BENGALURU: In the initial years of their life, children generally tend to have a lot of health issues, because of which cold and other infections become extremely common among them. One of the most severe infections that can arise in children is urinary tract infection (UTI). While it is mostly believed that UTI occurs only in adults, it has been reported that up to 8 per cent of girls and 2 per cent of boys suffer from UTI by the age of five.
Symptoms
Symptoms of the infection can be very subtle in young children. They may just have unexplained fever or associated with chills, fussiness, vomiting or even loose stools. Older children may complain pain while urinating or pain abdomen. If any of these symptoms are present, it is better to consult a doctor. If there is a suspicion of UTI, the pediatrician may ask for urine test. It is very important to appreciate that the urine culture test should be done before any antibiotics are given to the patient. Otherwise the test may be reported negatively in spite of patients having urinary tract infection. This may lead to under-treatment, kidney scarring and chronic kidney ailments.
Children particularly girls may have UTI without any anomalies in the urinary system. But when a younger child (less than 5 years old) have the infection, it is important to screen the urinary system with an ultrasound abdomen to rule out the possibility of children being born with some congenital anomalies involving urinary tract.
Depending on the results of the Ultrasound, some children may need further evaluation of their urinary tract with other more specific tests such as DMSA scan or Micturating Cystourethrogram, etc. These tests are done to rule out if there is reflux of urine (part of the urine going up the urinary system while voiding out) and also to see if there is any scarring of the kidneys. The children with these abnormalities need close supervision for a few years to see if they grow out of their problems by themselves or need any surgical interventions.
Treatment
The treatment involves mainly antibiotics. This is best guided by the urine culture report, which generally gives us the information regarding the bacteria causing the infection and also a suitable antibiotic for the same.
Children who are born with certain urinary tract anomalies may be put on prophylactic daily antibiotics for the first few years. This is for prevention of infection as they are prone for developing urinary tract infection. They also need close monitoring for any urinary tract infection.
The other way to prevent urinary tract infection in children is proper hygiene practices. This includes cleaning the perineum from front to back rather than back to front in order to avoid contamination of stool material into the urinary tract (particularly girls); avoiding constipation (which can cause secondary urinary tract infection) by healthy diet rich in fibre and water; regular and frequent timely
Voiding of urine rather than suppressing the urge and holding for a long time (particularly young children in schools). The schools should provide for this by having clean toilets and promoting hygienic practices among students.
UTI not only causes acute illness in children but it is also one of the commonest causes for scarred kidneys when the infections are recurrent and undertreated. This may lead to decreased kidney function in the long run and eventually kidney failure. Scarred kidneys is also one of the many causes for hypertension at a later age. Hence it is vital to prevent and treat it in a timely and comprehensive care.
The author is consultant paediatrician and paediatric intensivist, Vikram Hospital Bangalore