Urinary tract infections (UTIs)
are common in kids. By age 5, about 8% of girls and 1%-2% of boys
have had at least one UTI. They occur when the
kidneys, ureters, bladder, or urethra
Symptoms of a UTI can include:
- pain when urinating
- changes in frequency, appearance, or smell of urine
- loss of appetite
- lower abdominal pain
- lower back pain or discomfort
UTIs can also cause
in kids who were previously dry at night. Infants and young
children may only show nonspecific signs such as fever, vomiting,
or decreased appetite or activity.
Some kids experience UTIs again and again - these are called
recurrent UTIs. If left untreated, recurrent UTIs can cause kidney
damage, especially in kids younger than 6. So it's important to
know how to recognize the signs of these infections and get help
for your child.
Types of UTIs
Common types of UTIs include:
, the most common type of UTI, is a bladder infection that can
move up the urethra (the tube-like structure that allows urine to
exit the body from the bladder) and into the bladder
, when bacteria infect the urethra
, a kidney infection that can occur when infected urine flows
backward from the bladder to the kidneys, or when an infection in
the bloodstream reaches the kidneys
Related Conditions Associated With Recurrent UTIs
Recurrent UTIs are sometimes seen in conjunction with other
conditions, such as:
- vesico-ureteral reflux(VUR)
, which is found in 30%-50% of kids diagnosed with a UTI and is a
congenital (present at birth) condition in which urine flows
backward from the bladder to the ureters (the thin, tube-like
structures that carry urine from the kidney to the bladder) and
sometimes reaches the kidneys. If the urine in the bladder is
infected with bacteria, VUR can lead to pyelonephritis.
, which is an enlargement of one or both kidneys due to backup or
blockage of urine flow and is usually caused by severe VUR or a
blocked ureter. Kids with hydronephrosis are sometimes at risk of
recurrent UTIs and may need to take daily low doses of
antibiotics to prevent them.
But not all cases of recurrent UTIs can be traced back to these
body structure-related abnormalities. For example,
- when a child doesn't urinate frequently enough or doesn't
relax his or her muscles properly while urinating - is a common
cause of UTIs.
Unrelated conditions that compromise the body's natural
defenses, such as diseases of the immune system, can also lead to
recurrent UTIs. In addition, using a nonsterile urinary catheter
can introduce bacteria into the urinary tract and cause an
Although UTIs can be treated with antibiotics, it's
important for your child's doctor to rule out any underlying
abnormalities in the urinary system when these infections occur
Some abnormalities can be detected even before birth.
Hydronephrosis, when it occurs as a congenital condition, can be
detected in a fetus by ultrasound as early as 16 weeks of
gestation. When hydronephrosis poses significant danger to the
developing kidneys, surgery may be performed while the baby is in
the womb; however, in most cases, doctors wait until after birth
before treating the condition because almost half of all cases that
are diagnosed prenatally disappear by birth.
Once a baby suspected to have hydronephrosis or another urinary
system abnormality is born, the baby's blood pressure will be
monitored carefully because some kidney abnormalities can cause
high blood pressure
. An ultrasound may be used again to get a closer look at the
bladder and kidneys.
Diagnosis and Treatment
If your doctor suspects that your child may have an abnormality
of the urinary tract, he or she may order tests to make an accurate
Using high-frequency sound waves to "echo," or bounce,
off the body and create a picture of it, an ultrasound can detect
some abnormalities in the kidneys, ureters, and bladder. It can
also measure the size and shape of the kidneys. When an ultrasound
suggests VUR, a voiding cystourethrogram (VCUG) or a renal scan
(see below for descriptions of both) may be performed for further
Renal scan (nuclear scan)
Radioactive material is injected into a vein and followed
through the urinary tract. The material can show the shape of the
kidneys, how well they function, if there is damaged kidney tissue,
and the course of the urine. A small amount of radiation is
received in the study and leaves the body in the urine.
