What to know about UTIs in kids

One in 30 children experience a urinary tract infection (UTI) at some point in their young life, but it's not always one of the more easily recognizable issues for parents and caregivers. Experts from the pediatric urology program at Lurie Children's - Dr. Emilie Johnson, Dr. Edward Gong, physician assistant Reumah Ravoori and advanced nurse practitioner Lynn Freedman - share recommendations for how families can identify UTIs in their children, what treatment looks like, and how to prevent them to begin with.

As suggested by the statistic above, UTIs are one of the most common bacterial infections in childhood. "UTIs are caused by bacteria in the bladder which lead to inflammation of the bladder and/or kidneys," said Johnson. For those at risk, Johnson notes infections are often attributed to the following:

• Anatomic problems with the bladder or kidneys

• Poor bladder emptying

• Holding the urine

• Constipation

When it comes to signs and symptoms, UTIs often present in kids as they do in adults. "Parents should keep a close eye out for any pain with urination, urinary frequency (going very often), urinary urgency (not able to hold urine), new accidents, blood in the urine, fevers and back pain," Johnson said.

"For younger children," she said, "oftentimes the most prevalent sign will be a fever."

In the event of these symptoms, the urology experts recommend seeking medical attention at a pediatrician's office, urgent care or emergency room for proper diagnosis.

"When a child is experiencing what may be a UTI, a diagnosis can be made by obtaining a urine sample, which is sent for a urinalysis (screening test) and a urine culture (bacteria check)," Gong said. "The urinalysis gives us immediate insight into if the child is experiencing a UTI, whereas the urine culture test results come back a few days later and can further guide treatment."

Gong notes that for toilet-trained children, the sample is collected by urinating into a cup. For children in diapers, the urine is often taken by catheter (a small, temporary tube inserted into the bladder) to ensure the sample is not contaminated by other organisms found in a diaper or on the child's skin. In some circumstances, a bagged urine sample can screen for a UTI in a child but, when possible, UTI should be confirmed by catheterized urine in a non-toilet trained child.

"Children with recurrent or severe UTIs may be referred to a urology specialist," Gong said. "At this visit, a detailed medical history will be taken, and the family may be asked to fill out a 'voiding diary' about when the child pees and poops. As urologists, we may also request X-rays to look at the amount of stool retention, or an ultrasound to look at the bladder and kidneys."

Once a proper diagnosis has been made, a child's pediatrician or urologist will determine the best course of action for treatment.

"Since UTIs are caused by bacteria, they are usually treated with antibiotics by mouth for no longer than two weeks," Ravoori said. "If the infection is severe or if the urine culture grows an unusual bacterium, a child may require antibiotics through an IV infusion."

Ravoori notes that a repeat urine test should be done after treatment to ensure the UTI has resolved in response to the antibiotic. Additionally, doctors may recommend other medications to address a child's specific symptoms such as fever or pain.

"Oftentimes parents can make an effort to prevent UTIs in their children by helping them practice good bladder and bowel habits," said Freedman. "This includes things such as encouraging a child to pee at least every two to three hours, helping them avoid holding their urine, which can foster bacterial growth; ensuring a child has soft, daily bowel movements (and treating constipation if present), and encouraging them to stay hydrated and drink plenty of water.

"A doctor may have other recommendations based on a child's specific situation, so we always highly encourage parents to work closely with them to determine what those are," Freedman said.

For more information on urinary tract infections, urology and the Lurie Children's experts, visit www.luriechildrens.org/en/specialties-conditions/pediatric-urology.

• Children's health is a continuing series. This week's article is courtesy of Ann & Robert H. Lurie Children's Hospital of Chicago. For more information, visit www.LurieChildrens.org.