• 1 week ago

Urinary Tract Infections (UTIs) in Children

What Are Urinary Tract Infections?

Urinary tract infections (UTIs) occur when bacteria infect any part of the urinary system—including the urethra, bladder, ureters, or kidneys. The most common culprit is E. coli, a bacteria normally found in the intestines that can enter the urinary tract through the urethra.

In infants, especially those under 12 months, UTIs often cause fever without other clear symptoms, making urine testing an essential part of evaluating any unexplained fever in babies.

Why Do UTIs Happen in Children?

Children, particularly girls, are more prone to UTIs due to anatomical and behavioral factors. Key contributors include:

  • Short urethra in girls, allowing bacteria easier access to the bladder
  • Improper wiping during toilet training (back-to-front instead of front-to-back)
  • Chronic constipation, which can compress the bladder and disrupt normal voiding
  • Infrequent urination or withholding
  • Low fluid intake
  • Anatomical abnormalities, such as vesicoureteral reflux (VUR)

Symptoms of UTI by Age Group

In Infants (0–24 months):

  • Unexplained fever
  • Irritability, frequent crying
  • Poor feeding or refusal to breastfeed
  • Vomiting
  • Foul-smelling or cloudy urine
  • Occasionally blood in the urine

In Older Children:

  • Pain or burning during urination
  • Frequent or urgent need to urinate
  • Bedwetting (after previously staying dry)
  • Lower abdominal or back pain
  • Fever and fatigue
  • Urine with a strong odor or blood

How Are UTIs Diagnosed?

Accurate diagnosis requires a clean, properly collected urine sample, especially in young children.

  • Urinalysis (dipstick + microscopy): Checks for white blood cells, nitrites, bacteria
  • Urine culture: Confirms bacterial growth and identifies the most effective antibiotic
  • Blood tests: May be used for febrile infants or severe infections
  • Ultrasound: Recommended for recurrent UTIs to rule out anatomical problems

Treatment of UTIs

Antibiotics:

  • Prescribed based on urine culture results
  • Typical course: 5–10 days, depending on severity and age
  • Completing the full course is essential to prevent recurrence

Fluids:

  • Encourage plenty of water intake to flush bacteria from the system

Fever Management:

  • Use paracetamol or ibuprofen as needed, with physician approval
  • Monitor urine output and general hydration status

Untreated UTIs can lead to kidney infections (pyelonephritis), scarring, and long-term damage—especially in infants. Timely intervention prevents complications.

What If UTIs Keep Coming Back?

Recurrent UTIs may indicate an underlying issue. Further evaluation may include:

  • Kidney and bladder ultrasound
  • Voiding cystourethrogram (VCUG) to detect vesicoureteral reflux
  • Assessing toilet habits and constipation
  • Behavioral and hygiene guidance

Management often requires a multi-disciplinary approach with pediatrics, urology, and nephrology.

What Can Parents Do?

  • Have a low threshold for urine testing in babies with unexplained fever
  • Teach girls to wipe front to back
  • Treat constipation early
  • Encourage frequent urination, especially during toilet training
  • Offer water regularly
  • Take bedwetting seriously if it reappears after toilet training

Care and Follow-Up with Dr. Ekin Pasinlioğlu

  • Symptom-based screening and clinical evaluation
  • Timely urine testing with culture
  • Accurate antibiotic planning and monitoring
  • Imaging referrals for high-risk or recurrent cases
  • Education on hygiene, hydration, and bowel habits
  • Coordinated care with specialists when needed