Urinary tract infections are seen quite commonly in children more so in girls than boys. They can present as bladder infections (Cystitis) or kidney infections (Pyelonephritis).
Symptoms in children are very variable, and can be non specific, and may include burning/discomfort on passing urine, urgency, frequency and ‘smelly’ urine – although none of these is specific. If they are severe they can include fever and vomiting as well. In some cases, children previously potty trained may start bed wetting or dribbling into their underpants if they can’t get to the loo in time.
This is not normal and there is a need to confirm that these symptoms represent a ‘true’, confirmed UTI and so needs to be investigated. Diagnosing a Urinary tract infection ( UTI) is often not very straightforward, and frequently the diagnosis is applied incorrectly.
Initially this includes:
A clean catch urine in older children and preferably in infants, although sometimes a bag collection is used. These are frequently contaminated and may need to be repeated several times. A clean catch is preferred. This is then tested using urine dipstick which looks for evidence of infection – such as white cells and nitrites but also other signs of possible disease in the urinary system, such as blood and protein.
This fresh urine, if abnormal on dipstix, is then sent to the laboratory to be looked at under a microscope and also to be grown on a special medium to see what kind of bug is responsible and to assess which antibiotic would work best.
If it is proven to be a UTI, and this may take several specimens, then an ultrasound of the kidneys and bladder may be indicated to exclude any structural problem (these may have already been picked up as now as all mothers have ante-natal scans which include assessment of the babies’ kidneys). If this test shows abnormalities such as swollen/blocked tubes from the kidneys – called hydronephrosis, then further tests may need to be done.
In addition, if the infection is severe or recurrent, a test called a DMSA scan should be done to exclude scarring of the kidneys. In this situation, children may be put onto a low dose night-time antibiotic to prevent any further infections for a time period of 6 months – 2 years (the variable duration depends on their age), and then reassessed.
Prevention of UTIs:
Good fluid intake – we suggest 6 – 8 cups of fluid a day up to 1 hour before bed-time
Avoiding constipation – passing a stool every day – if not use Lactulose, Movicol or oat bran added to food
Regular peeing every 3-4 hours – not holding on to urine
Probiotics in form of Actimel or Yakult yoghurt drinks
Good hygiene – daily bath/shower, avoiding bubble baths
Dr Andy Raffles
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