Urinary Tract Infections (UTIs) in Children

What is a Urinary tract infection?
This is an infection of one or more parts of the urinary system. This involves the bladder, kidneys, and the tubes involved known as the urethra and ureters. It is quite common in children especially girls (8%) and boys (2%) and is different from sexually transmitted infections.

How do children get UTIs?
The commonest way that children get urinary tract infections is by an ascending bacteria from their skin or poop (stool). The urinary path is very sterile (clean) and has no bacteria whereas the digestive system has a lot of bacteria. The infection may affect either of the four areas of the system. These include:-
1. The kidneys ( where urine is made after filtering out wastes) and this is called
2. The ureters ( two tube that allows urine to pass from the kidneys to the bladder)
3. The bladder which is a bag that collects and stores urine until it is passed out. When the bladder is infected we call it cystitis.
4. The urethra (the tube that allows urine to flow from the bladder out as the child passes urine.) This is quite short and wide in girls and that is why UTis are more common in girls than boys.

What are the symptoms of UTIs?
Children commonly will present with non-specific signs like:-
• Irritability or fussiness
• Reduced appetite
• Failure to thrive/grow in a healthy manner
Older children may have specific signs that include:-
• Abdominal pain that may be on the back, sides or lower tummy areas.
• Pain when passing urine
• The need to urgently pass urine
• Frequently passing urine
• Foul smelling or cloudy urine
• Some children who are already toilet trained may lose control to hold urine.
• Other children who had been dry at night may begin to wet the bed

How is a UTI diagnosed?
The doctor will take a urine sample for testing in the laboratory. This test is known as microscopy, culture and sensitivity. The result comes out in two or more phases. The first result which is the microscopy and dipstick comes out immediately and will guide the immediate treatment. After 72 hours( three days) , the laboratory will release the culture result. ( this is a test where the laboratory attempts to grow and identify the specific type of bacteria in the urine and check which antibiotic will eradicate it effectively) Your child`s treatment need not wait for the culture result.

How is urine collected?
A small child who is not potty trained will have a plastic urine bag fitted around the genital area by the laboratory staff beneath the diaper/ nappy. You will then be asked to breastfeed the child as you keep checking whether they have passed any urine. The laboratory staff will remove the bag and collect the urine for you.
For older children, you will be requested to give a clean catch (midstream urine sample). This means you should clean your child`s genital area well with clean water. You will then tell them to start passing urine and collect a sample midway as they pass urine. About 10mls is required. The girls get a wider bottle and the boys a slimmer one that is already labelled with your child`s details. You will then return the sample to the laboratory in a brown bag. Make sure the sample gets to the laboratory within less than 2 hours from the time of voiding.

How are UTIs treated?
1. The child is encouraged to drink or breastfeed regularly in order to maintain a good fluid intake
2. Paracetamol is given to manage pain and fever
3. Antibiotics will be prescribed .These are taken for 7-10days. This will follow the hospital guidelines at first/ immediate treatment. In case the symptoms are still present after three days the doctor may decide to change your antibiotic after looking at your child`s urine culture results. It is important to complete your dose even when your child begins to feel better. This prevents antibiotic resistance.
4. Ten days after your child completes their antibiotics, another urine test will be conducted to confirm successful treatment.
5. If your child gets repeated UTIs they should be seen by a specialist nephrologist or pediatrician.

What should I expect at the specialist nephrology clinic?
The doctor will be checking whether there are other reasons why your child keeps getting a UTI. They may send you for an ultrasound which uses sound waves to show any blockages or problems in your kidneys, a micturating-cysto-urethrogram(MCU) or CT Scan depending on their assessment.

How can I prevent UTIs in my child from recurring in the future?
1. Change your baby`s diaper often to prevent bacteria from growing
2. Teach your daughter good bathroom habits as they get older. Girls should always wipe from front to back. This helps stool from the back and bacteria from the vaginal opening from getting to the urethra which is at the front.
3. Encourage your child not to hold urine in and use the washroom as soon as they feel the urge.
4. Avoid bubble baths and perfumed soaps in girls
5. Make sure your child always wears clean, well died and absorbent underwear
6. Encourage your child to drink a lot of water whenever they are thirsty and keep well hydrated