Urinary Tract Infections in Children - Symptoms, Diagnosis, Prevention & Treatment
Health Education

Urinary Tract Infections in Children

Dr.Surya Rao Poodipeddi profile Authored by Dr.Surya Rao Poodipeddi on 13 Nov 2014 - 14:33.

Urinary Tract Infection commonly known as UTI is a condition affecting the urinary tract. UTI doesn't spare any age or sex. It can strike infants, children,adolescents, adults and the old alike. However, UTI in infants and children is the most difficult entity to diagnose for the simple reason that child cannot express this discomfort.

Structure of Urinary Tract

To understand UTI, it is important to know the basics of the urinary tract. Urine is manufactured in two bean shaped organs in the abdominal cavity called kidneys, one on each side below the lower ribs They are connected to the urinary bladder in the pelvic cavity below the umbilicus, by two tubular structures called the ureters which transport the urine from thekidneys to the bladder.

The bladder leads to another tube called the urethra which has an opening at the end called the urinary meatus (meatus means an opening) for the urine to exit outside, when thebladder is full.   However, there is a variation in the size of the urethra between a male and a female. The female urethra is very short compared to the male counterpart, which is roughly 4 to 5 times longer than the female urethra. This explains the reason why girl babies are affected more than boy babies.  

The external urethral opening in females is very close to the vaginal opening, which in turn is very close to the anal opening. Therefore any infection around the anus or the vagina can easily ascend to the urinary bladder through the urethral opening.
 

However, a crying child though cannot express the problem, exhibits certain symptoms, which are:

  • Unexplained fever
  • Crying during urination because of the pain and burning sensation
  • Micturition
  • Urine in the diaper is thick and cloudy
  • Foul smell in the urine
  • Presence of blood tinged urine
  • Child is persistently irritable
  • May also vomit
  • Often refuses feed and in severe cases of infection
  • The child may have shivering mimicking an attack of malaria.

If still undetected and neglected, the infection in the bladder may as well travel up the ureters and infect the kidneys. If further neglected, this maylead to gross kidney problems and even kidney failure. Having said this it becomes important that one should be able to identify the problem as early as possible with a view to avoiding avoidable complications. This is very true if UTI affects children below 2 years in whom complications occur faster than in adults. The key to a confirmed diagnosis of UTI in children is first to suspect it early and then subject a sample of urine for a test called  C&S (Culture & Sensitivity).

In adults one can always advise the patient to collect a sample of urine in a pre-sterilized test tube. However, it is very difficult to collect the urine in infants, which finds its way to the diaper. Luckily sterile collecting bags are available which need to be fastened to the baby’s genital area and a sample of uncontaminated urine fills the collecting bag, which can be unfastened and sent to the laboratory for culture & sensitivity test.

This procedure hasits own hazards in those bacteria from the surrounding skin may travel down into the bag. The ideal method is to pass a sterile catheter to the baby’s urethra and collect the sample straight to a pre-sterilized test tube after making sure that the external genital area is thoroughly cleaned with an antiseptic lotion.

The next step is to find out what bacteria are grown from the sample fixed in a culture medium. If no bacteria are grown, prima facie there is no infection in the urine. However, if bacteria are detected, appropriate antibiotics are given to curtail the infection. Since it takes 48 hours for the confirmed report, the doctor normally starts a suitable antibiotic on the slightest suspicion particularly if the urine collected is turbid. Inneglected cases and chronic UTI, it is advisable to have a renal ultrasound examination as well as a Voiding CystoUrethroGram(VCUG), to check the functioning of the kidneys and the urinary bladder.

Once the bacteria is identified, usually the Eschericia group of bacteria, treatment becomes easy. However, care should be taken to select a liquid drug for easy administration to the child and the rules of the prescription must be rigorously followed in maintaining the 4 or 6-hourly administration of medicines.

If the baby has UTI for a prolonged duration or the infection is not controlled with oral drugs and the child is too weak to swallow the syrup, intravenous administration of an antibiotic is the only choice to control the infection faster. In suchcases, the baby may need hospitalized stay. To make sure that the bacteria have been successfully eliminated from the system you may need to subject urine for repeated C&S (culture& sensitivity tests).

Some children are prone to getting UTI. However, it can be prevented by wiping clean, the entire area above downwards, i.e.from front to back while changing a diaper to avoid infection from anus and vagina to enter the urethral opening. The same procedure is to be followed even in male babies. The child should be given plenty of fluids to avoid dehydration and flush out bacteria in the system.

*Disclaimer This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.