Urinary tract infections in children: what they are

Who I am
Catherine Le Nevez
@catherinelenevez
Author and references

Contents

  • 1 What are urinary tract infections 
  • 2 Who affect urinary tract infections
  • 3 Types of UTIs 
  • 4 Symptoms of urinary tract infections
  • 5 Diagnosis of urinary tract infections 
  • 6 How urinary tract infections are treated

Urinary tract infections are very common among children, both among the youngest and the oldest. They are sometimes sneaky and difficult to diagnose because they may have no symptoms. Other times these are very nuanced and can be mistaken for some other pathology. In general, these are ailments that should not worry mothers (even the most anxious). But they should definitely be treated to prevent them from turning into a more serious problem, such as permanent kidney damage or severe kidney failure.



What are urinary tract infections 

They are infections that are caused by infectious agents of various kinds. Only in very rare cases are these viral forms. Interested in:

  • kidneys;
  • renal pelvis (this is the part of the kidney where urine is collected before passing into the ureter);
  • ureter (the channel that connects the renal pelvis to the bladder).
  • bladder (the organ where urine collects);
  • urethra (channel that connects the bladder with the outside).

Early infections, that is, those that occur in the first year of a child's life, could indicate a malformation of the urinary tract, with consequent stagnation of urine, proliferation of germs and infection. In this case, surgery is often the solution.

Who do urinary tract infections affect

After those in the airways, these infections are the most frequent in children. In the first months of life, males are more prone to urinary tract infections. In particular, those who have a phimosis, or the "closed pea". This condition leads to easier contamination by germs and therefore these little ones tend to get sick more easily.



In slightly older children, the tendency is reversed and females suffer the most. This happens because their urethra is shorter and closer to the rectum and also because the vagina does not yet have a degree of acidity to destroy the germs that normally colonize the intestine.

Types of urinary tract infections 

Here is the classification of the Bambino Gesù pediatric hospital in the city:

  • Asymptomatic bacteriuria: it is the lightest form, with not particularly virulent bacteria. As the term suggests, the baby has no particular symptoms. It is then diagnosed "by chance" by doing a urinalysis or urine culture prescribed for other reasons. It does not require treatment, unless they are immunosuppressed children.
  • Symptomatic low urinary infection (acute cystitis): among the symptoms, fever is infrequent and generally below 38 ° C, while urinating disturbances prevail. In the infant, the symptoms are generally non-specific, therefore not immediately attributable to a urinary problem. It affects preschool girls more frequently. Sometimes, blood (including coagulated) may be present in the urine (macrohematuria) at the end of urination. Usually, blood test values ​​that indicate an inflammatory state (ESR and CRP) are normal or only slightly abnormal. If an ultrasound is done, the bladder wall may appear slightly thicker.
  • Recurrent low urinary tract infections: in 14-25% of cases they are associated with vesicoureteral reflux, usually of a mild degree. It is a disorder that occurs when urine flows back to the kidney. This type of infections are more common among females and are often associated with bladder and external urethral sphincter dysfunction, vulvo-vaginitis, synechiae of the labia minora, phimosis, oxyuriasis (presence of intestinal parasites) and constipation. Antibiotics must be combined with urinary re-education and regulating drugs of the bladder muscles.
  • High urinary infection or acute pyelonephritis (PNA): This form is typically characterized by a high fever, often with chills, sometimes lower back or abdominal pain. There is often urinary tract malformation or vesico-sphincter dysfunction. It is desirable that the diagnosis is very quick to start treatment as soon as possible and avoid major damage.

Symptoms of urinary tract infections

As mentioned, the signs of an infection of this type can vary or, sometimes, be completely absent. The newborn may present with fever and signs of generalized infection, persistent jaundice, vomiting and diarrhea, stunting and growth retardation.



In the infant and young child, a fever may be a sign of no apparent cause, often with continuous and repeated episodes that resolve without special treatment. Other times there are sudden rises in temperature that last 1-2 hours and then disappear without further disturbance.

Other symptoms can be:

  • abdominal pain;
  • growth retardation and arrest;
  • frequent inflammation of the bottom or external genitalia (caused by an excess of ammonia);
  • irritability;
  • sleep disorders;
  • lack of appetite.

More rarely, the typical discomfort of cystitis can be found, such as difficulty in urination, burning or blood in the urine.

Diagnosis of urinary tract infections 

To accurately diagnose the disorder, a urinalysis, a check of the white blood cells (when they are high they indicate that there is an infection) and a urine culture are necessary. The latter is very important because it is the test that allows us to identify which bacterium has triggered the infection. Based on this, the most appropriate type of therapy will be decided.


For urine collection, extreme attention must be paid to sterility and, in infants and very young children, it can be a problem. It is not as simple as the classic method of pee in the container. On the market there are special adhesive bags that are placed around the genitals of children, inside the diaper. We recommend buying a few more because it doesn't mean that the operation will be successful the first time around.

More in-depth tests may be ordered in case of recurring problems or in other circumstances decided by the doctor. These include renal ultrasound, voiding cystography or renal scintigraphy.

How urinary tract infections are treated

Before starting the therapy it is essential to have carried out all the necessary tests. If even one dose of antibiotic is taken before urine culture, the result may be skewed. If you do not know the bacterium responsible for the infection, you will not be able to treat yourself properly.


Specific antibiotics are then administered, chosen on the basis of the antibiogram. It is a test that allows to identify the most effective drugs against the germ identified by urine culture.

 

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