UTI in children

Urinary Tract Infections (UTI) in Children

The urinary tract consists of a pair of kidneys, a pair of ureters, the bladder, and the urethra. The main function of the urinary system is to remove waste products, and toxins from the body via urine. It regulates and maintains the balance of electrolytes, and other substances in the body. A hormone known as Erythropoietin, which is secreted by the kidneys helps to form red blood cells.


What is a UTI?

UTI occurs due to a bacterial infection of the urinary tract. UTI in children (under 16 years) should be identified and treated quickly because some upper urinary tract infections can affect the kidneys and damage them permanently.


Symptoms and signs of a UTI

  • The child is ill looking.
  • Nausea and vomiting
  • Fever
  • The child is irritable.
  • Tiredness
  • Refuse feeding or not feeding well
  • Reduced weight gain
  • Yellowish discolouration of the eyes and the skin (jaundice) in infants
  • Painful passage of urine (dysuria)
  • Abnormal bedwetting
  • Frequent passage of urine
  • Abdominal pain
  • Back pain
  • Bad smelling urine
  • Passage of urine with blood (haematuria)


How to test?

If your child has symptoms of a UTI and your doctor suspects the child has a UTI, they will ask to test a urine sample for a full report (UFR). The urine sample can be tested by two methods.

  • By a dipstick
  • Examination under a microscope


How to collect a urine sample properly?

In young children, who are toilet-trained,

  • Collect urine in a sterile urine specimen bottle.
  • Clean the introitus of the penis or the vagina before obtaining the urine sample.
  • In uncircumcised boys, retract the prepuce.
  • Obtain a midstream sample of urine.
  • Do not touch the rim of the bottle.


In babies and children, who are not toilet-trained,

  • A catheterised urine sample may be obtained by your healthcare professional.
  • Alternatively, collect the urine in an aseptic absorbent pad, which you put in the nappy after disinfection of the skin of the genitals. The urine sample can be sucked out of the pad using a sterile syringe.


How to treat a UTI?

  • Your doctor will ask details about the condition (symptoms, and family history of urinary tract problems).
  • The doctor will examine your child (generally, and specifically, the abdomen).
  • Tell the doctor about any urinary tract problems, which have been detected by the ultrasound scans before your child was born.
  • Your doctor may ask to do a urine culture, and antibiotic sensitivity test to select the best antibiotic for your child.
  • If your baby is under three months, they will refer him quickly to a paediatric specialist. He will select the best antibiotic for the child. It may be an intravenous (IV) antibiotic.
  • Your doctor will prescribe oral antibiotics for three days, if your child is three months or older and is having a UTI without kidney involvement (upper urinary tract infection). If there is no significant improvement of the condition after 24-48 hours, you should take the child to the doctor for reassessment.
  • If your child is three months or older and is having a UTI with kidney involvement, the child may have to stay in the hospital. The doctor will prescribe antibiotics for seven to ten days.
  • Most UTIs will improve within 24-48 hours after the antibiotic treatment.
  • Do not discontinue the course of antibiotics.


Other Investigations

If your child is six months or older and responds well to antibiotics, additional investigations are not needed. If the child has recurrent UTIs, further investigations should be done.

Ultrasound scans of the abdomen

Ultrasound scans may be done within six weeks after the UTI to visualise the kidneys, and the bladder to detect any abnormality. Following the scans, your doctor may recommend further investigations to detect any problems of the kidneys and the bladder.

If any problems of the kidneys or the bladder were found during the ultrasound scans, or your child has recurrent UTIs, the doctor will refer the child to a paediatric specialist. They will check the height, weight, the blood pressure of the child and a urine sample for any protein.

If the kidneys of your child are not working adequately, or if the blood pressure is high, or protein in the urine, they will refer the child to a paediatric kidney specialist.


How to prevent further UTIs?

  • Breast feeding may prevent UTIs during first six months of life.
  • Your doctor may ask to do periodic urine cultures during the first year after an initial UTI to detect UTIs early.
  • Voiding dysfunction should be treated with a voiding retraining programme. A drug such as Oxybutynin, Propantheline, or Hyoscyamine sulphate may be helpful.
  • Manage constipation.
  • Drink adequate fluids daily.
  • Pass urine as soon as they feel the need to.


(Photo courtesy: Saw Htoo)


Related Links:

How to Prevent Infections in Children?


About the author
Dr. Nalaka Priyantha is the founder and author of 'DRN Health'. He currently works at the Ministry of Health, Sri Lanka as a senior medical officer. He is blogging about healthy living since 2012.
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