Preventing UTI in Infants, Toddlers and Preschoolers

Surprisingly, urinary tract infection in children is more common than you think. It occurs more in girls, especially during the period when they are potty-trained. The infection also affects boys but more for those who are uncircumcised and under the age of one.

Urinary tract infection, UTI, is an infection in the urinary tract, which is composed of the bladder, kidney, urethra (the tube that is connected to the bladder and thus delivers urine out of the body) and ureter (the duct where urine passes from the kidney to bladder).

Signs and Symptoms of Urinary Tract Infection in Children

Urinary tract infection in children who are younger:

• Fever. Often, this is the sole symptoms in infants. In older kids, it may not even manifest.
• Pain during urination which causes crying
• Foul-odored urine
• Irritability
• Loss of appetite which leads to poor weight gain
• Vomiting
• Diarrhoea

Urinary tract infection in children who are older:

• The sensation of burning or pain during urination
• Frequent urge to urinate but only does so in small amounts
• Foul-odored urine
• Urine that is either reddish or pinkish because it is tinged with blood; urine that is cloudy
• Bed-wetting despite being potty-trained
• Pressure or pain under the navel
• Pain in the flank (abdomen and upper back), on either one side or in both

Signs that the infection has spread to the kidneys

• Fever
• Chills
• Nausea
• Vomiting
• Warm or red skin
• Pain in the side or back
• Severe pain in the belly

Causes of urinary tract infection in children

Bacteria is the most common cause of urinary tract infection in children. Their entry point is the urethra from where they continue to travel on top of the urinary tract.

Bacteria are found in areas around the anus and the vagina.

Bacteria can be from the large intestines (E. coli is usually the culprit) or stool. They can also be carried by the blood and the lymph system to be delivered to the urinary tract to cause bladder and kidney infections. Some viruses may also cause UTI.

The following cause bacteria buildup:

• Constipation
• Infrequent urination
• Improper hygiene; failing to remove all stool following a bowel movement or wiping from front to back, in girls, which causes stool to be delivered near the opening of where urine exits. Bacteria can then enter the urethra.
• Unsuccessful emptying of the bladder which causes bacteria to accumulate
• Irritation to the urethra caused by strong soaps in a bubble bath or tight-fitting clothes for girls

Complications with the function and structure of the urinary tract are common in infants and young children. Instances when the body is unable to completely remove urine are:

• A blockage that obstructs or impedes the flow of the urine such as kidney stones
• When urine flows backwards to the kidney, which is called vesicoureteral reflux (VUR)
• Other abnormalities that occur in the urinary tract

Risk Factors

• Infrequent urinating*
• Unsuccessful emptying of the bladder completely*
• Constipation*
• Uncircumcised boys are at high risk before they reach one. The foreskin may promote bacteria growth if not cleaned properly
• Urinary tract abnormalities such as urinary obstructions, kidney stones or a malformed kidney. These prevent the complete emptying of the bladder which increases the risk of contracting urinary tract infection in children. Such problems are either experienced by the child from birth or it may develop after.
• Backward flow of urine from the bladder to the kidneys or vesicoureteral reflux (VUR)
• Having a urinary catheter, a tube is inserted into the urethra when a child is unable to urinate. The catheter may be an entry point for bacteria
• Having experienced UTI before
• Having a family member who experienced UTI or VUR

*Note: These three commonly occur during the potty-training period.

Complications

• Long-term kidney damage
• High blood pressure
• Children who have untreated urinary obstructions or impaired immune systems or other conditions which affect the bladder or kidneys are more susceptible to complications
• Sepsis or widespread infection that affects kidney functions. Though rare, it is serious.

When to Call the Doctor

For urinary tract infection in children, early detection and treatment are paramount. Call the doctor immediately–do not wait–if your child experiences:

• Unexplained fever–38 C in infants; 38.3 C in children–that persists
• Vomiting
• Frequent urge to urinate, yet only passes a small amount of urine
• Burning pain while urinating
• Cloudy, redding, pinkish or brownish urine that smells foul
• Pain in the flank area
• Vaginal discharge accompanied by urinary tract infection symptoms

Call a doctor immediately if your infant: seems irritable, has a fever, reduced appetite and experiences vomiting.

