Urinary tract infections in children appear quite often. However, in the youngest, urinary tract infection is not so easy to recognize. This is especially true of infants and young children, who have non-specific symptoms of inflammation of the urinary tract. If treatment is not implemented on time, serious complications may occur. What are the causes and symptoms of urinary tract infections in children? What is the treatment? How to prevent urinary tract infections in children?
Urinary tract infections in childrenappear quite often. However, in the youngesturinary tract infection is not so easy to recognize. This is especially true of infants and young children in whominflammation of the urinary tractproduces non-specific symptoms. Additional problems are the method of collecting urine for testing and the correct interpretation of the obtained result, which is the basis for making a diagnosis and making a decision on the treatment method. And if treatment is not implemented on time, serious complications may occur.
Urinary tract infections in children - causes
The most common (80-90% of cases) cause of urinary tract infections in children is Escherichia coli. Other bacteria that cause inflammation of the urinary tract in children can be Proteus, Klebsiella, enterococci, streptococci, golden staphylococcus, Haemophilus influenzae. Less common causes of infection are viruses or fungi.
If the inflammation affects the kidneys, it is said to be inflammation of the upper urinary tract. Inflammation of the bladder and urethra means inflammation of the lower urinary tract.
The factors contributing to urinary tract infection in children are:
- previous urinary tract infection
- Presence of a recognized congenital defect of the urinary system, including vesicoureteral outflow (OPM)
Diaper rash, phimosis, fusion of the labia promote urinary tract infection in babies.
- abnormal results of ultrasound examinations (USG) in a history, including those performed prenatally
- positive family history of urinary tract infection (parents, siblings)
- positive family history of congenital urinary tract defects, including OPM
- bladder catheterization
- micturition disorders (urinary incontinence,frequent or infrequent micturitions, urgent pressures)
- constipation, faecal incontinence
The peak incidence is between 2 and 6 years of age. The risk of infection is 10-30 times higher in girls than in boys. This is due to the shorter urethra in girls, and therefore a shorter path for pathogens. The exception is the neonatal period. During this time, urinary tract infection is more common in boys than in girls, which is probably related to the frequent occurrence of urinary tract malformations in this sex.
Urinary tract infections in children - symptoms
The symptoms of a urinary tract infection depend on the age of the child. In infants (children up to 1 year of age) the following appear:
- fever
- lack of appetite
- vomiting
- no weight gain
- anxiety and crying
- excessive sleepiness
- change in color, transparency and smell of urine
However, in infants, often the only symptom of urinary tract inflammation is just a fever or low-grade fever. Therefore, when the thermometer shows high temperature and the child has no cough and no runny nose, inflammation of the urinary tract can be suspected.
2) Children aged 2 and over
Children at this age also develop fever, vomiting, lack of appetite, no weight gain, but also complain about:
- abdominal pain and pains in the lumbar region,
- dysuria symptoms, i.e. pain and burning when urinating. It can also be a feeling of urge to urinate, pollakiuria, stinging, itching or stinging when urinating
Urinary tract infections in children - diagnosis
The doctor should start the diagnosis by gathering information about the symptoms and performing a physical examination of the child, paying particular attention to the external urogenital organs and their abnormalities (e.g. phimosis, glued labia, signs of testicular and epididymitis, redness around the mouth external urethra, discharge from the external urethra), condition of the perineum, painful abdominal pain when pressing it with fingers, palpable kidneys, urinary bladder. The doctor should also measure the child's body temperature.
In addition, the baby's blood is tested. However, the test that confirms urinary tract infection is a microbiological urine test. Urine samples should be collected prior to treatment initiation, as administration of even one dose of antibiotic may falsify urine culture results. In any case, a positive culture result requires reference to the urinalysis result.
WIn some clinics, a quick strip test can be performed to aid diagnosis and allow you to start treatment quickly. However, such a test does not exempt you from performing a urine culture.
Worth knowingHow do I get a urine sample for testing from a child?A urine test is required to make a diagnosis. For a reliable result, the urine sample must be collected correctly. 1. Thoroughly wash your child's intimate area. 2. Prepare a sterile urine container, which is available at any pharmacy. For collecting urine for culture, urine bags are not recommended because contamination of the sample, e.g. with skin bacteria, is difficult to avoid. The test result is then unreliable. 3. While holding it over the bathtub or sink, wait until it begins to urinate. Then wait 2 seconds, and then "catch" the urine from the middle stream into the container (the first portion of urine rinses the urethra). It is good to use the help of a third party who will "catch" the urine sample 4. After the child has urinated, close the container, stick a piece of paper on it with the child's name and date of birth. 4. The urine container should be brought to the laboratory as soon as possible.
The first morning urine is the most reliable, although it is not always possible to pass a sample of the morning urine. It is usually good for your baby to eat nothing for a long time before collecting urine.
Urinary tract infections in children - treatment
Treatment consists of administering antibiotics or chemotherapeutic drugs, usually for 7-14 days.
Children up to 3 months of age require hospitalization because they are at high risk of generalization of the infection. In addition, the youngest up to 3 months of age usually require parenteral treatment due to the difficulties in administering oral medications due to lack of cooperation and the frequent occurrence of gastrointestinal symptoms such as reluctance to eat, nausea and vomiting.
Children over 3 months of age require hospitalization and parenteral treatment only in the case of severe condition, suspected generalized infection, immune disorders, vomiting, lack of response to treatment outside the hospital or inability to control outpatient treatment.
If the child is in good general condition and is taking oral medications, and there is no evidence that the bacterial flora is resistant to standard treatment, the child may be treated at home.
Remember to give your child antibiotics for as long and in the doses as recommended by the doctor, even if they improve quickly. Relief of symptoms of infectionbefore the end of the treatment, it does not mean a cure at all, but only that the bacteria have been brought under control. For the treatment to be successful, the treatment must be completed. If left untreated, the infection may recur.
ImportantUrinary tract infections - complications
Inflammation of the urinary tract in children can lead to kidney damage, scarring, and sepsis, i.e. infection of the entire body with bacteria that have migrated from the urinary system. Children under 3 months of age with urinary tract infection are particularly prone to sepsis, so they must be treated in hospital.
Urinary tract infections in children - how to prevent them?
To reduce your risk of a urinary tract infection:
1. Fight constipation in your baby, as it promotes urinary tract infections. 2. Change baby's nappies at least 6 times a day and whenever he poops. In a wet diaper there are ideal conditions for the growth of bacteria: moisture and heat. 3. When changing diapers, wash your baby's perineum thoroughly, preferably with warm water. Disposable wet wipes may not be enough. 4. Buy disposable diapers with the least oilcloth outer coating. The more plastic it is, the less it is permeable to air and it is conducive to the multiplication of germs.
Worth knowingAfter treatment, an ultrasound scan is recommended
After diagnosis of the first episode of urinary tract infection, it is recommended to perform ultrasound examination of the urinary system at:
- all children under 24 months
- in children over 24 months of age after diagnosing an atypical urinary tract infection or identifying risk factors for this disease recurrence
- in all children diagnosed with recurrent urinary tract infection
Bibliography:
1. Recommendations of the Polish Society of Pediatric Nephrology (PTNFD) regarding the management of a child with urinary tract infection
2. Dudzic P., Szalas A., Caring for a child with urinary tract infection, "Nowa Pediatria" 2012