If you’ve ever had a urinary tract infection, you know it can be very uncomfortable. Pretty much anyone who has had one would say that it’s not very fun, so prompt treatment is desired. Most moms will understand this as pregnancy increases your risk of having one. Believe it or not, urinary tract infections can also occur in children. In fact uncircumcised boys under 3 months of age and girls under 12 months of age have the highest prevalence of UTI in childhood according to the NIH. However, urinary tract infections can occur at any age. It’s important for parents to know the signs of a UTI and what to do about it.
Dr George Chiang, a pediatric urologist at Rady Children’s Hospital in San Diego, states that a urinary tract infection occurs “when bacteria start to cause inflammation, and potentially damage, to any part of the urinary tract system including the kidneys or bladder.” Because the bladder is most typically involved, many people know urinary tract infections simply as bladder infections, or cystitis. Dr. Chiang notes that it usually takes a large number of bacteria to cause a UTI, “but bacteria can grow quickly.”
Older children and teens with painful urination, increased frequency of urination, bedwetting and daytime accidents, abdominal pain and foul-smelling urine. In babies and toddlers however, the only symptom of a UTI may be a fever, so it is important to discuss a fever with your pediatrician, especially if there are no other symptoms or cause for the ever. Sometimes babies present with failure to gain weight, irritability or vomiting.
How do urinary tract infections occur?
- Babies : According to Dr. Chiang, “50% of babies with a UTI have vesicoureteral reflux”, a condition in which urine flows backwards from the bladder up to the kidneys. Other risk factors for UTIs in babies may include “birth anomalies such as kidney obstruction or bladder obstruction, severe constipation, and excessive washing of the female genitalia, since it can alter the normal bacteria flora in that area”, says Dr. Chiang. “Boys who are uncircumcised and less than 1 yr of age may also have a higher likelihood of UTIs. Dirty diapers and bubble baths are not known to cause an increase in UTIs.”
- Kids : “Aside from a late presentation of a birth anomaly such as kidney or bladder obstruction, or vesicoureteral reflux, UTIs in kids are usually from problems in which kids don’t empty their bowel and bladders well, also known as bowel/bladder dysfunction. Kids these days can get very busy so they may not pee to completion or pee on a good schedule throughout the day.” When urine stays in the bladder too long, bacteria start to grow. “Another rare cause of UTIs in kids is kidney stones, which usually presents with pain on urination or flank pain, but a UTI can also be a presenting symptom.” Furthermore, kids are frequently constipated. Stool build up pushes on the bladder which causes urine to build up in some parts while also pushing urine out of other parts, thus causing accidents. This urine build up in the bladder allows for bacteria to grow. Therefore, just as failure to fully urinate can cause infection, as Dr. Chiang stated above, so does constipation.
- Teens : Teens develop UTIs for similar reasons as stated above, “although teens usually don’t have as much bowel/bladder dysfunction. However, kidney stones are more common in teens versus kids”, according to Dr. Chiang.
Girls are at particular risk for UTI because they have a shorter urethra than boys and the opening is close to the rectum. It is usually bacteria from the gastrointestinal tract that causes UTI, so this proximity is a set up for infection. These bacteria can easily crawl up to the bladder, especially if there is friction in the area. Therefore, wiping back to front and sexual intercourse are 2 risk factors for UTIs. It is important to know that while sexual intercourse increases the risk of developing a UTI, most UTI’s are not associated with sexual intercourse. Furthermore, UTI’s are not considered a sexually transmitted disease. So just because your teenage daughter has a UTI, it does not mean she is sexually active.
How are UTIs treated?
- Babies : Any baby who has possible symptoms or risk factors for a urinary tract infection should be seen by their pediatrician. Dr. Chiang recommends “a catheterized urine specimen and then a full course of antibiotics” for culture positive infections. Following an infection, some babies may require “additional imaging such as an ultrasound of the kidneys or a VCUG.” A VCUG, voiding cystourethrogram, will look for reflux from the bladder to the kidney. Dr. Chiang says that if the imaging studies are abnormal or your baby has more than one UTI, a referral to a urologist may be needed.
- Kids : Kids who can pee in a cup do not need to have a catheter. A “clean catch” urine sample can be checked for signs of an infection. “If a urine culture is positive for bacteria, the child should receive a full course of antibiotics and then additional imaging may be required dependent upon the child’s history”, says Dr. Chiang.
- Teens : Kids in this age group can easily give a clean catch specimen and, again, a full course of antibiotics would be required to treat a culture-positive infection. It is also important to talk to teen girls about hygiene and also about the risks of sexual intercourse including UTI, as well as pregnancy and sexually transmitted infection.
With regards to non-antibiotic treatments, Dr. Chiang states that “there are some reports in the adult literature regarding liberal fluid intake washing out bladder infections, but that has not been repeated in children. Since it can be difficult to control how often and how effectively children void, non medical treatments are not known to be effective.”
How can UTIs be prevented?
Certainly good bowel and bladder habits, as well as good hygiene, is the most important way to prevent infections in children with normal anatomy. Congenital anatomical anomalies and also vesicoureteral reflux would need to be treated appropriately by a urologist in order to prevent infections. Preventing infections in these patients helps to protect the kidneys, which can be damaged from repeated infections.
Many people believe that cranberry juice is helpful in both treating and preventing infections. Dr Chiang says that cranberry juice is not replacement for appropriate use of antibiotics. He says, “specifically proanthocyanidins within cranberry juice, can [help] prevent UTIs through interference with binding of bacteria to the bladder.” Another myth regarding UTI is that making the urine more or less acidic will prevent or treat an infection. Dr. Chiang recommends caution. “Historically people have thought that acidification of urine can treat UTIs but it has been shown to also inhibit antibiotic action (which would prevent treatment of the infection). As a result, there is no clear certainty in acidification or alkalization of the urine.” Finally, while some studies have shown potential for use of probiotics or the supplement D-mannose, Dr. Chiang cautions that these studies are in adults and not children.
As always, if you have concerns about your child or think he/she may have a urinary tract infection, see your pediatrician.
Dr. George Chiang is a board-certified pediatric urologist at Rady Children's Hospital-San Diego, with fellowship training and board certification as a specialist in urology and pediatric urology. Earning his medical degree at Tufts University in Boston and completing a residency in urology at the Lahey Clinic in Burlington, Mass., Dr. Chiang went on to complete a fellowship in pediatric urology at Rady Children's. Since his training, Dr. Chiang has worked extensively with Spina Bifida San Diego, helping to organize the first annual Winter Bifida in 2009, which has become an annual event bringing together the community of patients, providers, and families affected by spina bifida in the region. He was also the first pediatric surgeon on the West Coast in 2008 to perform laparoscopic, single-site "scarless" surgery for the removal of kidneys in children. Dr. Chiang's clinical and research interests include the neurogenic bladder, minimally invasive surgery, and leveraging the electronic health record for comparative effectiveness research. He has lectured at both regional and national conferences in the field of spina bifida and pediatric urology. In training the urology residents of San Diego, he was awarded the UC San Diego Urology Faculty Educator Award in 2013. As faculty advisor to Project Nicaragua at UC San Diego, he continues to mentor undergraduates in the healthcare field. When not working, Dr. Chiang enjoys cycling, traveling, homebrewing and spending time with his wife.