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| |    Urinary Tract Infections: Overview by Lynn Cates, M.D., F.A.A.P. reviewed by Laura Jana, M.D., F.A.A.P. Many mothers are all too familiar with urinary tract infections (UTIs) since they have had at least one somewhere along the way. What they may not realize is that urinary tract infections also are relatively common in children. What are urinary tract infections? Urinary tract infections are infections of the bladder, kidneys, and/or their connecting tubes. Although they can be caused by any type of germ (e.g., bacteria, viruses, or fungi), they usually are caused by bacteria like Escherichia coli (or E coli) that are normally found in the stool. Most urinary tract infections are limited to the bladder and are not serious. However, some involve the kidneys and may lead to serious problems if they are not detected early and treated appropriately. Boys versus girls Overall, about three to five percent of girls and one percent of boys develop urinary tract infections by age 10 years. In boys, most infections occur in the first year of life and are more common in uncircumcised than circumcised boys. In contrast, in girls, the average age for first infections is about three years. Boys have more urinary tract infections in the newborn period than girls, but girls have many more infections than boys after the first couple of months of life through adulthood (after two years, girls have about 10 times as many). This is thought to be related in large part to differences in the anatomy of the urinary tracts of girls and boys. Signs and symptoms Your child's UTI may be hard to detect, particularly if she is an infant or toddler. In general, the younger the child, the less likely she will have any specific symptoms to point to her urinary tract. Because of this, her healthcare provider will always be alert to the possibility of a UTI when she is sick. Some of the most common general symptoms of urinary tract infections in children are nonspecific like fever, fussiness, tiredness, vomiting, diarrhea, or a poor appetite. If your child is old enough to communicate well, she may tell you she has symptoms directly related to her urinary tract such as painful urination (dysuria) and/or an urgent (urgency) need to urinate frequently (frequency). You also may notice changes in her pattern of urination (e.g., she may begin wetting the bed again after having been toilet trained). Newborn infants usually will just look sick in general, although about half of newborns will have a fever with a urinary tract infection. Why it is important to detect urinary tract infections Although it's important to detect a urinary tract infection in a child of any age because of the chance that it may cause permanent kidney damage, it is particularly important to diagnose first UTIs between the ages of two months and two years. At this age, children have a higher chance of developing permanent kidney (also known as renal) damage and high blood pressure (or hypertension) than older children because they are more likely to have undetected urinary tract abnormalities that predispose them to recurrent infections. Any child two months to two years with an unexplained fever should be evaluated for a urinary tract infection, and such an evaluation should be considered for persistent unexplained fever at any age. Treatment and follow-up If your healthcare professional strongly suspects that your child has a urinary tract infection, or if he has confirmed the diagnosis with a urine culture, he will treat her with an appropriate antibiotic(s). He also will evaluate her risk of having more infections. One of the most important factors that might predispose her to recurrent infections is an abnormality of her urinary tract that permits urine to flow backward (or reflux) up into the kidneys. Imaging tests such as ultrasound are recommended after the first episode of urinary tract infection and fever in all infants and young children to look for reflux or other abnormalities. Prevention Many urinary tract infections can be prevented by reducing the number of bacteria in the genital area by practicing good hygiene and by decreasing irritation to that region (e.g., avoiding exposure to bubble bath, soaps, shampoos, rough toilet tissue, and vigorous wiping). If imaging studies reveal abnormalities of the urinary tract, however, more aggressive measures such as long-term prophylactic antibiotics or surgical repair of the problem may be required to prevent recurrences and long-term complications. Complications of urinary tract infections The vast majority of urinary tract infections affect only the bladder and cause no permanent harm. However, a few--particularly those in children with congenital abnormalities of their urinary tracts--involve the kidneys and can be more serious. Kidneys serve to filter impurities from the blood and maintain the normal balance of chemicals and fluids in the body. If a child has recurrent urinary tract infections, the risk of kidney damage increases substantially. Complete destruction of kidney function (or renal failure) requires either kidney dialysis or transplant for survival. Other complications of urinary tract infections include poor growth, high blood pressure (hypertension), kidney stones (or nephrolithiasis) and, rarely, a serious infection called a renal abscess (or a walled off pocket of pus and bacteria in the kidney).
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