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Urinary Tract Infections In Children |
Urinary tract infections (UTI) are common in children. UTIs are caused by a growth of germs in the bladder and sometimes in the kidneys. An infection may make a child only mildly ill or very sick. All children who have UTI must be investigated for any underlying problems in the kidneys or bladder.
Symptoms in children over three years of age are similar to adults.
They may complain of:
- Go to the toilet more often.
- Accidentally wet their pants.
- Wet the bed at night.
- Feel unwell.
- Lose their appetite.
- Have a high temperature.
Symptoms in younger children and infants are different. They are unable to communicate their discomfort on passing urine and you may not notice them going more frequently. They are often sick with fevers and are very irritable.
Young babies can be extremely unwell, because the infection can spread into the bloodstream (septicaemia). Infants less than 6 months old have a significant risk of blood poisoning and often require hospitalisation.
If a urinary tract infection is suspected, you will be asked to collect a urine specimen. Specimens from infants may be collected in stick-on collecting bags or in older children by catching some of the urine when it comes out (although this can be pretty tricky!). If this can't be done, it may be necessary to collect urine by passing a fine tube into the bladder or by putting a needle into the bladder through the wall of the abdomen - just like having a blood test.
After the urine has been collected, antibiotics may be started. These antibiotics may need to be changed once the results are known. If tests confirm that your child has an infection, further tests will be required. If your child is quite sick, they may be admitted to hospital where the antibiotics will be given intravenously through a "drip". Otherwise, five to ten days of antibiotics by mouth will usually kill the infection though it is routine to arrange follow up urine tests to confirm this.
Antibiotics in a low dose may be continued until further tests are completed. Tests may include a kidney ultrasound and or a bladder x-ray called a Micturating Cysto-urethrogram (MCUG). During the MCUG, a fine tube is passed into the bladder. The bladder is filled with fluid, which shows up on the x-ray. This can be done either by an X-ray specialists or by Urologists (kidney surgeons). The most common abnormal finding is called vesico-ureteric reflux. This means that urine travels back up the wrong way through the tube connecting the kidney to the bladder.
Usually vesico-ureteric reflux will disappear by itself, as the child gets older, however in some situations the child may need protective antibiotics to prevent further infections until this occurs. Some children may even need an operation to cure the reflux.
The risk of development of chronic kidney damage in children with one or two episodes of UTI, properly diagnosed and treated, is very low however the combination of vesico-ureteric reflux, abnormal kidneys, recurrent urinary tract infection or renal scarring at the time of the first infection seems to be associated with increased risk of kidney damage.
Many doctors would recommend an ultrasound in all febrile children within the first few days. The ultrasound excludes obstruction, absent kidneys, dysplastic kidneys or pyonephrosis (an accumulation of pus within the kidney). Further investigation depends on the findings and the age of the child.
Under the age of three many would routinely recommend a MCUG.
Over the age of 3 a nuclear medicine renal scan called DMSA renal scintigraphy can be used to identify children at low risk. A renal scan should be performed more than 3 months after the acute infection. The test looks for signs of renal scars. Small renal scars detected on DMSA scan do not alter patient management, as their significance is uncertain. Moderate-severe renal scarring in a child over 3 years may be an indication for MCUG.
Sometimes long-term prophylactic (or preventative) antibiotics are prescribed by your doctor. These would most likely to be indicated in moderate–severe vesico-ureteric reflux and or children with frequent symptomatic UTIs.
Rarely surgical correction of vesico-ureteric reflux is needed.
Preschool children may have recurrent UTI related to bladder instability and constipation, and treatment directed at these areas is important regardless of whether vesico-ureteric reflux is present. Any child with severe kidney infection may develop renal scarring even when vesico-ureteric reflux is not present.
An annual blood pressure check is often recommended for children with moderate-severe renal scarring.
Remember
Urinary tract infections are common in children. Consider arranging a urine test in any unwell child or a child with a fever for more than three days.
Urinary tract infections must be treated.
Your doctor may recommend investigated for any underlying problems of the kidney and bladder if your child suffers a Urinary Tract Infection (UTI).
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