What is a UTI? (Urinary Tract Infection)
The urinary tract is made up of the kidneys (which produce urine), ureters (the tubes that carry urine from the kidneys to the bladder), the bladder (which stores urine) and the urethra (the tube that carries urine from the bladder out of the body).
UTIs are typically caused by a bacterial infection in the urethra and bladder. These bacteria usually live harmlessly on the skin around the genitals, but if they get inside the urethra, can grow rapidly and overpower the immune system. Some children have medical conditions that make it easier for germs to multiply through the urinary tract. There is also evidence that some people are genetically more susceptible to getting UTIs.
Left untreated, a UTI can spread beyond the bladder and travel into the ureters and kidneys, where it becomes an acute kidney infection (pyelonephritis). Both UTIs and acute pyelonephritis require prompt medical attention.
Who is at risk for getting a UTI?
Bacterial UTIs are one of the most common infections in children and account for millions of unplanned pediatrician and urgent care visits each year. UTIs are most common in boys and girls during their first year of life. Uncircumcised boys that are less than one year old are ten times more likely to get UTIs than circumcised boys, but by age two the risk decreases and circumcision does not have an effect on infection rates. Because the urethra in girls is shorter and closer to the anus, they are more likely to get UTIs than boys, and their risk for UTIs increases with age.
What are the Symptoms of a UTI?
Signs and symptoms vary with age:
- Newborns typically have no fever but poor feeding, vomiting, irritability and jaundice (yellow skin)
- Children under the age of two may have a fever over 101F (but not always), a poor appetite, vomiting and diarrhea
- Children over the age of two will likely have fever over 101F, appetite changes, stomach or lower back pain, symptoms of urgency, frequency and pain with urination
If a toilet trained child is having accidents during the day or night, it may be a sign of an infection. Typically a child’s urine will be cloudy, have a strong, foul odor, and there may be blood in the urine.
How is a UTI Diagnosed?
If your child has UTI symptoms, they will be asked to urinate into a special cup at the doctor’s office. In some cases, a catheter (a tiny tube) may need to be inserted into the urethra to get urine. A simple test can reveal within minutes if the urine shows signs of an infection such as the presence of white or red blood cells. Your pediatrician will also have your child’s urine cultured (this takes about 1-2 days) to see what kind of bacteria is causing the infection, and to make sure your child is getting the right treatment.
For boys and girls under the age of 5 with UTIs, physicians may recommend a kidney ultrasound to determine if there may be another cause for the infection and a voiding cystourethrogram (VCUG) to determine if urine is ‘refluxing’ or backing up into the kidneys.
How are UTIs Treated?
If the rapid urine test and symptoms suggest your child has a UTI, a physician will prescribe an oral antibiotic that is effective on a wide range of bacteria. Once the urine culture result is available, your doctor may change your child’s antibiotic. This can help make sure that your child is getting the most effective and least expensive medication that is also less likely to kill off other good bacteria and prevents the growth of “superbug” resistant strains of bacteria. It is critical that your child drinks a lot of fluids and finishes the entire dose of antibiotic treatment (usually 10 days), even if all of the symptoms have disappeared. In cases where a child is extremely dehydrated or unable to drink fluids, physicians may suggest IV antibiotics and a hospital stay. Chronic UTIs may be treated with ongoing antibiotics.
When Should I Take my Child to a Pediatric Urologist?
A referral to a Pediatric Urologist is recommended if an ultrasound reveals any abnormalities in bladder or kidney function or appearance.