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Definition:

A urinary tract infection (UTI) occurs when bacteria get into the bladder or kidney. The bacteria enters the bladder through the urethra (the tube connecting the bladder to the hole where the urine exits the body). UTIs are more likely to occur if the urethra is irritated by bubble baths, fecal soiling, or poor hygienic techniques (for instance, girls should always wipe from front to back especially after a bowel movement).

Symptoms of a urinary tract infection include:

• Pain with urination
• Increased frequency of urination
• Urine ‘accidents’
• Abdominal pain (especially the lower part of the abdomen)
• Foul smelling urine
• Fever
• Vomiting

To confirm the diagnosis, a urine sample will be examined in the office (called a urinalysis). If our suspicion of infection is high (by history and office urinalysis), we will empirically begin treatment with an antibiotic that is usually effective against the bacteria responsible for UTIs. Your child’s urine will then be sent for a culture. The culture results (which can take 48 - 72 hours) determine if an infection is present and which antibiotic will eliminate the infection.

Other treatments include:

• Plenty of fluids to ‘flush out’ the bacteria
• Acetaminophen or ibuprofen for pain or fever

A follow-up urine culture will be obtained after completing the antibiotic therapy.

Some children with urinary tract infections are found to be susceptible to repeated infections or have an associated condition (such as urinary reflux) which can cause kidney damage over time. Therefore, your practitioner may recommend a work-up for your child. Two tests are often recommended:

• Renal/Bladder ultrasound. This test identifies structural anomalies in the urinary system.
• Voiding Cystoureterogram (VCUG). This test identifies children with kidney (urinary) reflux, a condition in which the bladder contents are forced up toward the kidneys when the bladder contracts to empty. It is performed by inserting a catheter into the bladder and filling the bladder with a radio-opaque dye. An x-ray is then taken while the patient urinates.

For further information about these tests go to the Northside Imaging web site at www.pedsimaging.com and click on the appropriate test.

UTIs may be prevented by:

• Stopping use of bubble baths
• Limiting bath time to less than 15 minutes
• Using soap and shampoo only at the end of bath time
• Not letting the soap float around in the water
• Having your child urinate after baths
• Encouraging frequent bathroom breaks (every 4 hours) to prevent holding back of urine
• Watching for and treating constipation
• Teaching girls to always wipe from front to back after using the toilet

CALL OUR OFFICE if:

• Your child has symptoms of a urinary tract infection.
• Your child has a UTI and is not improving within 2 days on antibiotics.
• Your child is vomiting the medication.
• Your child starts to act very sick
• You have other concerns or questions.

Adapted from Instructions for Pediatric Patients by Barton Schmitt (2nd edition, 1999) with permission from the author.

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