RespiteMatch.com Health Blog

Urinary tract infections (UTIs) are common in kids. By 5 years old, about 8% of girls and about 1% to 2% of boys have had at least one UTI. They occur when the kidneys, ureters, bladder, or urethra become infected.

Symptoms of a UTI include:

pain when urinating
changes in frequency, appearance, or smell of urine
fever
chills
loss of appetite
nausea
vomiting
lower abdominal pain
lower back pain or discomfort
Recurrent UTIs can also cause bedwetting in children who were previously dry at night. Infants and young children may only show nonspecific signs such as fever, vomiting, or decreased appetite or activity.

Some children experience UTIs again and again (also called recurrent UTIs). If left untreated, recurrent UTIs can cause kidney damage, especially in children younger than 6. Read on to find out how you can recognize the signs of these repeated infections and get help for your child.

Types of UTIs
Common types of UTIs include:

cystitis, the most common type of UTI, which is a bladder infection that can occur when bacteria move up the urethra (the tube-like structure that allows urine to exit the body from the bladder) and into the bladder
urethritis, which occurs when bacteria infect the urethra
pyelonephritis, which is a kidney infection that can occur when infected urine flows backward from the bladder to the kidneys, or when an infection in the bloodstream reaches the kidneys
Related Urinary Tract Conditions Associated With Recurrent UTIs
Recurrent UTIs are sometimes seen in conjunction with other conditions, such as:

vesico-ureteral reflux (VUR), which is found in 30% to 50% of children diagnosed with a UTI and is a congenital condition (it’s present at birth) in which urine flows backward from the bladder to the ureters (the thin, tube-like structures that carry urine from the kidney to the bladder) and sometimes reaches the kidneys. If the urine in the bladder is infected with bacteria, VUR can lead to pyelonephritis.
hydronephrosis, which is an enlargement of one or both kidneys due to backup or blockage of urine flow and is usually caused by severe VUR or a blocked ureter. Children with hydronephrosis are sometimes at risk of recurrent UTIs and may need to take daily low doses of antibiotics to prevent UTIs.
But not all cases of recurrent UTIs can be traced back to these body structure-related abnormalities. For example, dysfunctional voiding - when a child doesn’t urinate frequently enough or doesn’t relax properly while urinating - is a common cause of UTIs. Unrelated conditions that compromise the body’s natural defenses, such as diseases of the immune system, can also lead to recurrent UTIs. In addition, using a nonsterile urinary catheter can introduce bacteria into the urinary tract and cause an infection.

Detecting Kidney and Urinary System Abnormalities
Although UTIs can be treated with antibiotics, it’s important for your child’s doctor to rule out any underlying abnormalities in the urinary system when these infections occur repeatedly.

Some abnormalities can be detected even before birth. Hydronephrosis, when it occurs as a congenital condition, can be detected in a fetus by ultrasound as early as 16 weeks of gestation. When hydronephrosis poses significant danger to the developing kidneys, surgery may be performed while the baby is in the womb; however, in most cases, doctors wait until after birth before treating the condition because almost half of all cases that are diagnosed prenatally disappear by birth.

Once a baby suspected to have hydronephrosis or another urinary system abnormality is born, the baby’s blood pressure will be monitored carefully because some kidney abnormalities can cause high blood pressure. An ultrasound may be used again to get a closer look at the bladder and kidneys.

Approximately 1% of children will have a duplicated, or double, collecting system from one or both kidneys. Some of these children will have an obstruction in one of the two collecting systems, which may result in hydronephrosis. A prenatal ultrasound can detect this condition in many cases.

Diagnosis and Treatment
If your doctor suspects that your child may have an abnormality of the urinary tract, he or she may order tests to make an accurate diagnosis including:

Ultrasound
Using high-frequency sound waves to “echo,” or bounce, off the body and create a picture of it, an ultrasound can detect some abnormalities in the kidneys, ureters, and bladder. It can also measure the size and shape of the kidneys. When an ultrasound suggests VUR, a voiding cystourethrogram (VCUG) or a renal scan (see below for descriptions of both) may be performed for further evaluation.

Renal scan (nuclear scan)
Radioactive material is injected into a child’s vein and followed through the urinary tract. The material can show the shape of the kidneys, how well the kidneys function, if there is damaged kidney tissue, and the course of the urine. The amount of radiation received is similar to or less than a plain X-ray and the radioactive material leaves the body in the urine.

Voiding cystourethrogram (VCUG or cystogram)
A catheter (a hollow, soft tube) is used to inject an opaque dye into the bladder. This X-ray test can identify problems with the bladder or urethra and can also diagnose VUR.

