Urinary Tract Infection

What is a urinary tract infection (UTI)?
Urinary tract infections are a serious, but common, health problem affecting millions of people each year. An estimated 3 percent of girls and 1 percent of boys will have had a urinary tract infection (UTI) by the age of 11, and some healthcare professionals believe these estimates are low because many cases of UTI go undetected or unreported.

Young children are at the greatest risk for kidney damage from urinary tract infections, especially if they have some unknown urinary tract abnormality. Damage may include:

• kidney scars
• poor kidney development
• poor kidney function
• high blood pressure

How do UTIs occur?
Normal urine is sterile and contains fluids, salts, and waste products, but it is free of bacteria, viruses, and fungi. An infection occurs when microorganisms, usually bacteria from the digestive tract, cling to the opening of the urethra and begin to multiply.

Most infections arise from Escherichia coli (E. coli) bacteria, which normally live in the colon.

• An infection limited to the urethra is called urethritis.

• From the urethra, bacteria often move on to the bladder, causing a bladder infection, which is called cystitis.

• If the infection is not treated promptly, bacteria may then go up the ureters to infect the kidneys. This is called pyelonephritis.

In other cases, children develop urinary tract infections because they are prone to such infections.

Some children may get an infection with a type of bacteria likely to cause urinary tract infections.

What are the symptoms of UTI?
The lining of the bladder, urethra, ureters, and kidneys become irritated with a urinary tract infection, just like the inside of the nose or throat with a cold.

The most common symptoms for babies or young children, particularly those still in diapers, who are unable to tell you how they are feeling, may include:

• fever
• irritability
• loss of appetite
• nausea and vomiting
• unhealthy appearance
• urine that smells

For older children, you may notice, or the child may be able to tell you about the following symptoms:

• pain in the abdomen and pelvic area
• frequent urination
• pain under the side of the rib cage or in the lower back pain
• pain when urinating
• produce only a few drops of urine at a time
• difficulty controlling the urine
• leak urine into clothing or bedsheets
• urine that smells unusual
• urine that looks cloudy

The symptoms of UTIs may resemble other conditions or medical problems. Only by consulting a healthcare provider can you determine whether your child has a urinary tract infection.

How are UTIs diagnosed?
In addition to a complete physical examination and medical history, laboratory tests on a sample of urine for pus and bacteria are used to diagnose UTIs. The process of growing bacteria in the laboratory is known as performing a culture and often takes a day or more to complete. The reliability of the culture depends on how long the urine stands before the culture is started. If you collect your child's urine at home, it should be refrigerated as soon as collected and the container should be transported in a plastic bag filled with ice.

How are UTIs treated?
Specific treatment will be determined by the child's physician(s) based on:

• patient's age, overall health, and medical history
• extent of the disease
• expectations for the course of the disease
• patient's tolerance for specific medications, procedures, or therapies
• patient's or parent's opinion or preference

UTIs are usually treated with antibacterial medications. Other drugs are available to relieve the pain and a heating pad may also help. Drinking plenty of water helps cleanse the urinary tract of bacteria.

After a few doses of the antibiotic, your child may appear much better, but often several days may pass before all symptoms disappear. Your child should take the medication for as long as the child's physician directs. Do not stop medications because the symptoms have gone away. Infections may return, and germs can resist future treatment if the drug is stopped too soon.

Encourage your child to drink often, but do not force your child to drink large amounts of fluid.

Additional testing after treatment:
In some children a urinary tract infection may be a sign of an abnormal urinary tract that is prone to repeated problems. For this reason, when a child is found to have a urinary infection, additional tests are often recommended. The kinds of tests ordered will depend on your child and the type of urinary infection. One or more of the following tests may be needed:

• kidney and bladder ultrasound
  A test that examines the kidney and bladder using sound waves, which may show certain abnormalities, but cannot reveal all urinary abnormalities or measure how well a kidney works.

• voiding cystourethrogram (VCUG)
  A test that examines the urethra and bladder while the bladder fills and empties using a special liquid and x-rays to show abnormalities of the inside of the urethra and bladder.

• intravenous pyelogram
  A test that examines the whole urinary tract using a liquid that can be seen on x-rays to show possible obstructions.

• nuclear scans
  A number of tests using radioactive materials that are usually injected into a vein to show how well the kidneys work, the shape of the kidneys, and whether urine empties from the kidneys in a normal way. Nuclear scans expose a child to the same amount of radiation as a conventional x-ray.

How the urinary system works:
The urinary system is made up of the kidneys, ureters bladder, and urethra.

The kidneys filter and remove waste and water from the blood to produce urine.

• The urine travels from the kidneys down two narrow tubes called the ureters.
• The urine is stored in a balloon-like container called the bladder.
• In a child, the bladder can hold about 1 to 1-1/2 ounces of urine for each year of the child's age. For example, the bladder of a 4-year-old child may hold about 4 to 6 ounces (less than 1 cup), whereas, an 8-year-old's bladder can hold 8 to 12 ounces.
• When the bladder empties, urine flows out of the body through the urethra, a tube at the bottom of the bladder.

• Symptoms of urinary tract infection are not always obvious to parents, and children may be unable to describe how they feel.

• Recognizing and treating urinary tract infections is important. Untreated UTIs can lead to serious kidney problems that could threaten the life of your child.