Urinary Tract Infections in Children

Bacteria love warm, wet places, so the urinary tract is a great place for them to invade. When that happens, a child may complain of burning during urination, have an urgent need to urinate and have trouble “holding it.” The child may have a fever, foul-smelling urine, abdominal pain and accidental bed-wetting.

To help prevent UTIs, children:

• should urinate when they get the urge
• should not “hold it” for long periods of time
• should drink plenty of fluids

Recurrent UTIs can be prevented with a small, daily dose of
antibiotics to be taken for several months. Cranberry juice and
probiotics have not been proven to prevent UTIs in children,
although there is active research to try to determine their value
in adults.

A urinary tract infection likely is to blame.

The urinary tract consists of the kidneys (where urine is made), the ureters (the long tubes that lead from the kidneys to the bladder), the bladder (where urine is stored), and the urethra (the tube that urine comes out of). An infection can occur anywhere along the urinary tract.

Urethritis is an infection of the urethra, cystitis is an infection of the bladder, and pyelonephritis is an infection of the kidneys. A kidney infection is often more serious and makes a child sicker than infections in other parts of the urinary tract.

A UTI occurs when the bacteria that naturally lives on the skin travels up the urethra and into the bladder. Girls get UTIs more often than boys because their urethra is much shorter. Uncircumcised boys get UTIs more often than those who have been circumcised because bacteria can live under the foreskin of the penis.

A UTI is diagnosed by testing a sample of the child’s urine. It’s very important that the sample truly reflects the germs in the bladder or urethra and not the germs that are living harmlessly on the child’s skin. Collecting a urine specimen in older children can be done by “clean catch” where the skin around the urethra is thoroughly cleaned and the child urinates into a sterile cup. In babies and young children, the urine is collected by placing a small tube through the urethra and into the bladder (catheterization) or using a needle to prick the bladder through the skin just above the child’s pubic bone (suprapubic collection).

In most cases, a UTI is not serious and goes away quickly with antibiotics, which should be taken as directed to make sure the infection is completely eliminated. An untreated UTI can spread and cause damage to the kidneys.

Some children are prone to repeat UTIs, which are uncomfortable, but usually harmless if treated. Occasionally, multiple UTIs may signal a problem in the urinary tract.

Editor’s note: This is not medical advice. See a doctor for your specific health concerns or those of your children.

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. Email her at drlisathornton@gmail.com.

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