Do not wait and observe your child further if you suspect he has UTI. The untreated infection can lead to complications such as high blood pressure and permanent kidney damage.

Contact the doctor if 48 hours after beginning antibiotics your child still isn’t feeling better and/or the symptoms continue or recur more than twice in a span of six months.

Tests and Diagnosis

If symptoms for urinary tract infection for kids are present, then the doctor will check the child’s medical history and conduct a physical exam.

Then, a urinalysis, which can detect the presence of the urinary tract infection in children, will be done. A urine culture, which determines the bacteria causing the infection, may also be ordered by the doctor.

Though the results from the urine culture may take days, the doctor will prescribe antibiotics immediately.

Methods of collecting urine

To collect a urine sample in younger children, they will be asked to urinate into a container.

For babies, a catheter may be inserted into the urethra to collect urine from the bladder. However, this method is likely to have substances contaminate the urine sample.

An alternate method is the insertion of a needle into the abdomen to collect urine from the bladder directly.

Further tests

If your child has urinary tract infection, additional tests may be ordered under the following circumstances:

• Your child has a history of bladder or kidney problems or an abnormality in the urinary tract. These can cause difficulty in treating the infection
• Your child does not improve after four days of medication
• Your child has a bacteria that resists the treatment
• Your child has an injury to his kidney

Additional tests that can be ordered by the doctor are:

• Kidney ultrasound
• Cystourethrogram or voiding cystourethrogram (VCUG) is an x-ray done while the child urinates to capture pictures of the urethra and bladder in action. This catches any abnormalities in the urinary tract.

Treatments and Drugs

The objective of the treatment is to prevent both short- and long-term damage to the kidneys through the complete eradication of the infection. This is why early detection is crucial.

Treatment for children is done through oral antibiotics and at-home care.

A shot of antibiotics is given to a child who is: too sick to swallow the medicine, has an impaired immune system or is under three months old.

A child may also be admitted to the hospital to receive brief course antibiotics administered intravenously following these circumstances:

• The child is six months or below
• The infection has spread to the blood
• Kidney infection is suspected
• The child cannot take oral medicines
• The child is dehydrated

After he improves, he can be released to continue on oral contraceptives.

The duration of the treatment depends on the child’s age, type of illness and type of antibiotics given.

If a child experiences severe pain while urinating, then a doctor may prescribe medicine to alleviate the pain.

If a child does not get better or has recurring UTI, then he will need to be evaluated again and be given additional antibiotics.

Prognosis

Proper treatment will cure most children. Any recurring infection can be prevented through antibiotics and at-home care.

Note that recurring infections that involve the kidneys may lead to long-term kidney damage.

Prevention

It is difficult to prevent urinary tract infection in children. However, a doctor may give antibiotics to prevent the infection from recurring in a child who already has suffered from UTI. (With each UTI comes increased risk of contracting the infection again.)

For children who are at high risk of suffering from recurring UTI, they may be given the long-term treatment of antibiotics.

At-Home Care

Despite the challenge in preventing the infection, here are tips that reduce the risks contracting the infection:

• Frequent diaper change for infants and toddlers
• During potty training, where children may not be able to empty their bladder, schedule regular trips to the potty to help children pass all their urine
• Keep your child’s genitals clean
• Encourage children to urinate as soon as they can. Holding it in increases the risk for the infection
• Use of cotton underwear for girls; avoid nylon which promotes bacterial growth
• Teach proper hygiene after bowel movements
• Encourage children to increase their liquid intake which also increases the frequency of urinating.
• To avoid constipation, offer a diet rich in fibres such as whole grain bread; oatmeal; fruits (apples, bananas, strawberries, oranges); dark-coloured vegetables (spinach, broccoli, carrots); potatoes; beans and even popcorn
• Avoid caffeine which irritates the bladder

Keep your child safe!