At some point in time, a urinary tract infection develops in 8% of girls and 2% of boys.
The urinary tract is responsible for ridding the body from urine, a form of bodily waste. Urine travels from the kidneys down tube-like structures, the ureters, into a balloon-like container called the bladder. In children, the bladder can contain 30 to 45 mL of urine for every year of age (e.g., 120 to 170 mL, or a little less than a cup, in a four-year-old). When the bladder empties, the urine is thrown out of the body through the urethra, a tube at the bottom of the bladder. The urethra opens at the end of the penis in boys and in front of the vagina in girls. In normal children, urine flows only in one direction: the kidneys the ureters the bladder the urethra. This unidirectional flow is maintained to prevent infections.
Causes urinary tract infections in children
Normal urine is sterile, that is to say it contains no bacteria. At times, bacteria cover the skin, in the rectal area, and within stools may move into the urinary tract and travel up the urethra into the bladder, where they multiply and form colonies. If the body fails to eliminate the bacteria, they can cause infection (urinary tract infection or "UTI.")
There are two main types of UTIs:
-bladder infection: inflammation, swelling and pain of the bladder. This is called cystitis
-kidney infection: this occurs when bacteria travel upward from the bladder through the ureters and get into the kidneys, the kidney infection is called pyelonephritis.
Kidney infections are more serious than bladder infections, and can result in kidney damage especially in young children.
Symptoms of urinary tract infections in children
In a urinary tract infection, the bladder, urethra, ureters, and kidneys become inflamed, red and irritated. The result is frequent urination with associated pain; urine may also have a bad smell. If the infection reaches the kidneys, abdominal or back pain and fever may occur. In toddlers and younger children , as is the case of your son, the signs are likely to be vague and unrelated to the urinary tract. For example, your child may only develop a high fever without any other symptoms, or be fussy and refusing to eat, or sometimes have only a low-grade fever, loose stools, or just not seem well. You may notice that the diaper urine "smells bad." If your child has a high temperature and is ill-looking without another obvious source for his symptoms (such as runny nose or cough), it could be a bladder or kidney infection. If a kidney infection is not treated promptly, the bacteria may spread to the bloodstream and cause a life-threatening infection or permanent kidney damage.
Older children may complain of pain in the low stomach area or back as well as the need to urinate frequently. Then may cry upon passing urine, or say that it hurts to urinate and only a few drops of urine come out. It may be difficult for them to control their urine so they may have urinary accidents or bed-wetting. They may also produce urine that smells bad or looks cloudy.
Diagnosing urinary tract infections in children
The only way to diagnose a urinary infection is with a urine test: a urine analysis and culture are needed to identify the causative bacteria. If your child is not toilet-trained, your doctor may simply attach a plastic bag to their skin to collect the sample. If your child is older, you may be asked to collect a urine specimen by a method that is known as mid-stream catch: you collect the urine specimen midway through as your child empties his bladder. If this method fails, and because it is necessary to collect bacteria-free urine (urine can get contaminated by bacteria on the surrounding skin), it is sometimes necessary to pass a small tube into the urethra into the bladder directly to collect a good sample.
This sample of urine is then examined under a microscope (urine analysis). If an infection is present, bacteria and pus (white blood cells) may be seen. This test takes only a few minutes. A urine culture, however, bacteria from urine are grown in a laboratory incubator to be identified and tested to see which drugs will most effectively treat the infection.
Treatment of urinary tract infections treated in children
Urinary tract infections are treated with antibiotics. If your doctor thinks your child has a urine infection, they will choose a drug that treats the bacteria most likely to be causing the problem.
After treatment for urinary tract infections in children
Once the infection has cleared, the doctor may recommend additional tests, particularly if the infection has reached the kidney. The tests are done to rule out any abnormalities in the kidneys: kidney damage or scarring. Additional tests may include a kidney and/or bladder ultrasonography or a Voiding cystourethrogram (VCUG): can show abnormalities of the inside of the urethra and bladder, and if urinary flow is normal during bladder emptying. It also detects if urine from the bladder is backing up into the ureters (vesicoureteral reflux) and whether it reaches the kidneys.