ADAM Health Encyclopedia

Urinary tract infection - children

Definition

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

The urinary tract includes the:

• Bladder
• Kidneys
• Ureters -- the tubes that take urine from each kidney to the bladder
• Urethra -- the tube that empties urine from the bladder to the outside

See also:

• Catheter-associated UTI
• Kidney infection
• Urinary tract infection - adults

Alternative Names

UTI - chronic; Cystitis - chronic

Causes

Some children develop UTIs. In boys, they are most common before the first birthday. In young girls, UTIs are most common around age 3, overlapping with the toilet training period.

UTIs in children may be caused by problems in the urinary tract. These may include vesicoureteral reflux -- a problem with a valve in the bladder that allows urine to back up into the ureters and kidneys.

The following risk factors increase a child's chance of developing a UTI:

• Constipation
• Enlarged bladder
• Family history of vesicoureteral reflux (VUR) or kidney disease
• Fever that keeps returning and has no clear cause
• Growth (mass) in the abdomen
• High blood pressure
• History of UTIs
• Myelomeningocele or other defect of the spine
• Poor growth
• Poor urine flow
• Problems in the urinary system anatomy
• Problems urinating (dysfunctional voiding)

Most urinary tract infections occur in the lower urinary tract, which includes the bladder and urethra. The condition occurs when the normally clean lower urinary tract is infected by bacteria and becomes inflamed.

Symptoms

Young children with UTIs may only have a fever, or no symptoms at all.

Symptoms of a UTI in children include:

• Blood in the urine
• Chills with shaking
• Cloudy urine
• Fever
• Flushed, warm, or reddened skin
• Foul or strong urine odor
• Frequent or urgent need to urinate, day and night
• General ill feeling (malaise)
• Lethargy
• Pain in the side (flank) or back
• Pain or burning with urination
• Pressure in the lower pelvis
• Severe pain in the abdomen
• Urinary incontinence after the child has been toilet trained
• Vomiting, nausea

Exams and Tests

To diagnose a UTI in children, the doctor will collect a urine sample. The sample will be examined under a microscope and sent to a lab for a urine culture.

In children who are not toilet trained, getting a urine sample can be difficult. The doctor cannot use a wet diaper. Possible ways to collect a urine sample in very young children include:

• The doctor or nurse places a special plastic bag over the child's penis or vagina to catch the urine (however, this is not the best method because the specimen may become contaminated by the skin or vagina).
• The health care provider may place a needle through the skin of the lower abdomen and muscles into the bladder (suprapubic urine collection).
• The health care provider may insert a plastic tube or catheter into the tip of the penis or into the vagina to collect urine directly from the bladder.

Some children with a first UTI need special imaging tests to find out why they got the infection. Special studies usually include an ultrasound of the kidneys and an x-ray taken while the child is urinating (called a voiding cystourethrogram or VCUG). These studies may be done while the child has an infection, or weeks to several months afterward.

Your doctor will consider many factors in deciding if and when a special study is needed, including:

• How old is the child? Is the child younger than 6 months?
• Has the child had infections in the past?
• Is the infection severe?
• Does the child have other medical illnesses?
• Does the child have a problem with the spinal cord or defects of the urinary tract?
• Has the child responded quickly to antibiotic treatment?

Treatment

In children, UTIs should be treated quickly with antibiotics to protect the developing kidneys. Any child under 3 - 6 months or who has other complications should see a specialist immediately.

Younger infants will usually stay in the hospital and be treated with antibiotics through a vein (intravenously). Older infants and children are treated with either oral antibiotics (if possible) or intravenous antibiotics in the hospital.

The child might need to take antibiotics for long periods of time (as long as 6 months - 2 years), or may need stronger antibiotics. The health care provider may also recommend low-dose antibiotics after the first symptoms have gone away.

Antibiotics commonly used in children include:

• Amoxicillin or amoxicillin/clavulanic acid (Augmentin)
• Cephalosporins
• Doxycycline (should not be used in children under age 8)
• Nitrofurantoin
• Trimethoprim-sulfamethoxazole

Follow-up urine cultures may be needed to make sure that bacteria are no longer in the bladder.

Outlook (Prognosis)

Most children are cured with proper treatment. The treatment may continue over a long period of time.

The long-term consequences of repeated UTIs in children can be serious. However, these infections can usually be prevented.

Possible Complications

• High blood pressure (hypertension)
• Kidney abscess
• Kidney infection (pyelonephritis)
• Renal insufficiency or kidney failure
• Swelling of the kidneys (hydronephrosis)

When to Contact a Medical Professional

Call for an appointment with your health care provider if your child's UTI symptoms continue after treatment or come back more than two times in 6 months.

Call your health care provider if the child's symptoms get worse, or new symptoms develop, especially:

• Back pain or flank pain
• Persistent fever
• Vomiting

Prevention

• Avoid giving your child bubble baths.
• Increase the child's intake of fluids.
• Keep your child's genital area clean to prevent bacteria from entering through the urethra.
• Wipe the genital area from front to back to reduce the chance of "dragging" bacteria from the rectal area to the urethra.

Long-term use of preventive (prophylactic) antibiotics may be recommended for some children who are prone to chronic UTIs.

Roussey-Kesler G, Gadjos V, Idres N, Horen B, Ichay L, Leclair MD, et al. Antibiotic prophylaxis for the prevention of recurrent urinary tract infection in children with low grade vesicoureteral reflux: results from a prospective randomized study. J Urol. 2008;179:674-679; discussion 679. Epub 2007, Dec 20.

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.

Mori R. Kakhanpaul M, Verrier-Jones K. Diagnosis and management of urinary tract infection in children: summary of NICE guidelines. BMJ. 2007; 335:395-397.