Children with Recurrent Urinary Tract Infection WHAT IS A UTI? Your child is said to have a urinary tract infection (or UTI for short) when bacteria (germs) grows in a properly collected urine sample. Your child usually will have symptoms as well. WHY DO RECURRENT UTIs IN CHILDREN MATTER? They do matter as your child may have recurrent illness associated with urine infection. They may also lose bladder control and have problems with wetting. In some children urine infections point to an abnormality of the urinary tract (see diagram right) that might need treatment. One such abnormality is a condition called reflux. Diagram of Urinary Tract WHAT ARE THE SYMPTOMS (complaints or signs) OF A UTI IN CHILDREN? A lot of children have bladder or cystitis like symptoms which include: Discomfort or crying when the child passes urine - this is called dysuria. Because of the discomfort you might notice your child being reluctant to go to the toilet. The child needs to go to the toilet very frequently. The child begins to wet his or her pants during the day or night. The urine is cloudy and strong smelling. The urine has blood in it - this is called haematuria. The child may complain of tummy pain. Some children may have a more severe infection involving the kidneys called pyelenephritis and we suspect this when they have a very high temperature, severe stomach or back pains, vomiting and are unwell. WHAT SHALL I DO IF I SUSPECT A URINE INFECTION? To prove a urine infection a proper urine sample has to be obtained for sending to the laboratory. This may be obtained by one of the following methods. Please check with the nurse if you are unclear as to how to collect a sample from your child. MIDSTREAM SPECIMEN OF URINE (MSU) - This is the method used to collect urine specimens in all children who can pass urine when asked to. The reason a midstream specimen is asked for is that the beginning of the stream can be contaminated by organisms (bacteria, as mentioned earlier) which are around the entrance of the urethra.The child should be encouraged to pass some urine, stop and then pass some into a sterile container. CLEAN CATCH URINE - Infants and young children often pass urine after they have been given milk or other feeds. Although it requires some patience, urine can be collected into a sterile tray provided by the surgery/clinic or you can catch part of the urine stream directly into the sterile container. Collecting urine into a potty is NOT acceptable. A URINE BAG may be used in infants. Your child’s private part should be cleaned with cool boiled water and the bag applied. The bag should be emptied immediately once urine has been passed. The urine should be put into the proper urine container from the bottom end of the bag and not out through the top. It is easy to contaminate such bags and you may have to start again. some units use special PADS to collect urine. SUPRAPUBIC OR CATHETER SPECIMEN - Only in special circumstances in young children do hospital staff obtain urine from the bladder by using a needle or using a catheter directly into the bladder. HOW CAN I FIND OUT MORE ABOUT THESE TESTS AND PREPARE MY CHILD? Many units produce information booklets about these tests which help prepare you and your child. You should be sent one of these booklets when the test is booked. If you can read one of these booklets to your child it will help to prepare them for the test they are to undergo. Some parents are anxious about telling their children about procedures as they are afraid this will upset them. However, research has shown that it is beneficial to prepare them. Although the child may become upset when told at home, this gives them a chance to learn what lies ahead and gain reassurance from their parents. Further help may be available from the hospital. Do talk to the nurse or doctor if you have any questions. WHAT CAN I DO TO PREVENT FURTHER INFECTION? You have probably already received some information about this already but in case not, the following would be advised: Avoiding constipation - Children who are constipated may not empty their bladder very well. Often parents do not know that their children are constipated, but if you suspect it then ask for advice about dietary treatment for your child. A healthy eating diet which includes high fibre food such as wholemeal bread, wholewheat cereals with fresh fruit and vegetables should be encouraged. Sometimes laxatives may be prescribed for your child but these are not the answer in the long term. Encourage your child to drink plenty and EMPTY THE BLADDER adequately. Sometimes children have to be reminded to use the toilet every 2-3 hours. Also check that your child is using the toilet at break-time at school. In young girls it is important to AVOID ANY IRRITANTS in the vaginal area. Sometimes bubble-bath and soaps can be such an irritant and it is generally advised you avoid these in young children suffering recurrent problems. Also in young girls proper wiping from front to back after they have been to the toilet may also be important. Try to ensure that your child wears loose cotton underwear rather than tight nylon underwear. In young boys the foreskin may be a source of infection and this area should be kept clean. WHAT IF MY CHILD IS FOUND TO HAVE TO HAVE REFLUX? This refers to the passage of urine back up the bladder to the kidney or kidneys. Urine may carry infection with it and this could lead to damage of the kidneys. It is therefore suggested that your child should receive antibiotics in a single dose every night. This is called ‘prophylaxis’. By using a very small dose it is hoped to prevent further infections occurring, whilst avoiding problems with your child becoming resistant to the antibiotics. Please make sure that your child gets the antibiotic on a regular basis and report to the doctor if there are any problems with your child taking the medicine regularly. There is long experience of children on prophylaxis for many years and very few problems have occurred. If you do have any objections to your child receiving long term antibiotics please be frank and discuss the point with the doctor in the clinic. The following points are very important: Try to avoid missing any doses. Do not double up the dose if your child has a suspected urine infection. Do obtain a urine culture and take it to your doctor or clinic. If your child is given another antibiotic for an infection such as a sore throat, then continue the prophylactic antibiotic RECORDING INFECTIONS If your child has symptoms then it is IMPORTANT that your child always has a urine culture BEFORE the antibiotic is changed. Please ask your doctor for the result of the urine culture and write it down. You should also write down what antibiotic was given and check that the urine has cleared of infection with a follow up culture one week after stopping the antibiotics. You should take these details to the children's clinic whenever you attend so that the hospital doctor can see what has happened since you were last seen Click here to view an example WILL URINE INFECTION DAMAGE MY CHILD'S KIDNEYS? The majority of children with urine infections, even if recurrent, have no problems and the kidneys remain perfectly healthy. However, damage to the kidneys can occur either from severe reflux in the womb before the baby is born and can occur in children who have severe reflux and infection after birth. It is therefore important for tests to be carried out to detect reflux in your child and define whether there has been any scarring or damage to the kidneys. Scars on the kidney can lead to high blood pressure (hypertension) but again this is very uncommon. Children who have damage to both kidneys can have chronic kidney damage and need to be followed long term in clinic. Again it should be stressed that most children with urine infections do not have long term damage. Content compiled by members of the Children’s Renal & Urology Unit, QMC Campus, Nottingham University Hospitals. The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.