Pediatric urinary tract infections (UTIs)

Pediatric urinary tract infections (UTIs) are common in children and can involve any part of the urinary system, including the urethra, bladder, ureters, and kidneys. UTIs are more frequent in girls than boys, especially after the newborn period, due to the shorter length of the female urethra, which makes it easier for bacteria to reach the bladder. However, in the first year of life, boys who are uncircumcised are slightly more at risk than girls.

Causes

The primary cause of UTIs in children is the entry of bacteria into the urinary tract, which can then multiply and cause an infection. The most common bacterium causing UTIs is Escherichia coli (E. coli), which is normally found in the intestines. Factors that can increase the risk of UTIs in children include:

• Vesicoureteral reflux (VUR), a condition where urine flows back from the bladder towards the kidneys.
• Obstructions in the urinary tract, such as urethral strictures or kidney stones.
• Infrequent urination, which can allow bacteria to multiply within the bladder.
• Poor toilet and hygiene habits, such as wiping from back to front, which can introduce bacteria to the urethral opening.
• Being uncircumcised, for younger boys, as bacteria can thrive under the foreskin.

Symptoms

Symptoms of UTIs in children vary depending on the child’s age and the part of the urinary tract that’s infected. Common symptoms include:

• Fever, sometimes without other signs of UTI.
• Foul-smelling, cloudy, or bloody urine.
• Frequent or painful urination.
• Irritability or fussiness.
• Vomiting or refusal to eat.
• Lower abdominal or back pain.
• In infants, unexplained fever, jaundice, and poor feeding might be the only signs.

Diagnosis

To diagnose a UTI in a child, a healthcare provider will usually request a urine sample. For older children, this may involve urinating into a cup (clean catch). For infants and young children who aren’t toilet-trained, a catheter may need to be inserted into the bladder to obtain a sterile sample, or a special collection bag may be used. The urine is then tested for the presence of bacteria and white blood cells. Further investigations, such as ultrasound or a voiding cystourethrogram (VCUG), may be recommended if the child has recurrent UTIs, to check for abnormalities in the urinary tract.

Treatment

Treatment for pediatric UTIs typically involves antibiotics to kill the bacteria causing the infection. The type of antibiotic and the duration of treatment depend on the severity of the infection and whether it affects the lower or upper urinary tract. For a simple bladder infection, oral antibiotics may be prescribed for 7-10 days. For a kidney infection, or pyelonephritis, treatment might be longer and could require hospitalization for intravenous antibiotics in severe cases.

Prevention

Preventive measures for reducing the risk of UTIs in children include:

• Encouraging frequent urination and proper hydration to help flush bacteria from the urinary tract.
• Teaching proper genital hygiene practices.
• Avoiding bubble baths and harsh soaps that can irritate the urethra.
• For toilet-trained children, making sure they empty their bladder completely when urinating.
• For infants, frequent diaper changes can help prevent the spread of bacteria.

Follow-up

After treatment for a UTI, follow-up urine tests may be necessary to ensure the infection has cleared. In cases of recurrent UTIs or underlying urinary tract abnormalities, ongoing monitoring by a pediatrician or pediatric urologist may be recommended to prevent future infections and protect kidney function.