UTI (Urinary Tract Infections) in Children: Causes, Types & Treatment

In this video SimpliHealth expert urologist, Dr. Virendra Dhankhar will explain UTI (Urinary Tract Infections) in Children. 

Why do children feel pain during urination? / what causes a urinary tract infection in a child

During infection the urine becomes acidic and there is inflammation in the mucosa. So whenever they pass acidic urine, it burns or hurts. This pain while passing urine in Medical terms is known as dysuria. The infection in the urine. This infectious urine touches the congested mucosa and causes pain during urination.  

What are the different kinds of infections in urinary tract infections/urine infection in children? 

The infection in children differs from the infection in adults. Because in children the most common cause is an abnormality in the urine tract during their birth. So again women or girl child is more at risk of infection in infants and toddlers compared to male child. So if the UTI occurs in the male child we definitely know that there are some congenital abnormalities in the urinary tract which is responsible for the UTI.  

We have to look for causes after the first urinary tracking infection. The first test we do is an ultrasound. We see how the kidney, how the ureter is, how the bladder is. So if there are some structural abnormalities in the urine track, then we accordingly proceed and evaluate the cause. 

The most common cause in the male child or female is either a blockage in the urinary tract known as pelvic ureteric junction obstruction or there is a reflux of urine. The urine goes backward from the bladder to the kidney. This can be on one side and can be on both sides. It may be because of some reasons like a neurogenic bladder. Neurogenic bladder means any disease which affects the nerves of the bladder. 

There may be some defect in the spinal cord or maybe because of the non-urinary bladder in which there is no cause known. But the valve system which prevents the backward going of urine is defective so there is a reflux of the urine backward and once it goes into the kidney it can cause infection and damage the kidney.

Because kidneys are a growing organ that grows up to the age of five. So any back going of urine along with infection is a potential danger and can damage the kidney. It may lead to fever, infection, Pyelonephritis and can cause a scar in the kidney. If it goes untreated or unnoticed in the long run it can lead to failure of the kidney, because of scarring hypertension. So the children should be evaluated. 

After the second episode of the urinary tract infection according to the guideline, we thoroughly investigate the child to know the cause of UTI and accordingly treat it. 

So the UTI in children is mainly because of 

• Structural abnormalities during the birth processor 
• Maybe because of stone in the urine tract symptoms or 
• Maybe because of a neurogenic bladder.  

Is UTI contagious?

UTI is not contagious. Because it is the abnormality in the urinary tract which is responsible for UTI so it is not contagious. 

How do healthcare providers test UTI in children?

Culture 

Any UTI in children or in adults is tested by a simple urine examination. Urine examination is a mirror image of the kidney. So the urine test will tell us whether there is a pus cell in the urine, WBC or nitrite test is positive, what is the pH of the urine, whether there is any RBC in the urine associated with bleeding in the urine. 

For all this, we have a urinary culture. In the urinary culture, we find out what kind of organism is causing the urinary tract infection. The most common commutated infection is because of E. coli which is presented in the gut. Some are hospital-acquired infections like klebsiella, pseudomonas. This occurs when we do a characterization or any other procedure in the hospital so it is known as hospital-acquired infections. 

Colony count 

So culture tells about the type of organism it tells about what is a colony count, whether the organism is a significant amount to cause infection. So the colony count should be more than 105to be called significant. 

Culture sensitivity 

Third, the culture and sensitivity tell about what antibiotics the organism is sensitive to so that we can prescribe the same group of the same antibiotic which is most effective and treat the urinary tract infection. 

Ultrasound 

And then we look at what is the reason for urinary tract infections in children. We first do an ultrasound, which will tell about whether both kidneys are normal, whether there is a stone in the Kidney, whether there is swelling in the Kidney of the urinary tube, how does the bladder look what is the wall thickness of the bladder after passing urine how much urine remains in the bladder?

So if there is a significant abnormality in a urinary tract symptom we assess further, depending upon what we find in the ultrasound. If the ultrasound shows there is an obstruction between the kidney and ureter, then we do a functional study like IVP or DTPA to know the function of the kidney and differential function of the kidney and whether there is a blockage or not.

If we suspect there is a reflux of the urine then we do an MCUG. In which we put a catheter into the bladder and put a dye and do the X-ray. So with this, we know the grade of the reflex, or whether there is reflux prevention or not or DRUG. 

If we suspect it is a neurogenic bladder, we assess the spine with MRI. And do a urodynamic study to know about the bladder function in depth. To know whether the bladder is low compliant means the elasticity of the bladder is gone. Or the bladder is unable to empty the urine completely so we need to treat it accordingly. So these are the few tests we do and walk up to the child if there is any infection in infants or toddlers. 

How do we know that now is the time to get the child admitted to the hospital? / UTI in children treatment

Infants and young children who haven’t learned to speak yet will not be able to say anything about the infection. But they will cry while passing urine. Second, he will feel low, there will be fever if it’s a UTI  attack symptom, he will be irritable, he will have nausea or vomiting, so these are the symptoms which we see in any child. If it’s not associated with any other symptoms like rhinitis, cough cold then you should get a urine sample. If the urine test shows that there is a pus cell in the urine then we know it’s a UTI.  And we then treated it accordingly. 

What are the good habits children can adopt to be prevented from UTI?

1. Drink lots of water 
2. Use clean toilets
3. Clean the clothes daily 
4. Wash the area properly 
5. Avoid foods that cause constipation like milk, so if your child has a UTI, avoid giving him milk  
6. Use of curds 
7. A lot of water so that it can empty the bladder 

These are the few habits that can be used in children to prevent UTI. If it’s a male child and there’s a recurrent infection it is a structural abnormality probably. Doing a circumcision will also help to prevent recurrent UT. Now we have covered almost all the questions and we would like to thank Dr. Virendra for sparing his valuable time and sharing this information with all of us and I am hopeful that this will help our views in many ways.