How Do I Know If My Child Has A Urinary Tract Infection
UTIs are sometimes hard to diagnose in babies and young children, because they can’t tell us how they’re feeling. Therefore, urine should be tested in a baby or a young child who has an unexplained fever for three days. A UTI may be the cause of the fever. Fever might be the only symptom in a baby with pyelonephritis.
An older child might be able to tell you that it hurts to urinate. Children who have a sudden need to urinate and who hold themselves or squat to keep from urinating might have a UTI. If your child has a kidney infection, you may be able to tell that he or she is sick. Your child may act tired, or have a fever, or have nausea and vomiting.
Of course, babies and children can get a fever from many other illnesses, such as colds, ear infections and the flu. Also, other things can cause pain with urination or loss of urine control. Irritation at the opening of the urethra may cause pain with urination. Bubble baths can irritate the tender skin around the urethra and make urination hurt. Dirty diapers or underpants can irritate the skin around the genital area and cause pain. .
If you think your child has a UTI, call your doctor.
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AAP. 2018. Recurrent urinary tract infections in children. American Academy of Pediatrics. https://www.healthychildren.org/English/health-issues/conditions/genitourinary-tract/Pages/Urinary-Tract-Infections-in-Teens.aspx
AAP. 2016. Reaffirmation of AAP clinical practice guideline: The diagnosis and management of the initial urinary tract infection in febrile infants and young children 2 24 months of age. American Academy of Pediatrics. https://pediatrics.aappublications.org/content/138/6/e20163026
MedlinePlus. 2019. Urinary tract infection children. U.S. National Library of Medicine, National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000505.htm
NIDDK 2017b. Symptoms and causes of bladder infection in children. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. https://www.niddk.nih.gov/health-information/urologic-diseases/urinary-tract-infections-in-children/symptoms-causes
How Is A Urinary Tract Infection Diagnosed How Do Healthcare Providers Test For A Uti In Toddlers
After interviewing you about your childs history and performing a physical examination, the healthcare provider may order the following tests:
- Urine tests like the leukocyte esterase and a urine culture to test for the presence of bacteria or white blood cells.
- Blood tests looking for infection or kidney function.
- Ultrasound or CT of the kidneys and bladder.
- Voiding cystourethrogram , which evaluates the bladder and urethra to detect vesicoureteral reflux .
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What Is A Urinary Tract Infection In Toddlers
A UTI is an infection in your childs urinary tract which includes their kidneys, the ureters that connect them to the bladder and the urethra where urine exits their body. Bacteria get into their urinary tract through the skin around their rectum and genitals or through the bloodstream from any part of their body .
Because it may not be obvious when a child has an infection, especially if theyre too young to voice their symptoms, UTIs in children sometimes go unnoticed. Urinary tract infections need to be treated immediately to prevent the infection from spreading and damaging the kidneys.
Pyuria Is Defined As White Blood Cell Count Of 10/mm3
The standard method of detecting pyuria, defined as at least 5 WBCs per high-powered field, is useful in predicting less than half of the UTIs in infants.48 However, a method initially described by Dukes,49 in which WBCs are counted using a hemocytometer in uncentrifuged urine and reported as cells per cubic millimeter has been shown to be reproducible and more closely related to a positive urine culture. A pediatric study including young infants showed that a WBC count of 10/mm3 had a sensitivity of 91% and a specificity of 96% for predicting a positive culture of 50,000 cfu/mL.50 A more recent study, also including young infants, compared the enhanced method with automated urinalysis and found similar sensitivity and specificity for detecting pyuria associated with a bacterial culture of 50,000 cfu/mL.51 For bacteriuria, the same study found that the enhanced method using a manual Gram stain for organisms was about 10% more sensitive and specific than the automated analysis.
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Can Utis Be Prevented
These tips can help prevent UTIs:
- School-age girls should avoid bubble baths and strong soaps that might cause irritation. They also should wear cotton underwear instead of nylon because it’s less likely to encourage bacterial growth.
- All kids should be taught not to “hold it” when they have to go. Pee that stays in the bladder gives bacteria a good place to grow.
- Kids should drink plenty of fluids but avoid those with caffeine.
Is There Any Way To Prevent Urinary Tract Infections
Some children may just be prone to UTIs, but here are a few things you can do to minimize your baby’s risk of infection.
- Hydrate: Be sure your child gets plenty of fluids. Fluids also help prevent constipation, which would make a UTI more likely. Drinking more will make your child urinate more frequently, flushing out the urinary tract.
- Nurse: If you’re breastfeeding, continue until your baby is at least 7 months old, if possible. Some studies have shown that nursing for this long may protect against UTIs and that the benefits persist, even after weaning, for up to two years.
- Offer fiber-filled foods: If your baby has started solids, offer plenty of fruits, vegetables, and whole grains to help prevent constipation, which has been tied to recurrent UTIs. The same holds true for toddlers.
- Careful with soaps: If your baby or toddler is a girl, avoid harsh soaps and bubble baths .
