7 things you should know about urinary tract infections in children

November 14, 2019
  • The symptoms aren’t always clear-cut.
    1 / 7 The symptoms aren’t always clear-cut.

    Does your little one cry or complain about pain while urinating, or seem to be wetting more diapers than she usually does? Or has she stayed dry for much longer than usual? These could be signs of a urinary tract infection (UTI) and you should take her to the doctor, says the American Academy of Pediatrics (AAP).

    You should also look out for episodes when she passes urine that is cloudy, bloody or has a strong foul smell, or wets herself if she already knows how to use the toilet. Other signs include fever, vomiting, tummy pain and lethargy, as well, says Dr Oh Meng Choo, a paediatrician at Kids Clinic, a Singapore Medical Group paediatric clinic.

    But many of the signs can be easily missed in young children. About one in 20 babies can have fever without other common UTI symptoms. This lack of signs is why this infection often goes undetected in infants, the AAP notes.

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  • A soiled soggy diaper is the ideal breeding ground for germs.
    2 / 7 A soiled soggy diaper is the ideal breeding ground for germs.

    Many types of bacteria that cause UTIs are also found in the colon (large intestine), the most common one being Escherichia
    coli (E Coli), says Dr Leo Deng Jin, a paediatrician at Thomson Paediatric Centre (Bukit Panjang).

    He explains that most UTIs are due to “ascending” infections – the bacteria along the lower part of the urinary tract, like the urethra (the passageway that carries urine from the bladder out of the body), climb and invade the upper parts, causing an infection.

    Babies and toddlers are vulnerable to UTIs because they are in diapers most of the time. They also tend to urinate more frequently than adults because their bladders are smaller.

    Wet dirty diapers encourage bacteria to breed on the skin within the groin area, so change nappies regularly, Dr Leo says.

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  • Girls generally have a higher risk of getting UTIs than boys.
    3 / 7 Girls generally have a higher risk of getting UTIs than boys.

    Girls have a shorter urethra and this allows bacteria from the bowel to move to the bladder easily.

    Such infections are also common during the potty-training years, particularly if your toddler holds back stools for prolonged periods. Constipation can increase UTI risk, Dr Leo says.

    UTIs can occur due to other reasons, too, such as if your child has urinary tract abnormalities.

    Related: 7 things you should know about ear infections in babies

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  • Boys get it,  too, particularly if they have not been circumcised.
    4 / 7 Boys get it,  too, particularly if they have not been circumcised.

    Compared to infants who have had their penis’ foreskins surgically removed, those who’ve not face a four- to 10-fold risk of getting UTIs, Dr Leo says. The hypothesis is that bacteria may hide and build up under the foreskin and enter the urinary tract. A study by McGill University’s researchers calculated that the risk of infection may be 88 per cent lower in boys who have been circumcised.

    Dr Leo says circumcision can improve genital hygiene in boys, but the procedure “is not without risks”.

    Dr Oh says the procedure is unnecessary unless Junior keeps getting recurrent episodes of balanitis, an infection of the head of the penis which can cause an itchy red rash.

    Dr Leo suggests consulting with your baby’s paediatrician or surgeon to weigh the potential risks and benefits. If your son hasn’t been circumcised, retract the foreskin to clean his genitals. This should be done daily as part of the usual shower routine, Dr Leo advises.

    “Sometimes, this may be difficult to do for some boys with a tight foreskin. In such cases, gradually stretch back the foreskin during a warm shower when the skin is softer and more supple,” he adds.

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  • For a proper diagnosis, a urine sample is required.
    5 / 7 For a proper diagnosis, a urine sample is required.

    The only way to confirm if your child has UTI is to send a urine sample for testing. In older kids and adults, this usually involves collecting some mid-stream urine in a sterile container.

    With babies and toddlers who are not toilet-trained or are very sick, the doctor may perform a procedure known as the in-out catheterisation to get a proper urine sample, Dr Leo says.

    This involves using a soft, sterile silicone or rubber catheter (tube), and threading it up the urethra to get some urine from the bladder.

    Before doing so, the doctor performing the procedure will clean the genitals thoroughly to reduce the risk of bacteria getting into the bladder during the catheterisation process, Dr Leo explains.

    The procedure can be uncomfortable for your little one and she may cry during the process. But it helps your baby’s doctor to correctly diagnose UTI, determine the bacteria causing the infection and prescribe the right antibiotics for it,
    Dr Oh says.

    There is another method, which involves collecting urine in a bag pasted over the child’s genitals, she points out. But there is a chance that bacteria from around the genitals can contaminate the sample.

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  • It can turn deadly.
    6 / 7 It can turn deadly.

    If your little one has a UTI, she will need to be treated promptly with antibiotics and have her kidneys checked using an ultrasound scan. If she gets it before her first birthday, she may be hospitalised and given antibiotics via drip, says Dr Oh.

    Don’t delay treatment – you run the risk of the infection progressing to the bloodstream or to other organs, Dr Leo warns.

    If the infection spreads to the upper urinary tract, such as the kidneys, it could lead to kidney scarring and failure, Dr Oh adds. And if the bacteria enter your baby’s bloodstream, there could be life-threatening complications.

    Related: 7 things you should know about colds and flus in babies

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  • Don’t wait till  it happens.
    7 / 7 Don’t wait till it happens.

    Prevent UTI with these expert tips:

    – Maintain good hygiene. If you have a girl, always clean her genital area from front to back. If you have a boy, clean his genitals by retracting the foreskin gently.

    – Encourage good toilet habits. Train your toddler to go promptly whenever she feels the urge to pee or poo. Holding it in can increase UTI risk.

    – Choose cotton underpants and avoid tight-fitting bottoms.

    – Avoid bubble baths and other substances like deodorants and perfumed soaps that can irritate the genitals.

    – Encourage your child to drink plenty of plain water to “flush out” the bladder. Avoid giving food and beverages, like chocolates and caffeinated drinks, that can irritate the bladder.

    (Photos: 123RF.com)

    Related: 7 things you should know about fever in babies

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