Handling UTI in children

Bedwetting, rashes, fever...Here are signs that your child is suffering from a urinary tract infection

BENGALURU: Urinary Tract Infection (UTI) is a common bacterial infection in children and infants. The risk of having a UTI before the age of 14 is almost 3 per cent in boys and 8-10 per cent in girls. Symptoms can be non-specific, especially in infants and toddlers, resulting in inadequate detection and improper treatment. An inadequately/untreated UTI in a younger child can sometimes lead to disastrous effects with scarring of the kidney causing chronic hypertension and kidney disease.

Children can get UTI when the bacteria from the stools or skin surrounding the urethra enters the urinary tract. It can cause infection which can be localised to the urethra and bladder (the lowermost part of the urinary tract), or in some cases, the infection can ascend all the way up the tract to involve the kidneys, especially in children with a condition called vesicoureteral reflux (VUR).

With timely detection and treatment with appropriate antibiotics, the complications are minimised. In infants with UTI and children with recurrent infections, your doctor may suggest ultrasound scans and special tests to check on the condition of the kidneys and to rule out VUR.

The typical symptoms of UTI like burning while passing urine, or increased frequency of passing urine/ dribbling, lower back pain, abdominal pain. Here are a few red flags which if noticed, should be brought to the notice of your child’s paediatrician.

1. Inability to gain weight: This is a common sign in infants and toddlers which needs to be evaluated. In an otherwise healthy child with no signs of deficiency, a poor weight gain which may or may not be associated with loss of appetite needs to be evaluated. It has been seen that UTI if picked up and treated at this stage, results in good weight gain in the months following treatment.
2. Loose stools, vomiting: This need not always be a symptom of a ‘stomach bug’. Sometimes loose stools, especially if associated with fever and vomiting needs to be evaluated, if no other cause can be identified.
3. Fever: High-grade fever, lasting for more than 48 hours, especially associated with chills, will have to be evaluated. Do report to your paediatrician.
4. Bedwetting: For an older child who is toilet trained, a sudden step back to nocturnal bedwetting can be a red flag .
5. Rash: A rash in the genital area which may or may not be associated with fever or with any of the above symptoms should be always investigated, especially with foul smelling or cloudy-looking urine.

Minimising risk of UTI: Maintaining hygienic practices can minimise the risk of infection like frequent changing of diapers / nappies in infants, washing from front to back to ensure that stool does not enter the urinary tract. This practice is exceptionally important in girl children. In older school going children, ensure the child stays well-hydrated, and empties the bladder at regular intervals. ‘Holding in of urine’ due to reluctance to use the toilets at schools or while travel, and constipation can both predispose
to UTIs.

In some instances, your doctor may advise a catheterised sample to get an accurate report. Based on the culture, antibiotics are given anywhere between 7-14 days based on the clinical condition and severity of infection.

(The writer is consultant neonatologist and paediatrician, Fortis La Femme Hospital, Richmond Road)