- Wipe correctly: Wipe from front to back when you change your baby’s diaper to minimize the bacteria in the area. If your child is toilet trained, teach her to do this herself.
- Empty bladder: If your child is toilet trained, remind her to empty her bladder completely each time she goes rather than hopping off the toilet before she’s done.
- Cranberry juice: Consider offering your toddler small amounts of cranberry juice. Some studies suggest this popular home remedy may help ward off recurring UTIs. However, there’s no good evidence that cranberry juice is effective against an existing UTI.
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Underlying Renal Abnormalities Increase The Risk Of Neonatal Urinary Tract Infection
VUR is associated with approximately 20% of neonatal cases of UTI,5,26 although the incidence of VUR is not significantly different between genders, birth weight, gestational age, or mode of delivery.26,27 A study of infants less than 2 months of age in a neonatal intensive care unit with a median gestation age of 28 weeks reported a less than 5% rate of anatomic abnormalities in patients with UTI. VUR was, however, associated with a younger age at UTI presentation and was 4-fold higher in infants with Klebsiella UTI compared with E coli UTI.5,26 A study of 45 male infants with a first UTI renal ultrasound scan and voiding cystourethrogram found a renal abnormality in half of the infants, the most common being VUR and other abnormalities, including duplicated collecting system, posterior urethral valves, ureteropelvic junction stricture, and renal atrophy and scarring.28 The dimercaptosuccinic acid scan was abnormal almost exclusively in those with grade 3 or higher VUR. These results are similar to those in a recent study, in which 47% of febrile infants less than 30 days of age with a UTI had renal abnormalities, most of them hydronephrosis and pelviectasis .5 However, even in the absence of any abnormalities on the RUS or VCUG, infants with UTI can have an abnormal DMSA scan, indicating renal cortical damage, although that may be an effect rather than a cause of a UTI.29 Representative images for RUS and VCUG in infants are shown in Figs. 1 and and22.
Prophylactic Antibiotics Are Not Effective In Reducing Renal Scarring But Do Increase The Risk Of Recurrence With A Resistant Strain
Evidence regarding the efficacy of prophylactic therapy to prevent recurrences after the first episode of UTI is lacking for the neonatal population. Even for older infants, several small trials have found that antimicrobial prophylaxis may not be effective in preventing renal scarring.66,67 Other more recent studies found that although the prophylaxis may decrease the risk of recurrence, its effect on renal scarring is not significant, and recurrent episodes are more likely to be caused by a more resistant strain.68,69
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What Are The Treatments For Utis
Antibiotics, mainly. These medications kill bacteria. Kids usually take them for anywhere from 3 to 10 days . Your doctor might do another urine test after your child finishes the medicine to see if the infection has cleared up.
Make sure your child finishes all of their meds, even if they start to feel better. Stopping too soon can make germs resistant to antibiotics and cause another infection.
Most UTIs clear up in about a week. Some kids will have symptoms for a few weeks. Call your doctor if your child’s symptoms don’t start to improve after 3 days from when they started on antibiotics, or if they get worse.
Neonatal Urinary Tract Infection Can Be Treated With A Combination Of Parental And Oral Therapy
Data regarding the length of duration of treatment and the transition from parenteral to oral therapy in the infant are lacking. In the extremely premature infant, bioavailability of most antibiotics is not known therefore, intravenous therapy is typically preferred. Documentation of negative blood and CSF cultures in both extremely premature and older infants provides optimal care. In older infants, Benador and colleagues61 found that the risk of renal scarring was no different between infants that received 3 days of parental therapy followed by 7 days of oral therapy compared with 10 days of oral therapy. In older and more mature infants with negative blood and CSF cultures, 3 to 4 days of parental therapy followed by transition to oral medications to complete a 7- to 14-day course of treatment can be used.62
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Types Of Utis In Children
Common types of UTIs include:
- Cystitis: this bladder infection is the most common type of UTI. Cystitis occurs when bacteria move up the urethra and into the bladder
- Urethritis: when bacteria infect the urethra
- Pyelonephritis: a kidney infection caused by infected urine flowing backward from the bladder into the kidneys or an infection in the bloodstream reaching the kidneys
Urinary Tract Infections In Boys
Urinary tract infections in boys are the result of bacteria getting into the bladder and staying there. UTIs are common in kids, especially girls and uncircumcised boys. E. Coli, responsible for over 75% of UTIs, doubles every 20 minutes in the bladder. That means if there are 100 bacteria of E. Coli in the bladder and you wait three hours to go to the bathroom, you will have over 50,000 bacteria in your bladder. The more bacteria in the bladder and the longer it stays there, the more likely you are to get a UTI.
There are many things that can be done to both treat urinary tract infections in boys and prevent them in the future.
