Urinary Tract Infections in Children

Urinary tract infections and kidney infections are the third most frequent after respiratory tract infections and diarrhea in young children. 

Their non-specific symptoms can mimic other means, such as the just mentioned intestinal disease or respiratory tract infection. Quite often, kidney inflammation can accompany these diseases in the smallest children.

In addition, it is often a disease that requires the child to be placed in a hospital bed and, after the acute condition has been cured, long-term follow-up in a nephrology clinic. The infection can affect the lower or upper urinary tract. Childhood is characterized by a greater frequency of upper urinary tract infections (inflammation of the kidneys) than adulthood.

If a child has a congenital obstruction in the outflow of urine from the kidney or another congenital developmental defect of the urinary system, this type of inflammation in infancy or later is almost the rule. The situation is similar for children whose urine returns from the bladder to the kidneys due to poor ureteral function. In addition, inflammation of the kidneys can occur repeatedly.

SYMPTOMS

In inflammation of the lower urinary tract, as in adults, accompanying symptoms are burning and cutting during urination, frequent urination, change in the color of urine caused by the presence of blood, and increased temperature or fever.

It is different from upper urinary tract infections. At the youngest age, fever may be the only symptom of the disease. A tired, cranky infant with a fever who has no other problems, no cough, no runny nose, may just be suffering from nephritis.

In children and adults, kidney inflammation is often accompanied by back pain and abdominal pain. However, a small child does not always know how to describe his problems correctly, and in addition, his stomach hurts so often and with any moaning that parents often do not pay attention to it.

A URINE SAMPLE MUST BE TESTED TO MAKE A DIAGNOSIS

The basis for detecting a urinary infection is a urine examination. The pediatrician’s office usually uses test papers (chemical examination of white blood cells in the urine). 

A positive test with fever or other symptoms means a urinary tract infection with a high probability. A more accurate examination, which is no longer commonly available in the doctor’s office, is an accurate laboratory examination of a urine sample.

MIDSTREAM URINE COLLECTION

The urine sample should be obtained by the so-called midstream method. It is the retention of urine only after the start of urination. Hence the mean current. This should be preceded by washing the external genitalia. 

A small amount of urine is sufficient for the examination, but the collection requires skill and certain cooperation of the child. However, during this sampling, bacteria from the mouth of the urethra may enter the urine and distort the examination result. The most accurate sampling is with the urethra. 

For this and other examinations, a general pediatrician usually sends children to a hospital facility. An additional portion of urine is usually collected in a sterile tube, which is sent to the microbiological laboratory to determine the cause of the infection. While infants and toddlers are usually sent to an inpatient facility for further examination and treatment for suspected urinary tract infections,

ULTRASOUND AND OTHER EXAMINATIONS REVEAL BIRTH DEFECTS

An obvious part of diagnosing a urinary tract infection is blood sampling to determine inflammatory parameters in the blood sample. 

A sonographic examination and, if necessary, X-ray and radioisotope examinations are also carried out for a child with signs of a urinary tract infection. This is the only way to detect some congenital disabilities and functional disorders of the kidneys and urinary tract.

THERAPY

The basis of treating urinary tract infections is correctly selected sensitive antibiotics.

PREVENTION

Most newborns born in our maternity hospitals undergo a screening (search) ultrasound examination of the kidneys for the early detection of a congenital disability, which would later manifest as a serious urinary infection and sometimes severe kidney damage. However, not all urinary system defects can be detected by ultrasound.

Recurrent urinary tract infections in toddlers and preschoolers are unpleasant. Only exceptionally, nephritis occurs only once. 

Even in children whose examination does not show the above-described VUR – vesicoureteral reflux, i.e., the return of urine from the bladder to the kidneys, inflammation of the kidneys can occur repeatedly. The consequence can be the deterioration of kidney function and the formation of scars in the kidney tissue. 

A nephrologist monitors children for a long time until school age, who regularly examines their urine for the presence of bacteria and monitors the kidneys and bladder with ultrasound. Sometimes they use antibiotics as a preventive measure.

Proper hygiene is the basis for preventing urinary tract infections in toddlers. In one stroke, girls must pay attention to the correct way of wiping the bottom after the stool from front to back. Underwear should preferably be cotton, ironed, and cleaned every day. Taking off your clothes over your boots and putting them on the floor is incorrect.

Remember that most kidney infections in children, except newborns, are caused by the infection ascending from the mouth of the urethra through the bladder and onto the kidneys. 

At school age, the barrier preventing the passage of urinary infection from the bladder to the kidneys improves. In older children, we mostly encounter lower urinary tract infections, accompanied by unpleasant and painful burning and cutting and frequent urge to urinate. Still, we do not threaten the development and function of the kidneys.