Urinary Tract Infection (UTI) In Children: Causes & Treatment

Urinary tract infection (UTI) in children is one of the most common infections (1). The bacterial infection can affect different parts of the urinary tract, including the urethra, urinary bladder or kidneys.

UTIs are characterized by fever, frequent urination, pain while peeing, nausea, vomiting, chills, abdominal pain, excessive crying, etc. They are usually treatable but may cause complications if left untreated. This post will take you through the causes, types, symptoms, and management of UTI in children.

Types Of UTIs In Children

A UTI may be classified into two categories based on the organs involved (2):

• Upper UTI

An infection of the kidney or ureters (the tubes that connect the kidneys to the urinary bladder)

• Lower UTI

The infection of the bladder (cystitis) or urethra (the tube that carries urine from the urinary bladder to the out of the body)

Causes And Risk Factors Of UTI In Children

UTIs happen when the bacteria reach the urinary bladder or kidneys. Most infections happen due to the bacteria from the digestive tract. These bacteria may be commonly present near the anus or around the vagina.

The following factors may lead to the entry of the bacteria into the urinary tract (2) (3) (4)

• Not changing soiled underwear for long.
• Not wiping after peeing or pooping.
• Soiled toilet paper coming in contact with the genitals.
• Frequent diarrhea
• Bubble baths
• Tight-fitting clothes (for girls)
• Not urinating often throughout the day
• Wiping from the back to the front after peeing or pooping. Especially in girls, it can bring bacteria to the area from where girls pee.
• Blockage in the urinary tract
• Changes or congenital disabilities in the urinary tract
• Disorders of the brain or the nervous system such as myelomeningocele or an injury of the spinal cord.

The following factors may increase a child’s risk of developing UTI (2).

• Constipation

Children who are more prone to constipation may experience swelling of the large intestine. This swelling can put extra pressure on the urinary bladder and prevent normal emptying.

• Dysfunctional elimination syndrome

It is a common childhood condition where the child holds their pee despite having a strong urge to pee.

• Vesicoureteral reflux

It is an uncommon condition where urine leaks back from the bladder into the ureters and kidneys due to a problem with the valves in the ureters to the bladder.

Symptoms Of UTI In Children

Young children with UTI may experience fever, vomiting, poor appetite, or sometimes no symptoms at all. While UTIs in children are mostly associated with the bladder, they may also extend to the kidneys.

The following are the symptoms of UTI from the urinary bladder (cystitis) or the urethra (3) (4).

• Fever
• Increased fussiness
• Vomiting
• Frequent urge to pee, with little urinary output each time
• Wetting pants, despite being successfully potty trained
• Pain or burning sensation while peeing
• Pain or pressure in the lower portion of the belly or lower back
• Cloudy urine
• Blood in urine
• A general feeling of being unwell

The following are the symptoms of UTI from the kidneys (pyelonephritis) (3) (4)

• A fever higher than 101°
• Flu-like symptoms include chills, shaking, vomiting, nausea, or body aches.
• Pain in the belly, flanks, back, or groin.
• Pain or burning sensation while peeing
• Cloudy, foul-smelling, or red or dark brown color urine
• Pus or blood in the urine
• Urgent or frequent urge to pee
• Flushed, red, or warm skin

You should contact your healthcare provider if the child’s symptoms persist even after the prescribed duration of treatment or recur more than two times in six months or if the child shows the above symptoms (4).

Diagnosis Of UTI In Children

The pediatrician will conduct a thorough physical exam, ask about the child’s symptoms and health history, and run tests such as urine study or urine culture to diagnose UTI in children.

The urine is collected for testing to diagnose a UTI. The child is asked to initiate urination, and the urine is collected from the mid-stream. It avoids the collection of contaminating bacteria from genitalia.

The urine sample may be collected in the following ways for young children who are not potty trained and are still in diapers (4).

• Urine collection bag

A plastic bag is placed around the child’s vagina or penis to collect the urine. However, it may not be the preferred method as it may contaminate the sample.

• Catheterized specimen urine culture

The catheter is placed into the tip of the penis (in boys) or inserted into the urethra (in girls) to collect urine from the bladder. In rare cases, the following technique is used by doctors for urine collection.

• Suprapubic urine collection

A needle is inserted through the skin and passes the lower abdomen muscles to reach the urinary bladder to collect urine.

To check for any physical deformities or kidney functioning, the following tests may be performed.

• Ultrasounds
• X-ray is taken when the child is peeing (voiding cystourethrogram)

The type and number of the necessary diagnostic tests depend upon the child’s age, previous history of UTIs, the severity of infection, and other underlying medical conditions.

Treatment Of UTI In Children

Most UTIs in children get better with antibiotic treatment. However, while most children feel better with antibiotic administration at home, some might need hospitalization (5). A doctor prescribes specific antibiotics based on the age of the child after physical examination and urine test results.

Home treatment

Children over three months and who are not at risk of a serious illness can be treated at home using antibiotics.

• For lower UTI, a three days course is recommended.
• For an upper UTI, around seven to ten days of antibiotic course is recommended.

The doctor may prescribe an appropriate dose of paracetamol to address fever and abdominal pain issues. Avoid giving aspirin to children younger than 16 years.

Hospital treatment

Hospital treatment is recommended for children younger than three months or those at risk of severe conditions. For example, the following signs in your child may indicate a need for hospitalization.

• Children who appear to be unwell.
• Signs of dehydration and inability to keep the medicines down due to vomiting.
• Unusual symptoms such as reduced urinary output or flow, high blood pressure, a noticeable mass or lump in the tummy or urinary bladder.

The doctor may suggest intravenous administration of antibiotics in such scenarios. The children usually begin to feel better in 24-48 hours of oral or IV antibiotic administration.

Home Care For UTI In Children

The following tips can help your child recover from UTI sooner (3) (6).

• Complete the entire course of the prescribed medications. Do not discontinue the treatment despite the symptoms beginning to subside and the child feeling better.
• Ensure your child drinks enough water and other fluids so they pee regularly.
• Remind them to empty their bladder every time they go to pee.
• If the symptoms worsen or persist even two days after taking medicines, inform your doctor about it.
• UTI can irritate the tender skin around the child’s private parts. Give enough diaper-free time. If the skin does not heal, create a moisture barrier using petroleum jelly, zinc oxide, or lanolin. If it still does not improve, inform your doctor.

Prevention Of UTI In Children

While it is not always possible to prevent UTI, the following tips can reduce the risk of your child getting a UTI (2) (3) (6).

• Exclusive breastfeeding for the first six months of life can help improve the baby’s immune system and reduce the risk of constipation.
• Encourage girls to make it a habit to wipe themselves from the front to the back as it minimizes the chances of bacteria entering the urethra.
• Ensure ample hydration and frequent emptying of the bowels and the bladder. Holding the urine in for a long can increase bacterial colonization.
  Do not let the child sit in a bathtub containing bubble bath, shampoo, or soap as it may lead to irritation.
• Avoid caffeinated or carbonated drinks to children as it may irritate their bladder.
  Ensure to feed your child a fiber-rich diet to prevent constipation. If the child is chronically constipated, ask the doctor to prescribe a medicine to help prevent constipation.

References

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