Cystoscopy
A cystoscope uses lenses and a light source within a tube inserted through the urethra to directly view the inside of the bladder. It’s used when other tests or symptoms indicate a possible bladder abnormality.

Intravenous pyelogram
Opaque dye is injected into a child’s vein and then X-rays are taken to follow the course of the dye through the urinary system. Although this test is still used sometimes, the renal ultrasound and renal scan have replaced the intravenous pyelogram in most cases.

Because VUR can lead to kidney infection (pyelonephritis) and subsequent kidney damage, children with the condition must be monitored closely. Usually, surgery isn’t necessary because 75% of children will outgrow the condition. Even for kids who don’t outgrow it, surgery may be unnecessary because antibiotics are usually successful in warding off UTIs and preventing or limiting damage to the kidneys.

The most common type of surgery to correct VUR is ureteral reimplantation, in which one or both ureters are reattached to the bladder to decrease backflow of urine from the bladder to the ureters and kidneys. Although the success of ureteral reimplantation is greater than 90%, only those who have recurrent UTIs while on antibiotic prophylaxis (or preventive therapy) will be considered for surgery.

Blockages can interfere with normal urine flow, which serves to wash bacteria out of the urinary tract. Because severe blockages in the ureter or the urethra may ultimately lead to repeated kidney infections and kidney damage, they may require surgical intervention. Kidney stones are another source of blockage that may obstruct the path of urine.

When anatomical defects have been ruled out, antibiotics may be prescribed for months or even years to prevent recurrent infections and kidney damage. Fortunately, the problems often vanish when the child enters puberty because of the child’s growth and development.

The Future for Managing Recurrent UTIs
Doctors have started to use a less invasive way to correct VUR. The procedure involves the injection of such materials as Teflon, Delflux, or collagen into the bladder through a cystoscope. This procedure was considered experimental a few years ago, but is rapidly gaining wider acceptance.

A recent National Institutes of Health (NIH) study has linked recurrent UTIs with certain blood types. Further research is in progress, but researchers hope to use this information to identify those who may be at high risk.

Additional studies have found that women and children who get recurrent UTIs may lack certain immunoglobins (a group of proteins that fight infections). Some researchers are optimistic that a vaccine may be developed that could help boost a person’s production of antibodies that fight UTIs. The most promising vaccine would protect against E. coli (the most common bacterium that causes UTIs), but it’s still in the experimental stage.

Home Treatment
Here are some additional things to consider to help prevent recurrent UTIs in your child:

Diet Modifications
Encourage your child to drink 8 to 10 glasses of water and other fluids per day. Cranberry juice is often suggested because it may prevent E. coli from attaching to the walls of the bladder. Always ask your child’s doctor, though, if your child should drink cranberry juice because it can interfere with some medicines.

Multivitamins
Vitamin C acidifies the urine, making the environment less friendly to bacteria. Vitamins designed for children are generally safe, but always ask your child’s doctor before increasing the dose beyond the currently recommended daily allowance.

No Bubble Bath
Your child should avoid bubble baths and perfumed soaps because they can irritate the urethra.

Frequent Diaper Changes
If your child is in diapers, change him or her frequently to prevent stool from having prolonged contact with the genital area, which can increase the chance that bacteria will move up the urethra and into the bladder.

Proper Wiping Technique
In females, wiping from front to back after using the toilet will reduce exposure of the urethra to UTI-causing bacteria in the stool.

Cotton Underwear
Breathable cotton underwear is less likely to encourage bacterial growth near the urethra than nylon or other fabrics.

Frequent Bathroom Visits
Some children may object to using the school bathroom or may become so engrossed in a project that they delay urination. Children who experience UTIs should urinate at least every 3 to 4 hours to help flush bacteria from the urinary tract.

Follow-Up Visits
Your child’s doctor may advise performing another urine culture after treatment of a UTI is completed to be sure that the infection has cleared.

When to Call Your Child’s Doctor
As soon as you suspect a UTI in your child, it’s important to contact your child’s doctor.

Although most recurrent UTIs won’t cause long-term health problems, in a small portion of patients - primarily those who have had several undiagnosed and untreated UTIs - permanent kidney damage can happen.

If your child suffers from recurrent UTIs, seek out a pediatric nephrologist or urologist who can perform a thorough evaluation and, if necessary, order tests for urinary system abnormalities. In the meantime, follow your child’s doctor’s instructions for treating a UTI.

Reviewed by: Laszlo Hopp, MD
Date reviewed: May 2004