Urinary Tract Infection In Children

What is a urinary tract infection?

A urinary tract infection (UTI) is when germs (bacteria) get inside your child's urinary tract. Your child's urinary tract includes his kidneys, ureters, bladder, and urethra. Urine is made in the kidneys, and flows from the ureters to the bladder. Urine exits your child's body from his bladder through his urethra. A urinary tract infection in your child's lower urinary tract includes his bladder and urethra. A UTI that travels up into your child's kidneys is called pyelonephritis. Ask your child's caregiver for more information about pyelonephritis.

What causes a urinary tract infection?

A UTI is caused by germs that enter your child's urethra and travel up to his bladder. The germ that commonly causes a UTI is Escherichia coli (E coli). Your child's urethra is close to his anus, the opening where bowel movements (BMs) leave your child's body. This makes it easier for germs to enter your child's urinary tract. UTIs are more common in girls because the urethra is shorter allowing bacteria to enter the urinary tract more easily. Most germs that enter your child's urinary tract are washed out when he urinates. If the germs stay in your child's urinary tract, he may get an infection.

What increases my child's risk for a urinary tract infection?

The following may increase your child's risk of getting a UTI:

• Urination disorders: Your child may have problems urinating if he has vesicoureteral reflux (VUR). With VUR, urine flows backward from your child's bladder to his ureters and kidneys. Neurogenic bladder occurs when your child cannot empty his bladder properly because of nervous system problems. Your child's nervous system includes his brain, spinal cord, and nerves. Your child may also have problems urinating if he has trouble with constipation (hard to pass BMs). Ask your caregiver for more information about urination disorders.
  
  
• Abnormal urinary tract: Your child's UTI risk increases when there are problems with the organs in his urinary tract. This includes having an extra ureter, or problems with the way his ureter or urethra are formed. If your child has a larger bladder than normal his UTI risk increases. Your child's UTI risk is greater if he had kidney problems while you were pregnant with him. Your child's UTI risk also increases if he has had a UTI in the past.
  
  
• Blockages: A blockage may not allow your child's urine to flow freely, trapping germs in the urinary tract. Causes of a blockage include tissue growths or narrowed areas in your child's urinary tract. Stones that form in your child's kidney (kidney stones) also may cause a blockage in his urinary tract.
  
  
• Indwelling objects: Your child's UTI risk increases if he has an indwelling (stays inside the body) device. These devices include Foley catheters and ureteral stents. A Foley catheter is a thin tube that is put in your child's bladder. The catheter empties urine from his bladder into a bag. A ureteral stent is a tube placed in your child's ureter to help urine flow from his kidney to his bladder. Germs may attach to the devices and cause a UTI.
  
  
• Weak immune system: Your child's immune system is his body's defense against infection and disease. When your child's immune system is weak, it cannot fight against the germs that cause a UTI. Medical conditions, such as diabetes (high blood sugar) may lead to a weak immune system. A newborn baby's immune system is not fully developed, which can increase his UTI risk.
  
  
• No circumcision: Baby boys have a higher UTI risk in the first six months of life if they are not circumcised. Circumcision is a procedure that removes the foreskin from the tip of a baby boy's penis. Talk to your child's caregiver for more information about circumcision.
  
  
• Sexual activity: UTI risk increases if your child is having sex. If your child's partner has an infection your child is more likely to get an infection. Girls who use a diaphragm or spermicide (types of birth control) also have a higher UTI risk.

What are the signs and symptoms of a urinary tract infection?

The signs and symptoms of a UTI in children may be different depending on their age.

• Babies and children younger than age two may have the following signs and symptoms:
  
  
  • Bad-smelling urine.
    
    
  • Diarrhea (loose, watery BMs).
    
    
  • Fever (high body temperature).
    
    
  • Increased tiredness and irritability (crying more than usual).
    
    
  • Jaundice (yellowing of the skin and whites of the eyes).
    
    
  • More wet diapers (urinating more) than is normal for your child. Your child may also have fewer wet diapers than is normal for him.
    
    
  • Poor feeding, poor appetite for food, and not growing as your child's caregiver says he should.
  
  
• Children age two and older may have the following signs and symptoms:
  
  
  • Abdominal (belly) pain and tenderness (pain when touched).
    
    
  • Bad-smelling urine.
    
    
  • Feeling an urgent need to urinate. Your child may need to urinate more than what is normal for him. He may urinate small amounts, and he may leak urine. Your child may also wake from sleep often to urinate, and may wet the bed after he is toilet-trained.
    
    
  • Pain or a burning feeling when urinating.

How is a urinary tract infection diagnosed?

Your child's caregiver will ask about your child's signs and symptoms. Your child's caregiver will check your child's belly, back, and genitals (penis or vagina). He may check for discomfort by pressing on your child's belly, sides, and back. Your child may also need the following:

• Urine tests: A sample of your child's urine is collected and sent to a lab for tests. Testing may be done on your child's urine to learn what germ is causing his infection. The following may be done to collect your child's urine:
  
  
  • Clean-catch: Your child may be able to give a urine sample by urinating into a cup.
    
    
  • Collection pad: Your child's caregiver may give you a special pad to soak up your child's urine for testing.
    
    
  • Urine bag: If your child wears diapers, a small plastic bag may be attached to your child's genitals. When your child urinates, the urine will go into the bag.
    
    
  • Catheter: Your child may need a catheter put into his bladder to get a urine sample. Your child's urine will flow out of the catheter into a clean cup.
    
