Urinary Tract Infections (UTI) in kids are a painful and embarrassing issue. Sometimes, they hide the pain and do not discuss the problem, even with a parent. UTI is one of the most common of childhood infections. As a parent, you have to be aware and vigilant. Knowing about the condition can help you relieve your child of unnecessary pain and discomfort.
What is UTI?
UTI is an infection of the urinary system induced by micro-organisms like bacteria, viruses and fungi. This infection is in the excretory system through which urine passes; this includes the kidneys, ureters, bladder and urethra.
Causes of UTI
The causes of UTI in kids can be varied and diverse. Here are some of the most common ones:
- Holding back and not urinating when there is a need to. Children, especially in school, don’t use the restroom regularly. This may be because they are shy or not comfortable using the facility outside home.
- Not enough consumption of water. Children often have the ‘out of sight, out of mind’ attitude to water. A busy day filled with work and play can easily keep them away from optimum levels of water consumption for long.
- Congenital anomalies like Vesico ureteric reflux, which leaves the child predisposed to certain conditions and ailments associated with the urinary tract.
- Backward flow of urine from the bladder to the kidneys (reflux).
- Harmful bacteria from the digestive system infecting the urinary tract (through the skin in the anus region).
- Poor toilet and hygiene habits.
- Constipation can also cause UTI, as the hard stool in the bowel can put pressure on the urinary tract. This can, in turn, cause bacteria to grow.
- Spinal cord injury, hydrocephalus can cause difficulty in emptying the bladder and cause recurrent UTI.
Why children are at risk for UTI?
As UTI is common during childhood, around 8 per cent girls and 2 per cent boys get it. During infancy, boys are more at risk for UTI but after infancy, girls are at more risk for UTI.
Signs and symptoms of UTI in children are:
- Change in urinary habits
- Increased frequency in urination
- Pain while urinating
- Overall abdominal pain
- Fever – low or high – with vomiting/shivering
- Foul-smelling urine
- Urine that is cloudy
- Crying during urination
- Low back pain
- Being irritable
When to see a doctor
Symptoms of UTI may vary from one child to another. At the first sign of any of the above symptoms, consult a peadiatrician. A urine test (culture) is often required to confirm infection.
Six essential things to do to avoid UTI infections
- Urination at first urge, rather than postponing voiding the bladder (Always in sitting position for females)
- Adequate amount of liquids
- Avoid scented feminine products
- Avoid frequent bubble bath
- Regular urination and regular bowel movements
- In young boys, circumcision can prevent UTI.
UTI in babies
Prenatal ultrasound scans are regularly done for a pregnant woman. Any underlying problem in the foetus’ kidney can be identified at this stage, for it might lead to UTI after the birth of the child. Any baby with symptoms such as fever, vomiting, discomfort and pain while passing urine, passing droplets of urine, etc., should be screened for UTI.
Can UTI appear after delivery?
UTI is common postpartum infection occurring in 2-4 per cent of all deliveries. Postpartum UTI is a mild infection but it is associated with discomfort, prolonged hospital stay and readmission.
What are the risk factors of postpartum UTI?
- Higher after caesarean section due to cathetarisation ( A Danish nationwide cohort study found that 4-6 per cent of women with C-section and 3-5 per cent of women with vaginal delivery were treated for UTI )
- Use of sanitary pads
- Loss of natural protective mechanism because of reduced estrogen hormone during pregnancy
Treatment and care
For UTI, antibiotics are the main line of treatment. Do not discontinue the medicine as your symptoms disappear, it may reoccur.
- Antibiotics and probiotics are used to deal with UTI.
- Plenty of liquids orally like cranberry juice are recommended.
- A 2010 Cochrane review examined 21 good quality randomised trials that compared the efficacy of antibiotics like Trimethoprim-Sulfamethoxazole(TMP –SMX), Beta-lactam antibiotics, Nitrofurantoin and Fluoroquinolones for uncomplicated UTI in 6016 women. They found all were effective.
- For postpartum UTI, antibiotics and antimicrobials are recommended for treatment.
- The American Academy of Pediatrics Committee on Drugs says that TMP –SMX, Nitrofurantoin, Amoxicillin, Ciprofloxacin and Ofloxacin are also compatible in the postpartum period.
Preventive and precautionary measures
UTI is a common problem in children. It is important to follow the advice of your paediatrician and treat it. Here’s what Dr V K Sairam, Paediatric Nephrologist, requests parents to do, “Help your children lead a healthy life – playing outdoors, getting good sunlight, eating well and cultivating good habits.”
- Children are always in a hurry; they don’t seem to have time for anything. So, parents should make sure that children urinate regularly.
- Some teachers don’t let the children take breaks during class hours. Schools should allow for periodic breaks, keeping the child’s health in mind. Parents should get the child into the practice of drinking enough water every day.
- Make sure the child consumes generous amounts of vegetables and fruits. This also makes them pass stools every day and avoid constipation.
- Teach girls to wipe front to back after a bowel movement. Cleaning from back to front would transfer germs from the anus to the urethra and lead to infections.
- Let children wear loose-fitting cotton underwear. Tight-fitting clothes will trap the moisture and cause bacteria to grow.
- Be sure to change your baby's diaper frequently; wearing a soiled diaper for long could result in an infection.
Home remedies to treat UTI
- Plenty of liquids
- Coconut water is also said to be good when you have UTI
- 100 mg of vitamin c per day has a protective effect on UTI
- Consumption of cranberry products can lower UTI rate
- Probiotics can be effective in preventing UTI
- Bearberry leaf and garlic extract are natural supplements to prevent UTI
Normally caused by bacteria, to treat UTI, antibiotics or antimicrobials are given. In some cases, the treatment could be long as the length of treatment depend on the symptoms and medical history of the patient. It is important to note that the full course of treatment should always be completed for UTIs. This will ensure that the infection is fully clear and the risk of antibiotic resistance is lower. UTI symptoms can disappear before the infection has completely gone.
(With inputs from Dr Bijal Mistry, who is a consultant gynaecologist, Apollo Clinic)
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