Urinary Tract Infections (page 4)

Duration

Most UTIs are cured within a week with proper medical treatment. Recurrences are common in certain kids with urinary abnormalities, those who have problems emptying their bladders (such as children with spina bifida), or those with very poor toilet and hygiene habits.

Diagnosis

After performing a physical exam and asking about symptoms, your doctor may take a urine sample to check for and identify bacteria causing the infection. How a sample is taken depends on how old your child is. Older kids might simply need to pee into a sterile cup.

For younger children in diapers, a plastic bag with adhesive tape may be placed over their genitals to catch the urine. However, urine that comes in contact with the skin may become contaminated with the same bacteria causing the infection, so a catheter is usually preferred. This is when a thin tube is inserted into the urethra up to the bladder to get a "clean" urine sample.

The sample may be used for a urinalysis (a test that microscopically checks the urine for germs or pus) or a urine culture (which attempts to grow and identify bacteria in a laboratory). Knowing what bacteria are causing the infection can help your doctor choose the best medication to treat it.

Most children with a UTI recover just fine, but some of them — especially those who are very young when they have their first infection or those who have recurrent infections — may need further testing to rule out abnormalities of the urinary tract.

If an abnormality is suspected, the doctor may order special tests, such as an ultrasound of the kidneys and bladder or X-rays that are taken during urination (called a voiding cystourethrogram, or VCUG). These tests, as well as other imaging studies, can check for problems in the structure or function of the urinary tract. Your child may also be referred to a urologist (a doctor who specializes in diseases of the urinary tract).

Treatment

UTIs are treated with antibiotics. The type of antibiotic used and how long it must be taken will depend on the type of bacteria that is causing the infection and how severe it is. After several days of antibiotics, your doctor may repeat the urine tests to confirm that the infection is gone. It's important to make sure the infection is cleared because an incompletely treated UTI can recur or spread.

If a child is having severe pain with urination, the doctor may also prescribe a medication that numbs the lining of the urinary tract. This medication temporarily causes the pee to turn orange, but don't be alarmed — the color is of no significance.

Give prescribed antibiotics on schedule for as many days as your doctor directs. Keep track of your child's trips to the bathroom, and ask your child about symptoms like pain or burning on urination. These symptoms should improve within 2 to 3 days after antibiotics are started.

Take your child's temperature once each morning and each evening, and call the doctor if it rises above 101ºF (38.3ºC), or above 100.4ºF (38ºC) rectally in infants. Encourage your child to drink plenty of fluids, but avoid beverages containing caffeine, such as soda and iced tea.

Kids with a simple bladder infection are usually treated at home with oral antibiotics. However, those with a more severe infection may need to be treated in a hospital to receive antibiotics by injection or intravenously (delivered through a vein right into the bloodstream).

Kids tend to be hospitalized for UTI if:

• the child has high fever or looks very ill, or there is a probable kidney infection
• the child is younger than 6 months old
• bacteria from the infected urinary tract may have spread to the blood
• the child is dehydrated (has low levels of body fluids) or is vomiting and cannot take any fluids or medication by mouth

Kids diagnosed with vesicoureteral reflux (or VUR), in which urine goes back up into the ureters instead of flowing out of the urethra, will be watched closely by the doctor. Treatment may include medications or, less commonly, surgery. Most kids outgrow mild forms of VUR, but some can develop kidney damage or kidney failure later in life.

When to Call the Doctor

Call your doctor immediately if your child has an unexplained fever with shaking chills, especially if accompanied by back pain or any type of discomfort during urination.

Also call the doctor if your child has any of the following:

• unusually frequent urination or frequent urination during the night
• bad-smelling, bloody, or discolored urine
• low back pain or abdominal pain (especially below the navel)
• a fever of over 101ºF (38.3ºC) in children, or 100.4ºF (38ºC) rectally in infants

Call the doctor if your infant has a fever, feeds poorly, vomits repeatedly, or seems unusually irritable.

Reviewed by: T. Ernesto Figueroa, MD
Date reviewed: January 2012