Sugandha (name changed), 10 month old baby girl developed high fever for 3 days. She was evaluated by her neighbourhood medical practiotioner and urine examination revealed infection in urine. She was treated with oral syrups and she became better by 3-4 days and life moved on. However 2 weeks later she again developed a urine infection with a fever. She had 2 more such UTI till 3 years of age when she was detected to have underlying kidney disease. But by this time her kidneys had developed scarring and had low functionality.
Such are the stories of many small children who develop urinary infections.
Urinary Tract Infections (UTI) are one of the most common cause of fever in children < 5 years of age. They are also very common in older children and adults especially teenage girls and middle aged women. Urinary infections can lead to major long term consequences in kidneys of children as they grow and some times may lead to deterioration of kidney functions too.
What is a Urinary Tract Infection?
It is infection of kidney or urinary bladder usually by bacteria and rarely viruses.
What are the symptoms of UTI in children?
Usually it presents with moderate to high fever, chills, pain or crying while passing urine, increased frequency of urine, holding of urine etc. Infants usually present with fever with excessive irritability, poor feeding, vomiting, lethargy etc. as they can’t express their discomfort.
How does UTI occur in small children?
UTI usually occurs by bacteria which are present in our intestines which migrate to kidney/bladder. Constipation and postponing of urination are most important contributory factors. Congenital problems in kidney, ureter or bladder like VUR, PUJ etc contribute too.
What doesnot cause UTI in children ?
UTI doesnot occur by using Soiled/dirty toilets or by using Diapers as it is usually thought of in the society. No scientific research has proven this connection between Diapers or Soiled toilets. However Diapers must be changed frequently at regular intervals. UTI is not a contagious disease in children and cannot spread by coming into contact.
Why should parents be worried of UTI?
UTI in children less than 5 years of age can lead to far reaching consequences. It can cause Permanent Scarring of kidneys. This irreversible damage can lead to weak kidneys in future life. Scarring can also lead to elevated Blood pressure in childhood and adult life. This is the reason that every UTI in children to be diagnosed early and treated completely to prevent irreversible damage to kidneys.
Should UTI be further evaluated with root cause analysis (RCA) in children?
Definitely Yes. It is mandatory to evaluate all children with even with SINGLE simple looking UTI if they are below 7 years of age. In most of the cases only medical treatment happens but the further root cause analysis is neglected by parents even if suggested by doctors. This RCA includes Ultrasound/DMSA scan/MCUG scan /CT scan depending on the age of child. The evaluation helps to find out the structural cause if any causing UTI and in assessing the damage caused by UTI in form of Scarring if any.
How is UTI treated?
Bacterial UTI is always treated with Antibiotics to remove the bacteria from urinary tract and prevent its spread in blood. It is important to diagnose UTI as early as possible and initate treatment at earliest. Antibiotics can be oral and injectable. For children who are less than 1-2 years, have high fevers , appear sick, have severe pain , irritability , appear dehydrated and are not feeding well and have highly elevated total WBC count / CRP , injection Route with IV Fluids are recommended. For stable older children who don’t have above symptoms, oral antibiotics can be given.
If a child has recurrent UTI, then what to do?
YAny child with even more than 1 episode of UTI at any age, he/ she requires a definite detailed Root cause analysis and work up so as to find the cause of UTI. Such children can keep developing UTI and if not treated well can develop long term damage to kidneys.
Is it fine to give children long term antibiotics at night time if they have recurrent UTI or reflux?
Yes. Such strategy is adopted in children with underlying structural defects of urinary system. Long term antibiotics usually help such children to prevent repeat UTI and help prevent permanent scarring (damage) to kidneys. Evidence based research has clearly shown them to be safe and beneficial.
How to prevent UTI in children?
Simple strategies like treating and preventing Constipation, avoiding postponing of urine, frequent passing of urine, drinking adequate water daily can prevent UTI in children. Young teenage girls especially have a habit of not passing urine for long hours and hence they get lot of urine infections. The cleaning of female genitalia after stools must happen from front to back strokes and not vice versa. The foreskin of Penis in boys should be gently retracted daily during bathing with rinsing of water to prevent colonisation of bacteria.
Who best treats the UTI and Kidney diseases in children?
New born babies to Children less than 15 years are best treated by kidney specialist for children known as Paediatric Nephrologist. They are specially trained for kidney diseases in children and can take care properly.