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Urinary tract infection - children

Definition:

A urinary tract infection (UTI) is an infection of the urinary tract. This article discusses UTIs in children.

The infection can affect different parts of the urinary tract, including the:

  • Bladder, also called cystitis
  • Kidneys, also called pyelonephritis
  • Urethra -- the tube that empties urine from the bladder to the outside


Alternative Names:

UTI - children; Cystitis - children; Bladder infection - children; Kidney infection - children; Pyelonephritis - children



Causes, incidence, and risk factors:

Urinary tract infections (UTIs) can occur when bacteria get into the bladder or the kidneys. These bacteria are common on the skin around the anus. They can also be present near the vagina.

Normally, there are no bacteria in the urinary tract. However, some things make it easier for bacteria to enter or stay in the urinary tract. These include:

  • A problem in the urinary tract, called vesicoureteral reflux . This condition that is most often at birth allows urine to flow back up into the ureters and kidneys.
  • Brain or nervous system illnesses (such as myelomeningocele, spinal cord injury, hydrocephalus) that make it harder to empty the bladder
  • Bubble baths or tight-fitting clothes (girls)
  • Changes or birth defects in the structure of the urinary tract
  • Not urinating often enough during the day
  • Wiping from back (near the anus) to front after going to the bathroom. In girls, this can bring bacteria to the opening where the urine comes out.

UTIs are more common in girls. They may occur often around age 3as begin toilet training. Boys who are not circumcised have a slightly higher risk of UTIs before age 1.



Symptoms:

Young children with UTIs may have a fever, poor appetite, vomiting, or no symptoms at all.

Most urinary tract infections in children only involve the bladder. If the infection spreads to the kidneys (called pyelonephritis), may be more serious.

Symptoms of a bladder infection in children include:

Symptoms that the infection may have spread to the kidneys include:

  • Chills with shaking
  • Fever
  • Flushed, warm, or reddened skin
  • Nausea
  • Pain in the side (flank) or back
  • Severe pain in the belly area
  • Vomiting


Signs and tests:

A urine sample is needed to diagnose a UTI in children. The sample is examined under a microscope and sent to a lab for a urine culture .

It may be hard to get a urine sample in children who are not toilet trained. The test cannot be done using a wet diaper.

Ways to collect a urine sample in very young children include:

  • Urine collection bag -- A special plastic bag is placed over the child's penis or vagina to catch the urine. This is not the best method because the sample may become contaminated.
  • Catheterized specimen urine culture -- A plastic tube (catheter) placed into the tip of the penis in boys, or straight into the urethra in girls, collects urine right from the bladder.
  • Suprapubic urine collection -- A needle is placed through the skin of the lower abdomen and muscles into the bladder. It is used to collect urine.

If this is your child's first UTI, imaging tests may be done to find the cause of the infection or check for kidney damage. Tests may include:

These studies may be done while the child has an infection. Most often they are done weeks to several months afterward.

Your health care provider will consider many things when deciding if and when a special study is needed, including:

  • The child’s age and history or other UTIs (Infants and younger children usually need follow-up tests.)
  • The severity of the infection and how well it response to treatment
  • Other medical problems or physical defects the child may have


Treatment:

In children, UTIs should be treated quickly with antibiotics to protect the kidneys. Any child under 6 months old or who has other complications should see a specialist right away.

Younger infants will usually stay in the hospital and be given antibiotics through a vein. Older infants and children are treated with antibiotics by mouth. If this is not possible, they may need to get treated in the hospital.

Your child should drink plenty of fluids when being treated for a urinary tract infection.

Some children may be treated with antibiotics for periods as long as 6 months to 2 years. This treatment is more likely when the child has had repeat infections or vesicoureteral reflux.

After antibiotics are finished, your child’s health care provider may ask you to bring your child back to do another urine test. This may be needed to make sure that bacteria are no longer in the bladder.



Support Groups:



Expectations (prognosis):

Most children are cured with proper treatment. Most of the time, repeat infections can be prevented.

Repeated infections that involve the kidneys can lead to longterm damage to the kidneys.



Calling your health care provider:

Call your health care provider if your child's UTI symptoms continue after treatment or come back more than twice in 6 months.

Call your health care provider if the child's symptoms get worse. Also call if your child develops new symptoms such as:

  • Back pain or flank pain
  • Bad-smelling, bloody, or discolored urine
  • Fever of 100.4 °F (38 °C) rectally in infants, or over 101 °F (38.3 °C) in children
  • Low back pain or abdominal pain below the belly button
  • Fever that does not go away
  • Very frequent urination or need to urinate many times during the night
  • Vomiting


Prevention:
  • 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.

The health care provider may recommend low-dose antibiotics after the first symptoms have gone away to prevent recurrent UTIs.



References:

White B. Diagnosis and treatment of urinary tract infection in children. Am Fam Physician. 2011;83:409-415.

Williams G, Craig JC. Long-term antibiotics for preventing recurrent urinary tract infection in children. Cochrane Database Syst Rev. 2011;(3):CD001534.

Craig JC, Simpson JM, Williams GJ, et al. Antibiotic prophylaxis and recurrent urinary tract infection in children. N Engl J Med. 2009;361:1748-1759.

Skoog SJ, Peters CA, Arant BS Jr, et al. Pediatric Vesicoureteral Reflux Guidelines Panel summary report: clinical practice guidelines for screening siblings of children with vesicoureteral reflux and neonates/infants with prenatal hydronephrosis. J Urol. 2010;184:1145-1151.

Shaikh N, Morone NE, Lopez J, Chianese J, Sangvai S, D'Amico F, Hoberman A, Wald ER. Does this child have a urinary tract infection? JAMA. 2007;298:2895-2904.

Kliegman RM, Stanton BF, St. Geme JW, Schor NF, Behrman RE. Urinary tract infections. In: Kliegman RM, Stanton BF, St. GemeIII JW, Schor NF, Behrman RE, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa:Saunders Elsevier;2011:chap 169.




Review Date: 8/11/2013
Reviewed By: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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