Urinary Tract Infections

Urinary Tract Infection

Urinary tract infections (UTIs) affect about 3 percent of children in the United States every year. Throughout childhood, the risk of a UTI is 2 percent for boys and 8 percent for girls. UTIs account for more than 1 million visits to pediatricians’ offices every year. The symptoms are not always obvious to parents, and younger children are usually 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.

How does the urinary tract become infected?

Normal urine contains no bacteria (germs). Bacteria may, at times, get into the urinary tract and the urine from the skin around the rectum and genitals by traveling up the urethra into the bladder. When this happens, the bacteria can infect and inflame the bladder and cause swelling and pain in the lower abdomen and side. This bladder infection is called cystitis.

If the bacteria travel up through the ureters to the kidneys, a kidney infection can develop. The infection is usually accompanied by pain and fever. Kidney infections are much more serious than bladder infections.

In some children a urinary tract infection may be a sign of an abnormal urinary tract that may be prone to repeated problems. (See What abnormalities lead to urinary problems?) For this reason, when a child has a urinary infection, additional tests are often recommended. (See What tests may be needed after the infection is gone?) In other cases, children develop urinary tract infections because they are prone to such infections, just as other children are prone to getting coughs, colds, or ear infections. Or a child may happen to be infected by a type of bacteria with a special ability to cause urinary tract infections.

Children who frequently delay a trip to the bathroom are more likely to develop UTIs. Regular urination helps keep the urinary tract sterile by flushing away bacteria. Holding in urine allows bacteria to grow. Keeping the sphincter muscle tight for a long time also makes it more difficult to relax that muscle when it is time to urinate. As a result, the child’s bladder may not empty completely. This dysfunctional voiding can set the stage for a urinary infection.

What are the signs of urinary tract infection?

A urinary tract infection causes irritation of the lining of the bladder, urethra, ureters, and kidneys, just like the inside of the nose or the throat becomes irritated with a cold. If your child is an infant or only a few years old, the signs of a urinary tract infection may not be clear, since children that young cannot tell you exactly how they feel. Your child may have a high fever, be irritable, or not eat.

On the other hand, sometimes a child may have only a low-grade fever, experience nausea and vomiting, or just not seem healthy. The diaper urine may have an unusual smell. If your child has a high temperature and appears sick for more than a day without signs of a runny nose or other obvious cause for discomfort, he or she may need to be checked for a bladder infection.

An older child with bladder irritation may complain of pain in the abdomen and pelvic area. Your child may urinate often. If the kidney is infected, your child may complain of pain under the side of the rib cage, called the flank, or low back pain. Crying or complaining that it hurts to urinate and producing only a few drops of urine at a time are other signs of urinary tract infection. Your child may have difficulty controlling the urine and may leak urine into clothing or bedsheets. The urine may smell unusual or look cloudy or red.

How do you find out whether your child has a urinary tract infection?

Only by consulting a health care provider can you find out for certain whether your
child has a urinary tract infection.

Some of your child's urine will be collected and examined. The way urine is collected depends on your child’s age. If the child is not yet toilet trained, the health care provider may place a plastic collection bag over your child's genital area. It will be sealed to the skin with an adhesive strip. An older child may be asked to urinate into a container. The sample needs to come as directly into the container as possible to avoid picking up bacteria from the skin or rectal area. A doctor or nurse may need to pass a small tube into the urethra. Urine will drain directly from the bladder into a clean container through this tube, called a catheter. Sometimes the best way to get the urine is by placing a needle directly into the bladder through the skin of the lower abdomen. Getting urine through the tube or needle will ensure that the urine collected is pure.

Some of the urine will be examined under a microscope. If an infection is present, bacteria and sometimes pus will be found in the urine. If the bacteria from the sample are hard to see, the health care provider may place the sample in a tube or dish with a substance that encourages any bacteria present to grow. Once the germs have multiplied, they can then be identified and tested to see which medications will provide the most effective treatment. 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, refrigerate it as soon as it is collected and carry the container to the health care provider or lab in a plastic bag filled with ice.

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