Urinary Infection

Urinary tract infections occur at all ages with the youngest being susceptible to serious kidney damage if not recognised and treated appropriately. They are slightly more common in infant girls and the only acceptable treatment is appropriate antibiotics. It used to be the practice that all children and infants who were not toilet trained at the time of infection must have tests including an ultrasound and a catheter die test looking for reflux of urine from the bladder to the kidneys.  This and other unusual abnormalities occur in 30 40% of all infants and toddler with a urine infection. However recently this practice has been questioned. Speak to your paediatrician about the best course of action for your child.

 

How does it occur ?

Usually bacteria that are found around the entrance to the urethra find their way into the bladder. This leads to a bladder infection and sometimes this infection can spread up to the kidneys. Sometimes kidney infections can occur when bacteria in the blood lodge in the small blood vessels of the kidneys.

How is it recognised ?

In the infant their needs to be a high degree of suspicion. Any infant with a temperature that is not due to a virus must have a urine infection ruled out.  In the infant the common signs are irritability, vomiting and fever.

How is it diagnosed ?

Urine must be collected. Unfortunately this can prove difficult. The easiest way is with a bag placed under the nappy. Unfortunately the urine here is often contaminated and the information cannot be reliably interpreted if abnormal. If the urine is normal then there is no urine infection.  The second way is with a clean catch. This is easier in boys – particularly those that urinate as soon as the nappy is taken off.  The gold standard is to get a completely sterile sample. There are two choices here.  A catheter specimen of urine or a needle aspirate of the bladder. These tests are often used when the infant is unwell and a urine infection needs to be ruled out quickly.

Treatment and other tests.

In infants hospitalisation is usually necessary as sometimes the infection has spread to the kidney. Here antibiotics are given and sometimes an ultrasound performed.

Vesicoureteric reflux

This is the medical name for urine that refluxes from the bladder back to the kidneys. This occurs every time the bladder empties and may cause damage to the kidneys. As mentioned up to 40% of infants with a UTI will have this problem. The good news is that most infants grow out of this by the time they are toilet trained. The management of this is very controversial.

Older children

Urine infections can also occur with older children. This is usually contamination from bowel bacteria and is common if wiping is from back to front. Make sure children are trained to wipe front to back. This is especially for girls

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