Definition of Urinary tract infection in children

Urinary tract infection in children: Infection of the kidney, ureter, bladder, or urethra in a child. About 3% of girls and 1% of boys have had a recognized urinary tract infection (UTI) by age 11. The symptoms are not always obvious. They may range from just an unusual smell of the urine or mild burning on urination to very severe pain and high fever. Recognizing and treating urinary tract infections is important. A urinary tract infection in a child may be a sign of an abnormality in the urinary tract that could lead to repeated problems and serious kidney damage.

Younger children are usually unable to describe how they feel. They may have fever, be irritable, have nausea and vomiting, or not eat. An older child with bladder irritation may complain of pain in the abdomen and pelvic area. The child may urinate often. If the kidney is infected, the child may complain of pain in the flank or low back. Crying or complaining that it hurts to urinate and producing only a few drops of urine at a time are other signs of urinary tract infection. The child may have difficulty controlling the urine and may leak urine into clothing or bedsheets. The urine may smell unusual or look cloudy. If a child has a temperature and appears sick for more than a day without signs of a runny nose or other obvious cause for discomfort, he or she may need to be checked for a urinary infection.

The diagnosis is confirmed by examining a sample of the child's urine under a microscope for bacteria and white blood cells. The urine may also be cultured identify the bacteria and test to see which medications will provide the most effective treatment. The treatment is with antibiotics. Once culture results are known, the child may be switched to another antibiotic. After a few doses of the antibiotic, the child may appear much better, but often several days may pass before all symptoms are gone. The child should take the medicine for as long as the doctor says. Do not stop medications because the symptoms have gone away. Infections may return, and the bacteria may resist future treatment if the drug is stopped too soon.

After the infection has cleared, tests may be done to check for abnormalities in the urinary tract. The tests may include kidney and bladder ultrasound, a voiding cystourethrogram (VCUG), an intravenous pyelogram (IVP), or a nuclear scans with a radioactive material to show how well the kidneys work, the shape of the kidneys, and whether urine empties from the kidneys in a normal way. Many children who get urinary tract infections have normal kidneys and bladders. But if a child has an abnormality of thre urinary tract, it should be detected as early as possible in life to protect the kidneys against damage. Abnormalities can include vesicoureteral reflux (urine refluxing backwards from the bladder up the ureters to the kidneys) and urinary blockage. This can occur in many places in the urinary tract. The ureter or urethra may be too narrow or a kidney stone at some point stops the urinary flow from leaving the body. Or the ureter may join the kidney or bladder at the wrong place and prevent urine from leaving the kidney in the normal way.

Young children are at the greatest risk for kidney damage from urinary tract infections if they have an undetected urinary tract abnormality or if their UTIs are not recognized and treated effectively.