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Urinary tract infections describe a health problem that results from a bacterial infection along the urinary tract.
Urinary tract infections (UTIs) affect about 3 percent of children in the United States every year and account for more than 1 million visits to pediatricians' offices every year. UTIs are uncommon in children younger than age 3 to 5, but unlikely in boys at any age, unless an obstruction is present. They are much more common in girls as a result of a shorter urinary tract. Uncircumcised males are more likely to develop a UTI than circumcised males. Children with a complete or partial blockage in the urinary tract are more likely to develop a UTI.
Normal urine is sterile and contains fluids, salts, and waste products. It is free of bacteria, viruses, and fungi. An infection occurs when microorganisms, usually bacteria from the digestive tract, cling to the opening of the urethra, the hollow tube that carries urine from the bladder to the outside of the body, and travel up to the bladder.
Most infections arise from Escherichia coli (E. coli) bacteria, which normally live in the colon.
A urinary tract infection may involve different sections of the urinary tract including the following:
Urethritis. An infection of the urethra, the hollow tube that drains urine from the bladder to the outside of the body.
Cystitis. A bacterial infection in the bladder that often has moved up from the urethra.
Pyelonephritis. An infection of the kidneys that is usually a result of an infection that has spread up the tract, or from an obstruction in the urinary tract. An obstruction in the urinary tract causes urine to back flow into the ureters and kidneys.
The following are the most common symptoms of UTI. However, each child may experience symptoms differently. Symptoms may include:
In babies:
Fever
Abdominal pain
Abdominal fullness
Foul-smelling urine
Poor growth
Weight loss or failure to gain weight
Irritability
Vomiting
Poor feeding
Diarrhea
Older children:
Urgency to urinate
Incontinence during day and/or night
Frequent urination
Painful or difficult urination
Discomfort above the pubic bone
Blood in the urine
Nausea and/or vomiting
Chills
Pain in the back or side below the ribs
Fatigue
Small amount of urine while voiding despite feeling of urgency
The symptoms of a UTI may resemble other conditions or medical problems. Always consult your child's doctor for a diagnosis.
Your child's doctor may diagnose a urinary tract infection based on physical examination and a description of symptoms. Other studies may include a urinalysis (a laboratory examination of urine for various cells and chemicals, such as red blood cells, white blood cells, infection, or excessive protein) and culture that will detect the presence of an infection.
A boy with a UTI or girls younger than age 5 or 6 may require further diagnostic testing with a renal ultrasound. This is a diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels. A voiding cystourethrography (VCUG) may also be needed in some children to evaluate the bladder and urethra and to detect reflux (in which urine backs up to the kidneys instead of flowing out through the urethra). In some cases, your doctor may recommend an intravenous pyelogram, a nuclear medicine scan, a computed tomography (CT) scan, or magnetic resonance imaging (MRI). These tests may help to rule out a structural abnormality of the urinary system.
Specific treatment for a urinary tract infection will be determined by your child's doctor based on:
Your child's age, overall health, and medical history
Extent of the condition
Your child's tolerance for specific medications, procedures, or therapies
Expectations for the course of the condition
Your opinion or preference
Treatment may include:
Antibiotics
A heating pad or medications (to relieve pain)
Increased fluid intake (especially water)
Your child's doctor may ask you to bring your child back into the office a few days after treatment starts to reevaluate your child.
The following may help to prevent your child from developing urinary tract infections:
Have your child take a shower instead of a bath.
Instruct your child to urinate when he or she has the urge and not to resist.
Teach your child to wipe his or her bottom from front to back. If your son is uncircumcised, he should be taught how to retract the foreskin on his penis and clean himself. The foreskin should never be retracted forcibly. Do not allow the foreskin to stay retracted for long periods as this may shut off the blood supply causing pain and possible injury.