When Lauren was just under two years old, she developed a fever of 103, was irritable and lost her appetite. Mom, who suspected her daughter’s condition was more than “just a bug,” scheduled an appointment with Lauren’s pediatrician.
Based on her symptoms and physical examination, Lauren was diagnosed with a urinary tract infection (UTI). The tiny tot was treated and quickly felt better.
Unfortunately, the relief was short-lived. To mom’s surprise, the UTI returned.
“This is an incredibly common story,” says Dr. Caleb Nelson, urologist in the Boston Children’s Hospital Department of Urology. “We see dozens of children like Lauren who are referred to us for further imaging and testing for recurrent UTI.”
UTIs in children are not uncommon. By age 5, about eight percent of girls and one to two percent of boys have had at least one UTI. Anatomic factors, toileting habits (frequency and emptying the bladder completely), constipation and other factors may contribute to elevated risk of infection.
According to Nelson, any UTI in a child is worrisome.
“We see many children with UTIs and recommend kids get appropriately evaluated after the first UTI to identify risk factors for recurrence,” Nelson says.
Nelson answers parents’ most frequently asked questions about UTIs, including signs and symptoms, treatment options and when to see a pediatric urology specialist.
What causes a UTI?
Nelson: A urinary tract infection occurs when certain microorganisms (usually bacteria from the digestive tract) cling to the opening of the urethra (the hollow tube that carries urine from the bladder to the outside of the body).
The microorganisms travel back into the bladder, where they begin to multiply and cause infection. Most infections come from Escherichia coli (E. coli) bacteria, which are often found in the colon. Not all forms of E. coli cause infections; certain disease-causing strains are responsible for the majority of infections in otherwise healthy children.
Other factors that may cause a child to get a UTI include:
Anatomic abnormalities: Structural or functional problems with the urinary drainage system including the kidneys, ureters, bladder, or urethra can result in obstruction, a period of inactivity, incomplete emptying, and other problems.
Waiting to urinate. Regular urination helps flush away bacteria. Holding urine prompts bacteria growth.
Making too little urine. A child who doesn’t drink enough fluids may not make enough urine to flush away bacteria.
- Constipation. Constipation is a condition in which a larger-than-normal amount of stool gets backed up in the colon.
What are the symptoms of a UTI?
Nelson: Every child is different, and UTI symptoms vary depending on the child’s age.
In babies and toddlers, the primary indication of UTI is usually a fever. UTI should be considered in any young child with fever, although obviously kids get lots of fevers for many reasons, and most of these are not UTIs.
Older children are often able to describe urinary symptoms such as painful urination, urinary urgency or frequency, or leakage of urine. Your pediatrician can help figure out what is going on with your child.
Most children who have one UTI will not have another. However, recurrent UTI is a significant concern, and it is important to see a pediatric urology specialist for further testing.
How are children tested for a UTI?
Nelson: A urinary tract infection is often diagnosed based on a description of symptoms and a physical examination. A urinalysis, which is a simple lab test, can be done in the pediatrician’s office and the results are available right away. Your doctor may decide to treat your child for a UTI based on this test alone. A urine culture (a test where the bacteria are grown and identified in the lab) is usually ordered as well, although the results may take 1-2 days to become available. If further testing is required, your child’s pediatrician will recommend seeing a pediatric urology specialist.
How do doctors treat children with UTIs?
Nelson: The primary treatment for UTI is usually antibiotics; it is important to start antibiotics early and complete the entire course of medication to prevent the infection from worsening and possibly damaging organs such as the kidneys.
Your child’s pediatrician may also suggest treatments to reduce the symptoms of UTI, including medications to reduce fever and/or pain, a heating pad to alleviate pain and an increase in fluid intake (preferably water).
Following the antibiotic regimen, your child’s physician may ask you to bring your child back into the office a few days after treatment ends to make sure the infection has been cured.
Further imaging and evaluation (a renal and bladder ultrasound, voiding cystourethrogram, or other tests) is usually recommended for any child who has had a UTI. It is important to rule out other conditions related to UTIs. These conditions may include vesicoureteral reflux (VUR) and hydronephrosis.
How can parents and caregivers help prevent recurrent UTIs?
Nelson: For children with anatomic conditions of the urinary tract such as VUR, doctors sometimes prescribe once-daily preventive antibiotics to reduce the risk of recurrent UTI. These antibiotics are given in extremely low doses to minimize side effects while still providing enough medication to prevent infection.
For older, toilet-trained children, good toileting habits are essential to preventing UTI. Children should urinate every two to three hours throughout the day, and parents and caregivers should make sure the child take the time to completely empty the bladder.
Many children with recurrent UTIs also have constipation; even children who seem to have regular bowel movements may be “backed up” internally. Your pediatrician can recommend ways to keep the bowels moving.
For children with significant toileting issues leading to UTI or urinary accidents, the Department of Urology’s Voiding Improvement Program (VIP) can help parents and pediatricians address these problems.
Dr. Caleb P. Nelson trained in urology at the University of Michigan and in pediatric urology at the Johns Hopkins Hospital. Since 2006, he has been on the staff of Boston Children’s Hospital, with an academic appointment as an Associate Professor of Surgery (Urology) and Pediatrics at Harvard Medical School.