Dr Vijay Kundal
Urinary tract infections affect about 3 percent of children in the United States every year. UTIs account for more than 1 million visits to pediatric surgeon offices every year. Urinary tract Infections(UTIs) are caused by very small organisms such as bacteria, viruses and fungi. Bacteria are the most common cause of UTIs. Normally, bacteria that enter the urinary tract are rapidly removed by the body before they cause symptoms. However, sometimes bacteria overcome the human natural body defenses and cause infection.
Causes of UTI
Most UTIs are caused by bacteria. The urinary tract has several systems to prevent infection. The points where the ureters attach to the bladder act like one-way valves to prevent urine from backing up, or refluxing, toward the kidneys, and urination washes microbes out of the body. Children who often delay urination have more chances to develop UTIs. Regular & timely urination keeps the urinary tract clean by flushing away bacteria. Holding in urine allows bacteria to grow. Producing small quantity of urine because of less fluid intake can also increase the risk of developing a UTI. Chronic constipation, a condition in which a child has fewer than two stool movements per week, can increase, the risk of developing a UTI. When the bowel is full of hard stool, it presses against the bladder and bladder neck, blocking the flow of urine and allowing bacteria to grow.
High risk groups in UTIs
Throughout childhood, the risk of having a UTI is 2 percent for boys and 8 percent for girls. Having an abnormality of the urinary tract, such as urine reflux from the bladder back into the ureters, increases the risk of a UTI. Boys who are younger than 6 months old who are not circumcised are at greater risk for a UTI than circumcised boys the same age.
Are UTIs serious?
Urinary tract infections can make children feel very ill with vomiting, pain abdomen and high temperature. If infections enter the kidney, the infection can cause a scar to form on the kidney. Scars on kidneys can cause problems with how well the kidney functions and with high blood pressure. It is therefore very important that urinary tract infections are treated without delay to prevent these kidney scars formation. Some acute kidney infections, infections that develop suddenly-can be life threatening. Chronic kidney infections-infections that recur or last a long time-can cause permanent damage, including kidney scars, poor kidney growth, poor kidney function, high blood pressure. Because UTIs are less common in boys after the first 4 weeks of life, so a boys with a UTI should be assumed to have an some abnormality of the urinary tract until proven otherwise.
Signs and symptoms of a UTI
Symptoms of a UTI range from slight burning urination or unusual-smelling urine to severe pain and high fever. A child with a UTI may also have no symptoms. Children may have a high fever, irritability, decreased appetite. Some may have only a low-grade fever, nausea, vomiting, and diarrhea; or just sense of being unwell. Older children with UTIs may complain of pain in the middle and lower abdomen. They may have increased urinary frequency, excessive crying and burning urination & passing only a few drops of urine. Children may leak urine into under clothings or bedsheets. The urine may look cloudy or bloody. If a kidney is infected, children may complain of pain in the back or side below the ribs. Parents should immediately report to a doctor if they suspect their child has any of above mentioned symptoms.
Diagnosis of UTIs
A urine sample will be collected and examined. Some of the urine will be examined with a microscope. If an infection is present, bacteria and sometimes pus will be found in the urine. A urine culture should also be performed. The doctor may also order a sensitivity test, which tests the bacteria for sensitivity to different antibiotics to see which medication is best for treating the UTIs.
Treatment of UTIs
Most UTIs are caused by bacteria, which are treated with antibiotics. The choice of medication and length of treatment depend on the child’s history and the type of bacteria causing the infection. When a child is sick or unable to drink fluids, the antibiotic may need to be given through intra venous route. Otherwise, the medication-liquid or tablet-may be given by mouth. The medication is given for at least 3 to 5 days and possibly for as long as several weeks. In any case, the medication should be taken for as long as the doctor recommends. Antibiotics should not be stopped because the symptoms have gone away. Infections may return and resistant UTI may develop if the medication is stopped early.
Prevention of UTIs
If a child has a normal urinary tract, parents can help the child avoid UTIs by encouraging regular visit to the toilet. The parents should make sure the child takes plenty of fluids if infrequent urination is a problem. The child should be taught basic hygiene techniques after using the bathroom to keep bacteria from entering the urinary tract. Loose-fitting clothes and cotton underwear allow air to dry the area. Parents should consult the pediatric surgeons about the best ways to treat constipation. Children with a UTI should drink as much as they wish and not be forced to drink large amounts of fluid.
Take home message
Urinary tract infections (UTIs) usually occur when the body fails to remove bacteria rapidly from the urinary tract. UTIs affect about 3 percent of children in the United States every year. Most UTIs are not serious, but chronic kidney infections can cause permanent damage. A UTI in a young child may be a sign of an abnormality in the urinary tract that could lead to repeated problems. Symptoms of a UTI range from slight burning with urination or unusual-smelling urine to severe pain and high fever. A child with a UTI may also have no symptoms. Parents should consult there pediatric surgeon/urologist if they suspect their child has a UTI.
(The author is Consultant Neonatal & Pediatric Surgeon at Dayanand Medical College and Hospital Ludhiana )
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