UTI symptoms vary widely in children. In older children, they include burning or stinging during urination, an urgent need to urinate, frequent urination, and daytime and nighttime wetting or dribbling. Fever, stomach pain or vomiting are also common.
In infants or young children, the signs may not be clear, especially in those too young to say how they feel. Instead, the child may be irritable, not eat as much as usual, have a fever, or just seem unwell. If symptoms last more than a day, this may signal a need to see a doctor.
To understand what happens with a UTI, you first need to know how the urinary system works.
The urinary tract makes and stores urine. First, the kidneys remove waste and water from the blood, producing urine. Two narrow tubes called the ureters channel urine as it leaves the kidneys. It is then stored in the bladder, a balloon-like container. The bladder, muscles of the pelvis, and special centres in the brain and spinal cord work together to release the urine at an appropriate time. The urethra then carries it out of the bladder.
A urinary tract infection is an overgrowth of bacteria in the bladder and sometimes in the kidney. Normally, the urinary tract is sterile, containing no bacteria. Bacteria sometimes enter the urinary tract through the urethra, and can move upward to the bladder. The lining of the urethra and bladder become irritated, just as the inside of the nose or throat do when one has a cold. If the bladder is infected, it is called cystitis. If the kidneys are infected, it is called pyelonephritis. These infections must be treated so that the kidneys are not damaged.
Uncircumcised boys have a higher rate of bladder infections compared to circumcised boys. Some parents wonder if their sons should be circumcised just to prevent UTIs. However, circumcision is a personal choice for a family. There is not enough benefit to suggest that boys should be circumcised just to prevent this type of infection. The rate of infection in uncircumcised boys is still lower than that of girls.
Please talk to a family doctor if you have any questions regarding circumcision. Your doctor will be able to discuss the various pros and cons of circumcision with you.
Younger children are at increased risk of UTIs. Those at highest risk are boys under a year of age, and girls under age four.
The risk increases if any part of the urinary tract did not form correctly before birth, or the bladder does not work correctly. For instance, the bladder may not fully empty with urination (peeing). Some children need to have a tube (called a catheter) placed up the urethra into the bladder, allowing the urine to empty properly. Long-term catheter use is a risk factor for urinary tract infections. It provides an easy way for bacteria to enter the bladder.
The doctor first reviews your child’s medical history, looking for symptoms of past or present infection. An exam will also be done. A sample of urine can show whether red blood cells, white blood cells or bacteria are present. A urine culture test involves growing bacteria from the urine sample, then identifying and testing to see which antibiotics will kill them. Your doctor may also order a blood test, but this is not always done.
It is very important to collect the urine properly. The laboratory can provide specific instructions on the procedure. With infants or children who are not potty-trained, a catheter is inserted into the bladder to collect the urine. This ensures that the urine sample is not contaminated by anything on the skin or other contents in the diaper.
If you have a daughter, have her sit on the toilet seat with her legs spread widely so that the labia (skin folds of the vagina) do not touch each other. If you have a son, it is important to gently pull back the foreskin. The laboratory will provide a cleaning cloth. Use it to wipe the genital area for a girl or the head of the penis for a boy.
Since the first and last millilitres of urine that come out of the bladder can be contaminated with bacteria from the skin, you do not want to collect this urine. Instead, you will use a mid-stream catch. To start, encourage your child to urinate. Let the first of the urine go into the toilet. Now, place the clean container directly in line with the stream of urine. Collect a few millilitres of urine and remove the container before your child stops urinating.
Usually, antibiotics will clear it up. Your doctor will prescribe an antibiotic to kill the bacteria and prevent the spread of infection to the kidneys. Sometimes an antibiotic is prescribed before the results of the urine culture come back. The doctor could also use the results of the culture to prescribe an antibiotic.
Sometimes oral antibiotics do not work as expected, or a child is more seriously ill or dehydrated. In this case, hospitalization may be needed for more intensive treatment and testing. Infants under two months old are admitted to hospital for treatment.
Recovery depends on how severe the symptoms are when you begin treatment. With a mild case, your child may feel better within a day or two. In more severe cases, several days are needed before symptoms disappear.
If the symptoms return shortly after treatment is finished, more tests may be necessary. The doctor will assess whether an underlying cause for the illness is present. In some children, a urinary tract infection can be a sign of an abnormal urinary tract.
Young children are at the greatest risk for kidney damage from urinary tract infections. Such damage may lead to poor kidney function, high blood pressure, and other problems in the future. For this reason, make sure that infections are treated quickly, and carefully checked after treatment.
If you suspect a urinary tract infection, schedule an appointment with your doctor. Timely treatment will help your child to feel better, while avoiding complications.