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Screening Dipstick And Microscopy
Urine dipsticks are a quick, inexpensive bedside screening tool. Chemical reagent strips change colour in the presence of leucocyte esterase and nitrites, which may arise from UTI.26 Leucocytes generally appear in the urine in response to UTI. However, sterile pyuria can occur with other infections. Enterococcus, Klebsiella and Pseudomonas species are also less likely to produce pyuria than E.coli in children with symptomatic UTI.27 Most uropathogens convert dietary nitrates into urinary nitrites. However, not all do, including Enterococcus and Klebsiella species.26 Dipsticks are also less reliable in young infants, where frequent voiding flushes substrates out of the bladder.26
Neither leucocytes or nitrites are fully sensitive or specific for UTI, but they are a useful screening test, particularly when used in combination. If UTI is thought unlikely, dipsticks have a good negative predictive value to exclude the diagnosis.28 In the presence of suggestive symptoms and either leucocytes or nitrites, empirical antibiotics while awaiting culture is indicated.16
Urine microscopy also identifies leucocytes and bacteria, augmenting dipstick screening.
Diagnosing Urinary Tract Infections In Children
Urinary tract infections in children can usually be diagnosed by your GP. They’ll carry out a physical examination, ask about your child’s symptoms, and request a urine sample.
You may be asked to collect the urine sample yourself, or a doctor or nurse at your GP surgery may help you.
These tests help your GP identify what’s causing the infection and determine whether it’s in the lower or upper part of the urinary tract.
If your child is less than three months old, your GP may refer you straight to hospital to see a specialist in caring for children without asking for a urine sample.
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Recurrent Uti: Prophylaxis And Prevention
There are few pragmatic strategies to reduce the risk of recurrent UTI in children. Circumcision reduces the risk of UTI in males, but involves surgery, with a number needed to treat of > 100to prevent one UTI.42 There is insufficient evidence to support cranberry prophylaxis or probiotics.43 Antibiotic prophylaxis has modest benefits, increases antibiotic resistance44 and is not indicated after first or second UTI in otherwise healthy children.45 For children with VUR, antibiotic prophylaxis reduces UTI recurrence but does not reduce scarring.46 Simple hygiene such as wiping front to back in females can avoid introducing bacteria into the urethral orifice. Active management of toilet training and constipation is important to prevent functional bladderbowel dysfunction.4 21
What Is A Urinary Tract Infection
A urinary tract infection can occur in any of the parts of the urinary tract . Normally, urine in the kidneys, the ureters and the bladder doesn’t have any bacteria in it. Bacteria are normally present only at the very end of the urethra and on the skin around the opening of the urethra. The bacteria that are normally present around the urethra don’t usually cause an infection. When harmful bacteria get into the urinary tract, though, they may cause an infection. The bacteria that cause a UTI can get into the urinary tract at the opening of the urethra.
If bacteria get into your child’s bladder, they can cause a bladder infection. The medical word for a bladder infection is cystitis. When bacteria are in the bladder, they can irritate the bladder. The irritation makes it hurt when your child urinates. Your child might have a burning feeling when he or she urinates. Your child may also have a constant feeling of needing to urinate. Sometimes, children with a bladder infection lose control and wet themselves. There is usually little or no fever with a bladder infection.
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What If My Child Has Had Quite A Few Bladder Or Kidney Infections
If your child has had pyelonephritis or cystitis more than a few times, your doctor may want to get x-rays of your child’s urinary tract. The x-rays would show the bladder, the ureters and the kidneys. Or your doctor might get a sonogram. The x-ray or the sonogram can show if there is a problem in the kidneys, the ureters or the bladder that causes infections. Your doctor may refer your child to a special doctor who treats urinary tract problems. Sometimes taking a low dose of an antibiotic for a long time can stop repeat infections.
Most children who have many UTIs don’t have a problem in the urinary tract. Instead, they have poor urinary habits. Teaching your child good bathroom habits can help prevent UTIs.
When To Contact A Medical Professional
Things you can do to prevent UTIs include:
- Avoid giving your child bubble baths.
- Have your child wear loose-fitting underpants and clothing.
- Increase your child’s intake of fluids.
- Keep your child’s genital area clean to prevent bacteria from entering through the urethra.
- Teach your child to go the bathroom several times every day.
- Teach your child to wipe the genital area from front to back to reduce the spread of bacteria.
To prevent recurrent UTIs, the provider may recommend low-dose antibiotics after the first symptoms have gone away.
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Urinary Tract Infections In Babies
It can be hard to figure out whats wrong with babies when all they can do to communicate pain is cry. A fussy infant may have any number of health problems, from colds to rashes, but some medical problems are harder to identify than others. For example, many parents may not know that babies can get infections in their urinary tract. In fact, childhood urinary tract infections account for more than 1 million pediatrician visits each year in the US.
UTIs are usually caused by bacteria in the kidneys, ureters , or bladder. Sometimes the body can rid itself of this bacteria but when it cannot, the bacteria can build up and cause an infection. Bacteria and other infection-causing microbes may enter the urinary tract when an infant has a dirty diaper or when babies are wiped from back to front. Good hydration enabling frequent urination and maintaining proper hygiene can help prevent UTIs.