Urinary tract infections (often called uvi) are common in infants and also quite common in older children. Urinary tract infections with fever, or renal pelvic inflammation, can become dangerous and needs to be treated quickly with antibiotics. Urinary tract infections without fever, catarrh or cystitis, are very unpleasant but not dangerous. Antibiotics also help there.
Urinary tract infections in infants and young children
Urinary tract infections are quite common in children under one year, and especially common in boys. Most children under the age of two who get a urinary tract infection suffer a high fever (over 38.5 degrees) without any other symptoms. So the urine does not smell bad, they have not taken care of the genitals and they often (but not always) eat well. The only thing that makes us suspect that they have urinary tract infection is that they have a fever without any other symptoms.
Infants may also have urinary tract infections without fever, which can be diagnosed if they are not eating, or are not gaining weight. Then it is always good to take a urine sample.
In case of suspected urinary tract infection in young children, a urine test is needed. Pads and bags unfortunately can give rise to tainted specimens, where one can diagnose a urinary tract infection by mistake, so peeing in a mug is necessary. You simply have to sit with the baby in the lap and fit with a mug until they pee.
If the urine test of the specimen shows signs of urinary tract infection, it needs to be treated. In babies, you do this by sticking a syringe through the stomach and sucking up urine through the bladder. It is quick but hurts a little. The advantage is that you completely eliminate the risk of diagnosing a urinary tract infection when there is none. This risk is always present in the urine test because the urine may have caught bacteria on the way out through the genitals.
Urinary tract infection in older children
In children over two years, there are three types of urinary tract infections: cystitis, pyelonephritis and asymptomatic bacteriuria (ABU). In smaller children, they do not differ, partly because they cannot discuss their symptoms, and partly because each is treated the same.
Bladder infection or cystitis
A cystitis, or lower urinary tract infection, is a urinary tract infection that irritates the bladder but has not risen to the kidneys. It is painful for the child but not as dangerous as a high urinary tract infection involving the kidneys.
The symptoms of a cystitis are burning or pain when the baby is peeing, that the baby needs to urinate often. The child has no fever. Leave a urine sample that is sent for cultivation. Antibiotics help.
Blood in the urine
Fresh red blood in the urine of children is almost always a sign of urinary tract infection. Dark blood in the urine, Coca-Cola-colored urine, is a sign of kidney disease. Seek medical attention at the medical centre for examination.
Pyelonephritis, or renal pelvic inflammation, is a urinary tract infection where the bacteria grow in the kidneys. It is also seen in children over two years of age as a fever without other symptoms. Sometimes the children complain of stomach or back pain, sometimes it hurts to pee, sometimes the urine smells bad. Sometimes the children vomit. Usually not.
Renal pelvic inflammation in children needs to be treated with antibiotics and should be followed up with examination of the urinary tract later.
Asymptomatic bacteriuria means bacteria in the urine without symptoms. That's not true. These girls (it is most common in girls) have smelly urine. Really smelly urine. They urinate frequently. But it does not burn when urinating.
Previously, girls with asymptomatic bacteriuria were treated aggressively by the health care system. They were given bactericidal agents directly into the bladder (terribly painful, repentant doctors and former patients) say time and time again. Thankfully, some wise researchers investigated if it helped and found that it didn't.
Unfortunately, antibiotics don't help either. Or, it removes the smell as long as you take it, but the smell and the bacteria come back. Also, antibiotics do not protect against pyelonephritis in children with ABU. On the contrary, the child has a bacterial strain in the bladder that the child manages to keep away from the kidneys. If you remove that bacterium with antibiotics, there is a risk that the next bacterium that creeps up through the urethra is a more aggressive bacterium that the child cannot manage to keep away from the kidneys.
Antibiotics for children with ABU do more harm than good!
Children with asymptomatic bacteriuria need to see a urotherapist or pediatric nurse who is an expert on urinating problems. She needs to check if the children empty the bladder when they are urinating, if they have overactive bladder or (usually) urinate infrequently and have an overcrowded bladder. Children need to be helped to pee regularly (every three hours). It can help but unfortunately it doesn't always.
Children over two years old with cystitis, pyelonephritis or ABU often have constipation. It should be treated, be sure to get good treatment for constipation if your child does not have soft plentiful stools without any problems every day, if your child has had urinary tract infection or ABU. The constipation means that there is a bowel stretched by the stool in the path of the bladder. This makes bladder control and bladder discharge more difficult, which in turn increases the risk of urinary tract infections.