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Urinary Tract Infections In Children Fact Book
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Aside from unexpected wetting, the most common urinary problem among
children is infections. An estimated 3 percent of girls and 1 percent of
boys have had a urinary tract infection (UTI) by the age of 11. Some
researchers believe these estimates are low because many cases of UTI go
undetected. 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.
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How Does the Urinary Tract Normally Function?
The kidneys filter and remove waste
and water from the blood to produce urine. They get rid of about 1-1/2 to
2 quarts of urine per day in an adult and less in a child, depending on
the child's age. The urine travels from the kidneys down two narrow tubes
called the ureters. The urine is then stored in a balloon-like container
called the bladder (see
figure 1). In a child, the bladder can hold about 1 to 1-1/2 ounces of
urine for each year of the child's age. So, the bladder of a 4-year-old
child may hold about 4 to 6 ounces (less than 1 cup); an 8-year-old can
hold 8 to 12 ounces. When the bladder empties, urine flows out of the body
through the urethra, a tube at the bottom of the bladder. The opening of
the urethra is at the end of the penis in boys (see
figure 2) and in front of the vagina in girls (see
figure 3).
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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, resulting in swelling and pain in the lower abdomen and side.
This is called "cystitis."
If the bacteria travel further 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 is found to have 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 the way, for example, other children are prone to getting
coughs, colds, or ear infections. Or a child may happen to get an
infection with a type of bacteria that has a special ability to cause
urinary tract infections.
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What Are the Signs of Urinary Tract Infection?
The lining of the bladder, urethra, ureters, and
kidneys become irritated with a urinary tract infection, just like the
inside of the nose or throat with a cold. If your child is an infant or is
only a few years old, the signs of a urinary tract infection may not be
clear, since children that young cannot tell you just 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
(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.
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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.
| Figure
3.--Side view of female urinary tract |
 | Some of your child's urine will be
collected and examined. The way urine is collected may depend on how old
your child is. The health care provider may place a plastic collection bag
over your child's genital area (sealed to the skin with an adhesive strip)
if the child is not yet toilet trained. 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 make sure
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 in the urine. If the
bacteria from the sample are hard to see at first, 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,
it should be refrigerated as soon as collected and the container should be
transported in a plastic bag filled with ice.
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How Are Urinary Tract Infections Treated?
Urinary tract infections are treated with
antibiotics (infection-fighting drugs). After a urine sample is obtained,
the health care provider may begin treatment with a drug that treats the
bacteria most likely to be causing the infection. Once culture results are
known, the health care provider may switch your child to another
antibiotic, if necessary.
The way the antibiotic is given and the number of days that it must be
taken depend in part on the type of infection and how severe it is. When a
child is sick or not able to drink fluids, the antibiotic may need to be
put directly into the bloodstream through a vein in the arm or hand.
Otherwise, the medicine (liquid or pills) may be given by mouth or by
shots. The medicine is given for at least 3 to 5 days and possibly for as
long as several weeks. The daily treatment schedule recommended depends on
the specific drug prescribed: The schedule may call for a single dose each
day or up to four doses each day. In some cases, your child will need to
take the medicine until further tests are finished.
After a few doses of the antibiotic, your child may appear much better,
but often several days may pass before all symptoms are gone. In any case,
your child should take the medicine for as long as the doctor says. Do not
stop medications because the symptoms have gone away. Infections may
return, and germs can resist future treatment if the drug is stopped too
soon.
Children should drink fluids when they wish. Make sure your child
drinks what he or she needs, but do not force your child to drink large
amounts of fluid. The health care provider needs to know if the child is
not interested in drinking.
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What Tests May Be Needed After the Infection Is Gone?
Once the infection has cleared, additional tests
may be recommended to check for abnormalities in the urinary tract.
Repeated infections in abnormal urinary tracts may cause kidney damage.
The kinds of tests ordered will depend on your child and the type of
urinary infection. Because no single test can tell everything about the
urinary tract that might be important to know, more than one of the
following tests may be needed:
- Kidney and bladder ultrasound: A test that examines the
kidney and bladder using sound waves. This test shows shadows of the
kidney and bladder that may point out certain abnormalities; this test
cannot reveal all important urinary abnormalities. It also cannot
measure how well a kidney works.
- Voiding cystourethrogram (VCUG): A test that examines the
urethra and bladder while the bladder fills and empties. A liquid that
can be seen on x-rays is placed into the bladder through a catheter. The
bladder is filled until the child urinates. This test can reveal
abnormalities of the inside of the urethra and bladder. The test can
also determine whether the flow of urine is normal when the bladder
empties.
- Intravenous pyelogram: A test that examines the whole urinary
tract. A liquid that can be seen on x-rays is injected into a vein. The
substance travels into the kidneys and bladder, revealing possible
obstructions.
- Nuclear scans: A number of tests using radioactive materials
that are usually injected into a vein to show how well the kidneys work,
the shape of the kidneys, and whether urine empties from the kidneys in
a normal way. The many kinds of nuclear scans each give different
information about the kidneys and bladder. Nuclear scans expose a child
to no more radiation than he or she would receive from a conventional
x-ray. At times, it can even be less.
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What Abnormalities Lead to Urinary Problems?
Many children who get urinary tract infections
have normal kidneys and bladders, but children who have an abnormality
need to have it detected as early as possible in life to try to protect
their kidneys against damage. Abnormalities that could occur include the
following:
- Vesicoureteral reflux. Urine normally flows from the kidneys
down the ureters to the bladder in one direction. With reflux, when the
bladder fills, the urine may also flow backward from the bladder up the
ureters to the kidneys. This abnormality is common in children with
urinary infections.
- Urinary obstruction. Blockages to urinary flow may occur at
many sites in the urinary tract. Blockages usually occur if the ureter
or urethra is too narrow or a kidney stone at some point stops the
urinary flow from leaving the body. Occasionally, the ureter may join
the kidney or bladder at the wrong place, preventing urine from leaving
the kidney in a normal way.
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Do Urinary Tract Infections Have Long-Term Effects?
Young children are at the greatest risk for
kidney damage from urinary tract infections, especially if they have some
unknown urinary tract abnormality. Such damage includes kidney scars, poor
kidney growth, poor kidney function, high blood pressure, and other
problems. For this reason it is important that children with urinary tract
infections receive prompt treatment and careful evaluation.
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Points To Remember
- Urinary tract infections occur in about 3 percent of girls and 1
percent of boys by age 11.
- A urinary tract infection in a young child may be a sign of an
abnormality in the urinary tract that could lead to repeated problems.
- Symptoms of a urinary infection range from slight burning with
urination or unusual smelling urine to severe pain and high fever.
- Untreated urinary infections can lead to serious kidney damage.
- Talk to a doctor if you suspect your child has a urinary tract
infection.
Keeping on Top of Your Condition
Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician.
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Additional Resources
American Foundation for Urologic Disease
1128 North Charles
Street
Baltimore, MD 21201
Phone: 1-800-242-2383 or (410)
468-1800
Email: admin@afud.org
Internet: http://www.afud.org/
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