    
  • Suprapubic aspiration: A needle may be inserted through your child's belly and into his bladder to collect a urine sample.
  
  
• Blood tests: Your child may need blood tests to give caregivers information about how his body is working. The blood may be taken from your child's arm, hand, finger, foot, heel, or IV.
  
  
• Imaging tests: Your child may need imaging tests if his symptoms do not get better after starting treatment. Imaging tests are pictures of your child's urinary tract that can show if his infection is in his kidneys. Imaging tests can check for reflux or other problems in your child's urinary tract. Your child may be given dye before certain imaging tests. The dye is used to help your child's caregiver see the pictures better. People who are allergic to shellfish (lobster, crab or shrimp) may be allergic to some dyes. Tell your child's caregiver if your child is allergic to shellfish, or has other allergies. Ask your child's caregiver about these or others imaging tests your child may need:
  
  
  • Nuclear medicine tests: During nuclear medicine tests, your child is given a special liquid through an IV or a catheter. An IV is a small tube put into your child's vein. Pictures may be taken of your child's urinary tract while the liquid enters his body. Pictures may also be taken while your child urinates, and after his bladder is empty.
    
    
  • Ultrasound: An ultrasound is a test that looks inside your child's body. Sound waves are used to show pictures of your child's urinary tract on a TV-like screen.
    
    
  • Voiding cystourethrogram: During a voiding cystourethrogram, a catheter is put into your child's urethra and bladder. Dye is put through the catheter, and pictures are taken of your child's urinary tract. The pictures are taken while the dye is going in, and while your child is urinating out the dye.

How is a urinary tract infection treated?

Treatment for your child's UTI depends on how serious (bad) his infection and symptoms are. With treatment, your child's symptoms, such as a fever and the need to urinate often, may go away. Treatment may prevent the infection from moving into his kidneys causing a serious health problem. Treatment may cure your child's UTI. Your child may need the following:

• Antibiotics: Your child may be given antibiotics to kill the germs causing his UTI. Your child may need to take long-term antibiotics if he has problems with his urinary tract. Your child may also need long-term antibiotics if he has had more than one UTI. Ask your child's caregiver how long your child will need antibiotic medicine.
  
  
• Surgery: Your child may need surgery to remove a blockage in his urinary tract, or to stop his reflux. He may also need surgery to repair damage or other problems in his urinary tract. Ask your child's caregiver for more information about any surgery your child may need.

What are the risks of a urinary tract infection?

• Your child may feel worried or scared about having tests. Your child may have an allergic response to the medicines used to treat his UTI. Even after your child takes medicine to treat his UTI, the infection may come back. Taking long-term antibiotic medicine may cause antibiotic resistance. Resistance means that germs in your child's body become harder to kill. Your child may get a UTI in the future that is very hard to treat. If your child needs surgery, he may be in the hospital for many days. Your child may have pain when urinating after surgery.
  
  
• Without treatment for your child's UTI, his infection and symptoms may get worse. The infection can spread to your child's blood, which can be life-threatening. The germs may travel to your child's kidneys, causing pyelonephritis. This can be a very serious condition, and your child may need treatment in the hospital. Pyelonephritis could lead to scarring in your child's kidneys and permanent (lifelong) kidney problems. Kidney problems may cause high blood pressure later in life. Girls may have problems with their blood pressure during a future pregnancy. Kidney problems may also lead to kidney failure. Talk with your child's caregiver if you have questions or concerns about your child's illness, care, or treatment.

How can I help prevent my child from getting a urinary tract infection?

• Breastfeed your baby: If you are able, breastfeeding your baby may help make his immune system stronger.
  
  
• Have your child empty his bladder often: Make sure your child urinates and empties his bladder as soon as he feels he needs to. Teach your child not to hold his urine for long periods of time.
  
  
• Make sure your child drinks enough liquids: Have your child drink more liquids each day to help wash out his urinary tract. Good choices for most children to drink include water, juice, and milk. Your caregiver may suggest your child drink cranberry juice. The high fruit acid levels in cranberry juice may help prevent another UTI. Ask your caregiver how much liquid your child should drink each day.
  
  
• Teach your child to wipe from front to back. Wiping from front to back after urinating or having a BM can decrease your child's risk for a UTI.
  
  
• Treat your child's constipation: Treating your child's constipation may lower his UTI risk. Ask your child's caregiver how to treat your child's constipation.

When should I call my child's caregiver?

Call your child's caregiver if:

• Your child has a fever.
  
  
• Your child is not getting better after 1 to 2 days of treatment.
  
  
• Your child is vomiting (throwing up) or has diarrhea.
  
  
• Your child is toilet trained and starts to wet himself.
  
  
• Your child is waking from sleep to urinate, or is wetting the bed.
  
  
• Your child's urine looks cloudy or smells bad.

When should I seek immediate help for my child?

Seek care immediately or call 911 if:

• Your child has a fever and chills, back pain, is urinating often, and has pain when he urinates.
  
  
• Your child's has blood in his urine.
  
  
• Your child has very strong pain in his belly, sides, or back.
  
  
• Your child is urinating very little, or not at all.

Where can I get more information?

Contact the following:

• American Academy of Pediatrics
  141 Northwest Point Boulevard
  Elk Grove Village , IL 60007-1098
  Phone: 1- 847 - 434-4000
  Web Address: http://www.aap.org
  

• American Urological Association
  1000 Corporate Boulevard
  Linthicum , MD 21090
  Phone: 1- 410 - 689-3700
  Phone: 1- 866 - 746-4282
  Web Address: http://www.auanet.org
  

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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