A urinary tract infection (UTI) is pretty unusual in a child, but they occur about four times as often in little girls as in little boys. In fact, they are so uncommon in boys that a single infection will typically require further exploration to be sure there isn't a more serious problem.
Urine is constantly being produced by the kidneys and drips down two tubes into the balloon-like bladder. It is kept from leaking out with the help of a "sphincter," a strong muscle at the opening of the bladder. When the child feels the urge to void, she will voluntarily relax the sphincter and urine will flow out.
In its normal, healthy state, the bladder doesn't contain any germs. When germs get into the bladder, they cause a UTI called cystitis. Sometimes the germs can move from the bladder to the kidneys and cause a kidney infection, which is more serious and is often accompanied by a fever.
UTIs are more common in little girls who take bubble baths, wear tight-fitting clothes and wipe from back to front (which carries germs from the anus toward the urinary system). They also are seen in children who hold their urine. In some of these children, the sphincter becomes less responsive, which can lead to recurrent infections.
A UTI can cause pain in the lower abdomen, burning during urination, foul-smelling or cloudy urine, the need to pee more often and trouble "holding it." In very young children, the symptoms of a UTI aren't always easy to detect. Sometimes the only symptoms in a baby are nausea, vomiting, irritability, low-grade fever, and decreased appetite, but there are many other more common infections that should be considered first.
The only way to know for sure if a child has a UTI is to test a sample of urine, which is looked at immediately to give an early diagnosis, but then is sent to a lab where the germs can be grown in a culture medium. This can take a couple of days. In the meantime, the doctor may put the child on an antibiotic. UTIs are usually very responsive to antibiotics and the child will feel better in a day or two, but it's important to take all of the medication as directed or germs left behind can cause another infection.
To avoid a UTI, children should be encouraged to wipe front to back, avoid tight clothing, avoid frequent bubble baths, and urinate when they need to. In other words, don't "hold it."
Dr. Lisa Thornton, a mother of three, is director of pediatric rehabilitation at Schwab Rehabilitation Hospital and LaRabida Children’s Hospital. She also is assistant professor of pediatrics at the University of Chicago.
See more of Dr. Thornton's stories here.