Urinary tract infections in children
Urinary tract infections (UTIs) are relatively common in children, particularly young children still in nappies. Girls are more likely than boys to develop a UTI, except in the first 12 months of life, when boys seem to be more susceptible.
The most common organisms that infect the urine are bacteria that normally live in the bowel. Wiping your child's bottom from the front to the back (rather than from back to front) can help prevent carrying bacteria from the bowel to the urinary tract.
UTIs, especially ones that recur, can also be caused by your child’s bladder not emptying properly or sometimes by structural problems of the kidneys or bladder.
Symptoms of urinary tract infections in children
Symptoms of a urinary tract infection can vary. In infants and young children, symptoms are often non-specific and can include:
- smelly urine;
- poor feeding; or
- failure to put on weight.
As children get older, the symptoms often become more specific, such as:
- pain or stinging on passing urine;
- accidentally wetting themselves when they’ve been toilet trained previously;
- abdominal or back pain; and
- going to the toilet more frequently than usual.
Fever may or may not be present.
UTI tests and diagnosis
Your doctor will ask about your child’s symptoms and perform a physical examination, looking for signs of a urinary tract infection.
To diagnose a UTI, your doctor will need to send a urine specimen to the laboratory for testing. In older children, this can easily be done by collecting a sample in a specimen jar as your child passes urine into the toilet.
In younger children, urine samples can be more difficult to collect. The most common collection method used in infants and toddlers who wear nappies is removing the nappy, waiting for the child to urinate and trying to catch some urine in a specimen jar.
Very occasionally, your doctor may need to insert a tube (catheter) through the urethra into your child’s bladder, or pass a fine needle into the bladder through the wall of the abdomen to collect a sample.
So called ‘bag urines’, where an adhesive plastic collecting bag is used to collect urine, frequently yield contaminated samples which cannot provide a diagnosis; if this method is used, it’s best that a nurse or doctor performs the collection rather than trying to do it yourself at home.
Treatment of urinary tract infections in kids
If your child is unwell and a UTI is strongly suspected, your doctor may prescribe antibiotics as soon as the urine specimen is collected. Otherwise your doctor may wait until the result of the urine test is known.
Commonly, antibiotics are given by mouth. However, in some cases, such as in children who are extremely unwell or in very young infants, antibiotics will be given via a drip into a vein (intravenous antibiotics). Intravenous (IV) antibiotics need to be given in hospital.
Some children with urinary tract infections may be referred to a paediatrician (specialist in children’s health) for further assessment and treatment.
Underlying kidney and bladder problems
Urine is made in the kidneys and then normally flows down from the kidneys into the bladder via the ureters. From the bladder, urine can leave the body via the urethra. In some children, urine flows back up the ureters towards the kidneys rather than being passed straight down the urethra. This abnormal flow of urine is called urinary reflux or sometimes vesico-ureteric reflux.
Urinary reflux can be harmful because it not only predisposes your child to infection (because of some urine always being left in the bladder) but it can also contribute to scarring of the kidneys if the reflux is severe.
Some children (including infants and those with severe infections) need to be tested for problems with their kidneys or bladder after having a single UTI. Most children should be tested after having recurrent UTIs. These tests help show any problems with the urinary tract and whether the urine is flowing in the right direction.
The tests usually include:
- a kidney and bladder ultrasound (which can show problems with the kidneys, ureters and bladder); with or without
- a bladder X-ray, known as a micturating cystourethrogram (MCUG).
In an MCUG, a catheter (thin tube) is passed into the bladder and dye is injected through it. It will show what happens when your child passes urine and whether urine is flowing in the right direction.
Occasionally, special nuclear medicine scans (DMSA and MAG3) may be recommended to help detect kidney scarring or urinary reflux.
The treatment of vesico-ureteric reflux may involve ongoing use of antibiotics in some children to prevent severe or recurrent infections. Antibiotics may be initially recommended for 6 months in these cases.
Usually with time, the reflux will improve by itself. In some severe cases, surgery may be recommended to treat the reflux.
Self-care measures for preventing UTIs
In children who have had urinary tract infections, the following measures may help prevent further infections.
- Getting your child to drink plenty of fluids.
- Ensuring your child empties their bladder when they get the urge and doesn’t delay going to the toilet.
- Making sure your child properly cleans themselves and wipes from front to back after toileting.
- Avoiding bubble baths (which may irritate the urethra).
- Seeing your doctor for advice on treating constipation in children, which can contribute to problems with bladder emptying.
2. The Royal Children’s Hospital Melbourne. Clinical Practice Guidelines: Urinary tract infection (updated April 2015). http://www.rch.org.au/clinicalguide/cpg.cfm?doc_id=5241 (accessed May 2017).
3. The Royal Children’s Hospital Melbourne. Kids Health Info: Urinary tract infection (UTI) (updated October 2010). http://www.rch.org.au/kidsinfo/factsheets.cfm?doc_id=3736 (accessed May 2017).
4. Mayo Clinic. Vesicoureteral reflux (last updated 20 Jun 2014). http://www.mayoclinic.org/diseases-conditions/vesicoureteral-reflux/basics/definition/con-20031544 (accessed May 2017).
5. Desai DJ, Gilbert B, McBride CA. Paediatric urinary tract infections: diagnosis and treatment. Australian Family Physician Aug 2016; 45:558-63. http://www.racgp.org.au/afp/2016/august/paediatric-urinary-tract-infections-diagnosis-and-treatment/ (accessed May 2017).