Voiding cystourethrogram (VCUG or cystogram)
A catheter (a hollow, soft tube) is used to inject an opaque dye
into the bladder. This X-ray test can diagnose VUR and identify
problems with the bladder or urethra.
A cystoscope uses lenses and a light source within a tube
inserted through the urethra to directly view the inside of the
bladder. It's used when other tests or symptoms indicate a
possible bladder abnormality.
Opaque dye is injected into a vein and then X-rays are taken to
follow the course of the dye through the urinary system. Although
this test is still used sometimes, the renal ultrasound and renal
scan have replaced intravenous pyelogram in most cases.
Because VUR can lead to kidney infection (pyelonephritis) and
subsequent kidney damage, children with the condition must be
monitored closely. Usually, surgery isn't necessary because
many kids will outgrow the condition. Even in those who don't,
surgery may be unnecessary because antibiotics are often successful
in warding off UTIs.
The most common type of surgery to correct VUR is
, in which one or both ureters are reattached to the bladder to
decrease backflow of urine from the bladder to the ureters and
kidneys. Although the success of ureteral reimplantation is greater
than 90%, only those who have recurrent UTIs while on antibiotic
prophylaxis (preventive therapy) will be considered for
Blockages can interfere with normal urine flow, which serves to
wash bacteria out of the urinary tract. Because severe blockages in
the ureter or the urethra may ultimately lead to repeated kidney
infections and kidney damage, they may require surgical
are another source of blockage that may obstruct the path of
When anatomical defects have been ruled out, antibiotics may be
prescribed for months or even years to prevent recurrent
The Future for Managing Recurrent UTIs
Doctors have started to use a less-invasive way to correct VUR
than implantation. The procedure involves the injection of such
materials as Teflon, Delflux, or collagen through a cystoscope.
This procedure was considered experimental a few years ago, but is
rapidly gaining wider acceptance.
Recent studies have found that women and children who get
recurrent UTIs may lack certain immunoglobins (a group of proteins
that fight infections). Some researchers are optimistic that a
vaccine may be developed that could help boost production of
antibodies that fight UTIs. A promising vaccine that would protect
(the most common bacterium that causes UTIs) is being tested.
Additional things to consider to help prevent recurrent UTIs in
Encourage kids to drink 8 to 10 glasses of water and other
fluids per day. Cranberry juice is often suggested because it may
from attaching to the walls of the bladder. Always ask your doctor,
though, if your child should drink cranberry juice because it can
interfere with some
Vitamin C acidifies the urine, making the environment less
friendly to bacteria. Vitamins designed for kids are generally
safe, but always ask your doctor before increasing the dose beyond
the currently recommended daily allowance.
No Bubble Baths
Kids should avoid bubble baths and perfumed soaps because they
can irritate the urethra.
Frequent Diaper Changes
Kids in diapers should be changed frequently to prevent stool
from having prolonged contact with the genital area, which can
increase the chance that bacteria will move up the urethra and into
Proper Wiping Technique
In females, wiping from front to back after using the toilet
will reduce exposure of the urethra to UTI-causing bacteria in the
Breathable cotton underwear is less likely to encourage
bacterial growth near the urethra than nylon or other fabrics.
Frequent Bathroom Visits
Some kids may object to using the school bathroom or may become
so engrossed in a project that they delay urination. Kids with UTIs
should urinate at least every 3 to 4 hours to help flush bacteria
from the urinary tract.
Your doctor may advise performing another urine culture after
treatment of a UTI is completed to be sure that the infection has
When to Call the Doctor
As soon as you suspect a UTI in your child, it's important
to contact your doctor.
If your child suffers from recurrent UTIs, consult a pediatric
nephrologist or urologist who can perform a thorough evaluation
and, if necessary, order tests for urinary system abnormalities. In
the meantime, follow your doctor's instructions for treating a
Larissa Hirsch, MD
Date reviewed: November 2006
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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