Urinary tract infections, or UTIs, are often thought of as an ailment that strictly affects adults. But the risk of UTIs in children is also significant. As a general rule, two percent of boys and nearly eight percent of girls will come down with a urinary tract infection. That means that in an average kindergarten class, at least one of the children will have suffered from a UTI.

Infections in the urinary tract are highly treatable, but it is important to catch them early. Undiagnosed or untreated UTIs can lead to kidney damage, especially in kids younger than six years of age. As a parent or childcare provider, you should know what symptoms to look for, possible causes, how to treat UTIs, and how to prevent them from recurring.

Urinary Tract Infections

When blood flows through the kidneys, the two bean-shaped organs lying against the spine in the lower back, waste products from the body are removed. The waste-filled urine is passed down two narrow tubes, called ureters, and stored in the urinary bladder, a balloon like organ. When the bladder empties the urine, it is passed out of the body through a tube-shaped organ called the urethra. The opening of the urethra is in front of the vagina in girls and at the end of the penis in boys. This system – the kidneys, urinary bladder and urethra – form the urinary tract.   

Urine is normally sterile. However, if harmful bacteria or germs move into the urinary tract, it can cause an infection. While an infection can occur anywhere along this tract, the urethra and bladder along the lower part of the tract are most commonly involved.  Bacteria can enter the urinary tract from the skin around the rectum or genitals, and then travel up the urethra into the bladder. If the bacterium continues to move up the ureters, a more serious kidney infection can develop. UTIs occur more frequently in girls, due to the urethra’s shorter size and closer proximity to the anus. Uncircumcised boys younger than one year old also have a slightly higher risk of developing a UTI.

There are a number of normal, everyday childhood activities that can contribute to a bacterial infection moving into a small child’s urinary tract. The soap in bubble baths can trap the germs and allow easy passage into the urethra. Tight-fitting clothes can also create an environment where germs can travel easily. 

As young children are learning potty habits, they may increase risks by either trying to hold urine for long lengths of time, or with girls, if they wipe from the back to the front (instead of front to back) after a bowel movement. Any unhygienic condition around the genital area, including dirty diapers, the appearance of small, white pinworms, or bacterial diarrhea, will increase the chances of contracting a UTI. 

An infection may also be transmitted to newborns through bacteria that already existed in the mother’s blood. And structural abnormalities in the urinary tract, such as blockages of urinary flow, or vesicoureteral reflux, where the urine flows backward from the bladder to the ureters and kidneys when the bladder fills, can make a child more prone to urinary infections.

Symptoms

Children with a urinary tract infection may experience a burning sensation or pain while urinating, or feel the need for frequent urination with only small amounts of urine being released. The child may also wet his or her clothes despite being potty trained.           

Of course, babies and infants do not make frequent trips to the bathroom and will not be able to describe these symptoms. Other symptoms to watch for include fever, diarrhea, vomiting, stomach or back pain, and bad smelling or bloody urine. The child may be more irritable and less active than normal as well.   

Wearing loose-fitting clothes is one good way to help children prevent urinary tract infections. Limiting or avoiding bubble baths is another. Proper hygiene is vital with toddlers who are ready to start taking care of themselves. Train the child to go to the bathroom several times a day and empty the bladder regularly. Girls should be taught to wipe themselves from front to back after using the bathroom to prevent rectal germs from entering the vagina or urinary tract. And boys should be taught to wash the foreskin on their penis regularly, if they have not been circumcised. For infants, changing diapers frequently is important, as well as watching for any symptoms that they may not be able to verbalize. 

A doctor will usually suspect a urinary tract infection if the child is suffering from fever without any accompanying symptoms of a cough or cold, and without any other obvious focus of the infection. The doctor will order a urinalysis or urine culture in order to identify the bacterium that is causing the infection. A urinalysis requires an examination of a urine sample under a microscope to detect any infection or pus, and a urine culture encourages the bacteria sample to grow for testing and identification.  

Treatment

Urinary tract infections in children are easily treated if they are caught quickly enough.  Early recognition is important to prevent more serious health problems. 

The simplest step in treating a UTI is to make sure that the child is drinking enough fluids to flush out the urinary tract with increased flow. This will also ensure that the child is staying hydrated and keeping toxins from gathering in the kidneys, which will create a darker, more concentrated urine stream. 

Medications to treat urinary tract infections can include antibiotics that are specific to the bacteria causing the infection. While the doctor may prescribe antibiotics that can be taken orally, if the infection is severe enough, the child may be admitted to the hospital for antibiotics to be administered intravenously. This is a more common occurrence for children who have a high fever, are younger than six months, are vomiting, or are severely dehydrated. In order to ensure an effective and complete cure, it is important to follow through with the entire dosage of any antibiotics prescribed by the doctor, either orally or intravenously. This could take 7 to 10 days. 

UTIs associated with high fevers are especially dangerous to children under 6 years old.  These infections can affect the kidneys and leave behind permanent scars. Damage may include stunted kidney growth, reduced kidney functions, and high blood pressure.

If a child suffers two or more UTIs within six months, they should possibly be evaluated for physical problems in the urinary tract that could be causing the infections. Long-term treatment with medication may be necessary, and surgery could even be an option to treat the problem if there are issues with the bladder or kidneys. 

Ultrasound examinations of the kidney and bladder can help detect any physical abnormalities. Other tests can examine the urethra and the bladder as they fill and empty, or search for blockages in the urinary tract with dye injected above the kidneys. Imaging tests such as CT, MRI, or nuclear scans may help to diagnose underlying disease conditions that could be causing recurrent UTIs.