During infancy and early childhood, both boys and girls are vulnerable to infections of the urinary tract, the system of organs and ducts through which urine is eliminated from the body. The two kidneys filter waste from the blood. By way of two tubes known as ureters, these wastes (now in the form of urine) move on to the bladder for storage. From there, a canal known as the urethra discharges the urine from the body. In boys, the urethra runs the length of the penis to its tip; in girls, the urine discharges through an opening found between the vagina and the clitoris.
WHAT HAPPENS DURING URINARY TRACT INFECTION?
Urinary tract infections occur when bacteria begin to multiply in the urethra, causing inflammation. Unchecked, inflammation and irritation will spread to the bladder wall. From there, if untreated, the infection can attack the kidneys, leading to a type of infection called pyelonephritis, which is a potentially dangerous condition. (For more information, see nephritis.) In addition, repeated urinary tract infections, usually caused by some obstruction in the urinary tract, can damage the bladder walls and scar kidney tissue. For this reason, it is important to find and correct the underlying cause of recurrent urinary infections.
WHAT CAUSES URINARY TRACT INFECTIONS?
Bacteria, primarily from the colon, sometimes gain access to the urinary tract. If these bacteria are allowed to multiply, infection results. During their first four months of life, infants of both sexes are at roughly equal risk for urinary tract infections. The bacteria usually enter directly from the blood at this early stage. However, girls and women are more susceptible than males because the female's urethra is closer to the anus (the source of fecal contamination), and the female's urethra is shorter than the males, allowing infection to spread more rapidly to other portions of the urinary tract. After an infant reaches four months of age, bacteria usually invade the urinary tract from the external genitalia and anal area.
WHEN SHOULD I SUSPECT THAT MY CHILD HAS A URINARY TRACT INFECTION?
In infants, the symptoms of urinary tract infections are nonspecific. They can include vomiting, diarrhea, irritablity, abnormal body temperature (either high or low), slowed weight gain and sometimes even jaundice, a yellowing of the skin. In an older child, abdominal pain and symptoms specific to the urinary tract may also arise. A weakened urine stream, frequent and/or painful urination, unpleasant urinary odor, feelings of urgency and bedwetting in a child who has been successfully toilet trained may signal the presence of a urinary tract infection.
IS MEDICAL ATTENTION NECESSARY?
Yes. Since urinary tract infections can spread to the kidney, treatment is essential.
HOW CAN THE PEDIATRICIAN TELL IF MY CHILD HAS A URINARY TRACT INFECTION?
The physician will send a urine sample for culture and urinalysis; the results will confirm the diagnosis and identify the specific bacteria responsible.
The physician will need to perform special X-ray and ultrasound tests to detect possible damage to urinary tract tissues and/or the presence of any congenital abnormalities that may have contributed to the infection.
WHAT TREATMENTS ARE AVAILABLE?
Several antibiotics are effective in combatting urinary tract infections. The medication usually will begin to relieve the symptoms within 24 to 48 hours of the initial dose. If not, notify the physician. To be certain that the infection is completely eliminated, administer the full prescribed course of antibiotics, even if the symptoms have disappeared.
Sometimes the physician will prescribe a urinary analgesic to reduce burning or other urinary discomfort. Do not be alarmed if this medication turns the child's urine red. The child should be encouraged to increase fluid intake, as well.
In the case of recurrent urinary tract infection, further studies may be needed to rule out obstructions, and long-term antibiotic prophylaxis may be required.
PREVENTING URINARY TRACT INFECTIONS
Several precautions can help prevent urinary tract infections from developing:
• Increase the child's fluid intake to help flush potentially dangerous bacteria from the urethra.
• Use careful diaper hygiene.
• During diaper changes, wipe little girls from the front to back to avoid fecal contamination of the urethra.
• Provide a healthy diet to prevent constipation, which can contribute to urinary tract infections.
• Avoid bubble baths, which can irritate the urethra.
WATCHING FOR RECURRENCES
Urinary tract infections recur at least once in 30 to 40 percent of children; they recur especially during the first three months after the initial infection. Symptoms will not necessarily reappear. To detect recurrence, your physician may check one or more follow-up urine cultures.
GETTING HELP
Call the pediatrician if:
• Your child has any signs or symptoms of a urinary tract infection.
• You notice any change in your child's usual pattern of urination.
