Urinary Tract Infections

What are urinary tract infections (UTIs)?

Urinary tract infections describe a health problem that results from a bacterial infection along the urinary tract. The urinary tract consists of two kidneys that remove liquid waste from the blood in the form of urine. Two narrow tubes called ureters carry urine from the kidneys to the bladder. The urine is stored in the bladder (a triangle-shaped, hollow organ). When the bladder is emptied, the urine travels through a tube called the urethra and passes outside the body.

Who is affected by urinary tract infections?

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 UTIs than circumcised males. Children with a complete or partial blockage in the urinary tract are more likely to develop UTIs.

What causes a urinary tract infection?

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, travel up into the bladder and/or kidney, and begin to multiply.

Most infections arise from Escherichia coli (E. coli) bacteria, which normally live in the colon.

What are the symptoms of a UTI?

The following are the most common symptoms of a 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

• Foul-smelling urine

• Nausea and/or vomiting

• Fever

• 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.

How are UTIs diagnosed?

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 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).

What is the treatment for a UTI?

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.