Urinary tract infections (UTIs) are a common condition in children and one of the most frequently under diagnosed and misdiagnosed problems encountered. Although they are commonly called “urinary tract infections”, the infection is usually really in the bladder and more accurately called cystitis. An infection that is really in the kidney itself is called pyelonephritis and usually causes a more serious illness that sometimes requires hospitalization.
By far most UTIs occur in girls especially after 1-2 years of age. The reason is obviously just the anatomy of girls. These infections usually start due to bacteria from the intestine getting on the skin and migrating into the genital area and moving into the bladder. Boys less than one year of age who are uncircumcised are at a higher risk of infection although it can still occur when they are older.
The common symptoms of these infections are burning with urination, frequent urination, and sometimes fever. The urine may or may not have an odor so this is not always a reliable indication of infection.
These infections can only be accurately diagnosed with a urinalysis and urine culture. The urine needs to be obtained so the possibility of contamination is minimized. The genitalia should be cleansed and the urine collected in a sterile container. The urinalysis and culture need to be done as soon as possible after collection to be reliable. A UTI cannot always be diagnosed with a urinalysis alone. The urinalysis is helpful to give an indication that there is or is not an infection, but even if there is blood or protein or white blood cells in the urine, that does not mean that there really is an infection. Also, the urine may look almost entirely normal, but an infection may still be present. This is because different bacteria that cause the infection cause different inflammatory responses in the wall of the bladder, therefore, causing the urine to look different.
It is essential that a urine culture be done to diagnose the infection. The culture can be done overnight to know if it is positive or negative. If it is positive it will need to be sent to a hospital lab or reference lab. This is done to identify the organism causing the infection and more importantly identify which specific antibiotics will treat the infection. Occasionally the initial antibiotic prescribed will have to be changed to one that is more effective.
It is normal that girls may have one or two infections when they are older. You have to be concerned if they start having frequent, recurrent infections. Also, you have to be concerned if girls have an infection less than one year of age or anytime a boy has an infection. The concern in these instances is that there may be an abnormality of the bladder or kidney causing the infections. Sometimes it is necessary to have x-rays or ultrasounds done to evaluate the problem. There is a real danger of serious, permanent kidney damage if they continue to have recurrent infections that are not diagnosed and evaluated properly.
In girls, these infections frequently occur when proper hygiene is not observed after urinating or having bowel movements. Cleaning carefully from front to back can minimize the risk of infections. Also avoiding bubble baths can be a helpful preventive measure. Circumcision in boys can reduce the likelihood of infections.
Of course, any time you have a suspicion of this type of problem, even if it does not seem to be severe, it is always a good idea to see your pediatrician.