A common infection which a lot of children have is UTI or urinary Tract Infection. Urinary infection is most commonly seen in children of age 2- 5 years. However, the infection is less commonly noted in neonates who are upto 28 days old. UTI occurs more in girls as compared to boys, as their ureters are shorter than boys and is closer to urethra. Before we go into the causes, signs, symptoms and management of UTI in children, let us understand the anatomy of the urinary system.
Urinary Tract Anatomy and UTI
The human excretory system is one of the most important systems of human body and the urinary tract is an important part of it. The urinary tract consists of a pair of kidney, urinary bladder, ureters, and the urethra. The kidneys have numerous arteries and contain functional units known as nephrons. These nephrons filter the renal blood and absorb the essential ingredients from the renal blood such as sodium and water content while extracting the waste fluid termed as “urine”. This urine then passes through the ureters and is stored in the urinary bladder. The bladder stores the urine and empties it outside the body through an opening termed as urethra. During urination, the bladder muscles contract to empty the bladder and expel the urine through the urethra, a muscular opening.
The urinary system is consisting of two parts- upper urinary tract system and lower urinary tract system. The upper urinary system includes kidneys and ureters while the lower include urethra and bladder.
Urinary tract infection can occur in any part of the urinary system like ureters, bladder or the urethra; however, it most commonly occurs in urethra and urinary bladder as they are located near the lower part of the tract. The upper urinary tract infection is comparatively less common and appears to be more severe.
The course of the infection may last from few days to month and may lead to severe complications if untreated or incompletely treated.
Signs and Symptoms of UTI in Children
The signs and symptoms of the urinary tract infection or UTI in children depend on the severity of infection and part of the urinary system infected. The UTI symptoms in children include:
- Burning pain while passing urine
- Cloudy urine
- Feeling of urgency to pass the urine followed by incomplete or minimal urine excretion
- Urine has foul and stringent smell
- Increased frequency of urination
- Often blood is seen in urine
- Severe abdominal and flank pain
- Pain in Pelvic and lower back area
- Micturition at night during sleep
- Fever and vomiting
- Associated diarrhea and nausea
- Weight loss
- Loss of appetite
- Warm skin due to inflammation
- Irritation and annoyed behavior with distress
- Skin rash.
If long standing UTI is left untreated in children or if the symptoms are ignored, the infection may present with more severe condition leading to:
- Abscess in the kidney
- Lowered kidney function leading to kidney failure
Swelling in kidney may occur either due to incomplete emptying of urine from the bladder due to blockage or as a consequence of underlying existing medical condition.
The infection may also lead to sepsis, which can turn life threatening.
Causes of UTI in Children
Mostly, urinary tract infections are caused by bacteria such as Escherichia coli. The bacteria enter the body through skin around the anus or vagina. E. coli is found in the intestine naturally. However, certain conditions increase the risk of urinary tract infection and make the body prone to develop the infection. The conditions include:
- Abnormal urinary tract function in children
- Wearing tight fitted cloths
- Congenital defect in the urinary tract resulting in backward flow of urine
- Improper toilet training to the child
- Poor hygiene leading to skin infection
- Holding urine for longer duration
- Obstruction in the urinary tract
- Wiping after the bowel movement in the back to forward direction.
Diagnosis of UTI in Children
Mostly, urinary tract infection is diagnosed by looking at the symptoms. Since, children cannot exactly describe the symptoms of UTI properly; it is a must that the parents keep a regular check on the symptoms in order to diagnose UTI at an early stage. It’s advisable to take the child immediately to doctor for early diagnosis and best treatment for the cure. Following tests are helpful in diagnosing:
- Urinalysis performed with test strip to check for blood in urine and white blood cells count.
- Mid-stream urine culture laboratory test is used to identify the infection causing bacteria.
- Catheterized urine culture is the most appropriate method to identify the infection, where the catheter is inserted in the urethra and to the bladder to collect the urine sample.
- Ultrasound of kidney and bladder is also recommendable.
- Nuclear medicine renal scan (DMSA), nuclear test using an isotope, can also be done to check UTI.
- CT scan and MRI also helpful for early diagnosis.
- Voiding cyst urethrogram (VCUG) is an x-ray test which is used to determine the flow of urine by using a contrast dye into the bladder, to identify if any structural blockage is present.
Management of UTI in Children
The management or treatment of the UTI in children depends on the severity and the type of infection; which in turn help in the prompt antibiotic selection.
The most common medication regime to treat UTI in children is as follows:
- Amoxicillin
- Amoxicillin and Clavulanic acid
- Cephalosporin
- Doxycycline
- Sulfamethoxazole-trimethoprim.
More severe or life-threatening infection may require the child to be hospitalized for continuous monitoring and medical support. The management then would also include:
- Intravenous infusion of fluids
- IV antibiotics
- Pain medications for unbearable abdominal pain.
Prevention of UTI in Children
It must always be kept in mind that prevention is better than cure. Hence, adequate precautionary measures must be taken to prevent the infection. The measures include:
- Monitor child’s urination and frequency for any sign
- Child is advised to drink enough water and stay hydrated
- Monitor the child’s fever and take him to the doctor if fever raises beyond 101degree F
- Parents are advised to change diapers properly
- Proper hygiene maintenance
- Parents are advised to give proper toilet training to the child
- Child is advised to avoid holding urine for longer duration
Although, UTI in children is very common; adequate measures must be taken to prevent an UTI infection in children.
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