UTI in Kids
Urinary tract infection refers to an infection of the urine and lining of the organs of the urinary tract which include the bladder, ureters, which are the tubes connecting bladder to kidneys and the kidneys. Mostly the infection is bacterial of which, Escherichia Coli, what we call as E Coli, is the most common bacterial causative agent. It is more frequently seen in girls than in boys.
In terms of causes and risk factors in UTI, we know that structural abnormality in the genitourinary pathway such as, what we call as VUR that is, vesicoureteral reflux. This is a condition where the valves between the bladder and ureters are dysfunctional, so they allow for  a backward flow of urine towards kidney, predisposing the child to kidney infections. The other causes can include constipation, withholding urine for long periods of time regularly, an inadequate fluid intake thereby lesser urine output, poor toilet cleaning habits where fecal contamination of the genitalia can lead to a UTI, History of the previous UTI puts you at high risk. While some children are just prone for UTI without any underlying cause.
Now, in terms of symptoms, older kids can complain about pain or burning upon urination. There can be frequent urination and the urine may be foul smelling or appear cloudy sometimes with a little bit of blood present. There can be fever, nausea or vomiting, loss of appetite, an abdominal pain. There can be something we call as flank pain that is pain on the sides of the back. Now, younger children cannot get specific with their complaints but can be presented with fever with no other obvious cause for this fever like runny nose or cough or anything. There can be vomiting, there can be diarrhea, there can be like a poor appetite. There can be irritability, there can be urine leakage into their underpants and a new onset bedwetting may be present. Now, in infants that are less than 3 months of age, sometimes fever maybe the only presenting symptom. However, there may be prolonged jaundice, there can be some lethargy, and a failure to thrive.
In terms of diagnosis, in younger children and infants a high index of suspicion needs to be present especially when they have any of the above said symptoms, we just discussed. Now, in babies less than 3 months, any fever should warranty investigation for UTI as it can cause septicemia where the infection can spill into the bloodstream and infect the other organs. Now, urine analysis and urine culture should be done in every child suspected of having a UTI. Now, this urine sample needs to be collected in a sterile container after the genitalia has been washed with warm water. It should be midstream catch. The sample should to be dropped off into the laboratory for plating as soon as possible, preferably in less than an hour. In a case of infants, the sample needs to be obtained ideally by urethral catheterization. It is a sterile and non-painful procedure performed by a trained personnel. Now the urine analysis reveals pus cells , positive nitrites and positive leucoesterase , which will imply the presence of a UTI. However, urine culture results wherein a bacteria in a specified amount is grown over a period of 48 hours, is what confirms a UTI. Any child between the ages of 2months to 2years with a UTI, will be required to also have an ultrasound of the bladder and kidney to check for the structure.  In other investigations such as VCUG to look for reflux, or a DMSA scan where you look for scarring in the kidney may be recommended by your pediatrician or a pediatric urologist, for children who have recurrent UTI.
In terms of management, UTIs once diagnosed are usually treated with appropriate antibiotics for 10 to 14 days. Infants less than 3 months or older babies who appear unwell will require hospitalization with additional blood work or a spinal tap in suspicion of sepsis and antibiotics may be given intravenously. Now, the fever will require paracetamol. Keep your child hydrated with adequate fluid intake and if not able to retain fluids orally, your child may require hospitalization to prevent dehydration. Now, in the case of VUR, which is urinary reflux, when diagnosed will require the child to be on prophylactic antibiotics for long periods of time and regular follow ups with the pediatric urologist.
In terms of prevention, make sure your child gets into the habit of drinking plenty of fluids. Ensure the children do not control their urinary urge and empty their bladder at least 3-4 times a day. Do not wash the genitalia with soap or other chemical irritants but instead with just plain water. Teach children to clean properly after bowel movements especially girls needing to clean from front to back direction only. Give kids a high fiber diet to prevent constipation, which is one of the risk factors for UTI.

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