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Symptoms of a urinary tract infection depend on the age

DEAR DR.PAUL: I was surprised to find out that children can get urinary tract infections. What are the symptoms and treatment of urinary tract infections in children? Thanks

PEDIATRICIAN DR.PAUL Answers: Urinary tract infections (UTI's) do occur in children and even babies. The symptoms, causes, and possible complications depend on the age of the child. The cause of a urinary tract infection is a bacteria in the urine and bladder. The bacteria can potentially infect the kidney or even enter the blood. In babies, the immune system is not as strong as an adult's is so these potential complications are quite serious.

As far as symptoms are concerned, the younger a child is the less specific the symptoms are. Symptoms of a UTI in older children and adults include pain on urination, frequent urination and new onset of bedwetting. Other less frequent symptoms include blood in the urine, abdominal pain, and sometimes a low-grade fever. Symptoms indicative of a kidney infection, known as pyelonephritis, are back pain, high fever, chills and sometimes vomiting. In younger children and babies the symptoms are even less specific and may include only fever, increased irritability decreased feeding, diarrhea and/or vomiting.

The only way to determine whether or not a child has a UTI is to do a urine test. Collecting urine from a baby is a challenge. A commonly-used technique is to attach a plastic bag around the child's genitalia and wait until the child voids into the bag so that the urine can be analyzed. The urine is examined microscopically in order to confirm the presence of infection. The definitive test however, to confirm a UTI is to send the urine for a culture. This takes twenty-four to forty-eight hours and will confirm the presence of bacteria in the urine.

The treatment of a UTI is antibiotics. Which one, how it is administered, and for how long depends on the age of the child, the history of the child, and how sick a child with a suspected UTI looks.

Certainly in young or sick-looking children, we will not wait for the 24 to 48 hours for the culture results before starting treatment. If the initial analysis is abnormal and suggestive of a UTI, we will treat first and wait for the cultures. In young babies, children who are vomiting, or children with a suspected kidney infection, the antibiotics are given intravenously in hospital. Children who are not sick looking and have no evidence complications are treated with antibiotics given by mouth.

The other issue in children with a UTI is the possibility of underlying kidney or bladder abnormalities. That's why most young children with a UTI, especially boys, need special tests to make sure there are no kidney or bladder problems. Typically, a kidney ultrasound is performed which can tell us about the kidney, bladder and urinary system in general. Depending on the situation and age, another test is performed called a Voiding Cysto-Urethrogram(VCUG). This test determines whether the connection between the kidneys and the bladder and the ureters is working well.

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