Urinary tract infections (UTI) in children
What are urinary tract infections in children?
A urinary tract infection (UTI) is an infection anywhere in the urinary tract. The urinary tract includes the kidneys, ureters, bladder and the urethra.
The urinary tract in a child.
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Bladder
An organ in the lower abdomen that stores urine for excretion.
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Ureters
The duct through which urine flows from the kidneys to the bladder.
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Urethra
The duct through which urine flows from the bladder to outside the body.
Causes
A UTI is usually caused by specific bacteria infecting the bladder or urethra. The most common cause of UTIs in children are Escherichia coli (E. coli) bacteria, which are normally present in poo (feces). Other bacteria known to cause UTIs include Klebsiella, Proteus mirabilis, Pseudomonas, Streptococci, and Staphylococcus aureus.
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Bladder
An organ in the lower abdomen that stores urine for excretion.
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Urethra
The duct through which urine flows from the bladder to outside the body.
Risk factors
Risk factors for UTIs include:
- Vesicoureteral reflux - this is a condition common at birth, in which urine flows back up to the ureters and kidneys;
- Birth defects or changes in the structure of the urinary tract;
- Not urinating often enough, and;
- Brain or nervous system problems that make it difficult to empty the bladder.
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Bladder
An organ in the lower abdomen that stores urine for excretion.
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Nervous system
The extensive network of cells and structures that is responsible for activating and coordinating the body's functions, sensory input and cognition.
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Ureters
The duct through which urine flows from the kidneys to the bladder.
Signs and symptoms
Younger children often have non-specific symptoms when they have a UTI. These symptoms include fever, vomiting, poor feeding and irritability.
In older children, symptoms may include:
- Frequent and urgent urination;
- Pain or a burning sensation while urinating;
- Abdominal or loin pain;
- Fatigue, and;
- Blood in the urine.
Infection may spread to the blood, causing the child to become very unwell. Symptoms of this include fever, extreme lethargy, pale skin and cold hands and feet.
Methods for diagnosis
Urine testing
Urine culture is the gold standard for diagnosing UTIs. A diagnosis is usually made on the basis of urine culture results and the presence of symptoms. Since this test can take a few days to produce results, your doctor may prescribe antibiotic treatment before the test results are in.
Your doctor may also perform a rapid test (known as a dipstick urine test) to check whether there are any features of a urinary tract infection. This test is often used only to support suspicion of a urinary tract infection, and it cannot be entirely relied upon for a diagnosis.
In infants and some young children, it can be difficult to obtain an uncontaminated specimen of urine. A clean bag may be attached over the genitals to help capture the urine. Or alternatively, your doctor may suggest inserting a small plastic tube called a catheter into the bladder, or a needle through the lower abdominal wall to draw urine directly from the bladder (suprapubic urine collection).
A urinary tract infection is typically diagnosed from a urine sample.
Scans
The most common imaging method used in assessing a UTI is an ultrasound scan of the kidneys, ureters and bladder. It is performed to determine if the urinary system has formed normally. It is recommended for all children under six months of age and any child who has recurrent UTIs.
A test called a 'voiding cystourethrogram' is sometimes performed on children who have multiple UTIs. This is an X-ray that shows the outline of the bladder and urethra. If the X-ray is taken while the child is peeing, it can show if urine is travelling backwards from the bladder to the kidneys (a disorder known as vesicoureteral reflux).
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Bladder
An organ in the lower abdomen that stores urine for excretion.
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Ureters
The duct through which urine flows from the kidneys to the bladder.
X
Urethra
The duct through which urine flows from the bladder to outside the body.
Types of treatment
UTIs in children require prompt treatment with antibiotics to protect the kidneys from damage. It is important to also drink plenty of water during a urinary tract infection.
In some cases children will need to be hospitalized and given antibiotics and fluids intravenously. Children with repeat infections or vesicoureteral reflux may receive preventative antibiotic treatment.
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Intravenously
Within a vein.
Complications
UTI complications are rare if the infection is treated in time. However, if left untreated, UTIs can cause a serious kidney infection or sepsis. These complications are more likely in recurrent infections.
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Kidney
A pair of organs responsible primarily for regulating the water balance in the body and filtering the blood.
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Sepsis
An illness caused by inflammation throughout the body in response to an infection. It can be life-threatening if it leads to septic shock, a dramatic loss of blood pressure.
Prognosis
With treatment the UTI is cleared and, most of the time, repeat infections are prevented. Symptoms are usually gone 1-2 days after treatment starts, but the full course of antibiotics should be continued until finished, even after symptoms have disappeared.
References
- Circumcision and Risk of Infection in the First Year: A Meta-analysis. Accessed 4 August 2014 from link here
- Circumcision: a decision analysis of its medical value. - Abstract - Europe PubMed Central. Accessed 4 August 2014 from link here
- Controversy in Urinary Tract Infection Management in Children: A Review of New Data and Subsequent Changes in Guidelines. Accessed 4 August 2014 from link here
- Decreased Incidence of Urinary Tract Infections in Circumcised Male Infants. Accessed 4 August 2014 from link here
- Evidence of Uncultivated Bacteria in the Adult Female Bladder. Accessed 14 August 2014 from link here
- Ovid: Diagnosis of urinary tract infections in children. Accessed 4 August 2014 from link here
- Urinary Tract Infection in Children (UTI): Bacterial Infections in Infants and Children: Merck Manual Home Edition. Accessed 16 September 2014 from link here
- Urinary tract infection - children - National Library of Medicine - PubMed Health. Accessed 4 August 2014 from link here
- Urinary tract infections in children. (-a). Accessed 4 August 2014 from link here
- Urinary tract infections in children. (-b). Accessed 4 August 2014 from link here
- Urine Is Not Sterile: Use of Enhanced Urine Culture Techniques To Detect Resident Bacterial Flora in the Adult Female Bladder. Accessed 4 August 2014 from link here
9 Most frequently asked questions (FAQs)
What are the symptoms of urinary tract infections in children? Younger children often have non-specific symptoms when they have a urinary tract infection. These symptoms can include fever, vomiting, poor feeding and irritability. In older children, symptoms may include frequent, urgent and painful urination, fatigue and stomach pain. What causes urinary tract infections in children? Urinary tract infections (UTIs) in children are usually caused by E. coli bacteria, which are normally present in poo (feces). Other bacteria known to cause UTIs include Klebsiella, Proteus mirabilis, Pseudomonas, Streptococci, and Staphylococcus aureus. How are urinary tract infections in children diagnosed? Urinary tract infections are typically diagnosed by culturing a urine sample to identify the type of bacteria present. Because the test's results can take a few days to produce, an antibiotic treatment is often started before the results come in. Another test that can provide a faster diagnosis is a 'dipstick test' of the urine sample. What is the outlook for urinary tract infections in children? With timely treatment, the outlook for urinary tract infections in children is usually good, as the infection is cleared by antibiotics and the risk of long-term damage is reduced. In cases of delayed treatment, or frequent recurring infections, damage to kidneys may occur.
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