recommending follow-up studies for children who have experienced a urinary tract infection. Children who should be further evaluated include

  • children 2 months of age to 2 years of age who sustain their first UTI,
  • any male child who experiences a UTI,
  • any child 3 years and older who has had more than one UTI,
  • any child who has had pyelonephritis.

The purpose of the studies detailed below is to accurately define the anatomy and functional physiology of these children who may be at risk for renal scarring and possible complete kidney failure.

  • Renal ultrasound: This procedure helps to define the renal anatomy (kidney location, size, shape).
  • VCUG (voiding cysto-urethrogram): This test involves passage of a catheter into the bladder to fill it with dye. After removal of the catheter, the bladder will empty. A radiologist performs imaging studies to monitor for complete bladder emptying without obstruction and/or backward flow (reflux) of the dye from the bladder into to ureters and up to the kidneys.
  • Renal scan: This test uses a small amount of radioactive material (radioisotope) to measure the function of the kidneys. It is designed to evaluate the functional capability of the kidneys and evaluate for possible renal scarring.
  • IVP (intravenous pyelogram): This is a rarely used test involving injecting dye into the bloodstream via an IV. The dye is excreted via the kidneys and then obtaining X-ray images. The renal ultrasound and renal scan have replaced the usefulness of this test.

Are there any home remedies for UTIs in children?

Home remedy suggestions for UTIs in adults are legion, and unfortunately many have no scientific basis in fact. Fewer still have been shown to be safe and possibly effective in children. Those that do fulfill such criteria include:

  1. Unsweetened cranberry or blueberry juice: These juices reportedly lessen the adherence of infective bacteria to the bladder wall and thus allow them to be expelled in urine.
  2. Pineapple: This fruit contains a chemical (bromelain) that reportedly possesses anti-inflammatory properties and thus reduces UTI symptoms.
  3. Yogurt: Some studies have indicated a benefit in consumption of this product. The exact mechanism of benefit is unclear at this time.
  4. Increase in overall fluid intake (for example, water): This would dilute bacteria concentration and allow more effective "flushing out" of harmful bacteria.

What are the risk factors for urinary tract infections (utis) in children?

Causes of UTI in children

UTIs are most commonly caused by bacteria, which may enter the urinary tract from the skin around the anus or vagina. The most common cause of UTIs is E. coli, which originates in the intestines. Most UTIs are caused when this type of bacteria or other bacteria spread from the anus to the urethra.

Is there a cure/medications for urinary tract infections (utis) in children?

The most common antibiotics used for treatment of UTIs in children are:

  • amoxicillin
  • amoxicillin and clavulanic acid
  • cephalosporins
  • doxycycline, but only in children over age 8
  • nitrofurantoin
  • sulfamethoxazole-trimethoprim

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