Managing UTIs in children

MANY parents, completely oblivious to the possibility of a urinary tract infection (UTI) in their children, sometimes go days on end trying to figure out the reason behind their children’s sudden fussiness. But having seen and treated her fair share of UTI cases in children, Dr Anona Griffith, paediatrician at Gateway Plaza, Old Harbour, said that not only are they possible, but they are among the most common infections that occur in infants.

“A UTI is not only one of the most common infections in infants, it also has the potential to cause serious complications if left undetected and untreated. This is directly related to the fact that the urinary system is a group of organs in the abdomen that filters the blood to remove waste and excess water in the form of urine which is carried to and stored in the bladder until it is passed from the body. The body has its methods of preventing infection from occurring along the tract; however, despite this, these defence mechanisms can become overwhelmed by bacteria, thereby producing infection,” Dr Griffith said.

She pointed out that the bacteria that are the primary culprit for infecting the urinary tract are often those found in stool, the types of which vary from one age group to another. She also expressed that while it is natural for parents to think that girls are the only ones affected because of the structure of their genitalia, it must be made clear that boys can also develop UTIs.

There are also other ways in which children can get UTIs.

“There are conditions that predispose babies to developing UTIs and these include structural abnormalities of the tract, such as the posterior urethral valves seen in male children which cause obstruction to the overflow of urine and prevent complete emptying of the bladder. Urine that is not emptied from the bladder could act as a medium for bacteria to grow, resulting in a UTI. Backflow of urine from the bladder into the tubes that connect it to the kidneys, known as the vesico-uteric reflux, is also a known risk factor for developing UTIs. When infected urine from the bladder refluxes to the kidney, this could lead to scarring of the kidney, which can predispose them to developing hypertension and kidney impairment later. Constipation and conditions associated with poor bladder emptying also predisposes one to UTIs,” Dr Griffith explained.

But how can parents know that a UTI could be the source of their children’s fussiness?

Dr Griffith said that in general, there is rarely any clear indication of the infection in babies.

“Since babies have an immature immune system, they are often unable to localise where an infection may be. They often present with non-specific symptoms such as poor feeding, poor weight gain, vomiting, fever, fussiness, and groaning. Other specific symptoms of a UTI are smelly urine, pain on passing urine, lower abdominal pain, change in the colour of urine (cloudy or bloody), and an increase in the frequency of passage of small amounts of urine. Any baby under three months who presents with a fever and/or non-localising symptoms must be investigated for a UTI,” Dr Griffith warned.

She said that a UTI can only be diagnosed by a urine culture using an appropriately collected sample. A urine dipstick or urinalysis provides supportive information, but it is not definitively diagnostic.

Generally, according to Dr Griffith, the natural course of treatment for a child with a UTI is antibiotics for a period of 10 days.

“After the infection has been treated, the infant will be placed on a low-dose antibiotic to prevent another UTI from occurring while awaiting the results of the investigation of the urinary tract. It is recommended that all infants under three months who have fever associated with a UTI be admitted to hospital for initial treatment of a presumed pyelonephritis — an infection of the kidney ­— as well as to ensure that a concomitant infection in the blood (sepsis) is not present,” Dr Griffith advised.

She outlined that often, additional investigation is required in the form of radiological studies to determine whether a structural problem of the urinary tract has predisposed the infant to UTIs. These include:

1. An abdominal ultrasound which looks specifically at the size, the structure and location of the kidneys.

2. A specialised form of X-ray known as a micturating cystourethrogram(MCUG) or voiding cystourethrogram(VCUG) which looks at the lower urinary tract — bladder, urethra — to identify backflow of urine up the urinary tract (vesicoureteric reflux), bladder abnormalities and posterior urethral valves.

3. Renal scan. This study aims to identify scarring of the kidneys by infection and also quantifies the function of the kidney. This should be done in all babies who have had a febrile UTI.

She warned parents that it is important that they act quickly should there be a recurrence of a UTI, so that it may be managed appropriately to prevent scarring and the possible long-term complications of hypertension and renal impairment.