Urinary tract infections in children
Urinary tract infection is a collective term for inflammation of the urinary tract caused mostly by bacteria , rarely by viruses or yeasts . These inflammations concern the kidneys , ureter , bladder and urethra . In boys, the prostate , vas deferens and epididymis may be affected . If the bladder is affected, we speak of cystitis. This inflammation takes place without fever . If fever is added, the kidneys are often affected; then we talk about inflammation of the upper urinary tract ( pyelonephritis ).
Urinary tract infection is usually not contagious, but it is one of the most common diseases in children. In the first year of life, girls are affected less often than boys, but later on significantly more often, because they have a shorter urethra and its end is located closer to the anus . About 1% of boys and 3% of girls will experience at least one urinary tract infection under the age of 10 .
What causes a urinary tract infection?
Most urinary tract infections are caused by bacteria that come from the intestine , especially Escherichia coli , Proteus , Pseudomonas , Klebsiella and enterococcus . They can travel from the urethra to the bladder or up to the renal pelvis . Rarely, viruses or fungi can also cause a urinary tract infection . Possible risk factors for recurrent urinary tract infections include:
- missing /insufficient stool hygiene ,
- bladder emptying disorders,
- a small amount of liquid,
- operation,
- reduced defense capacity,
- constipation ,
- backflow of urine from the bladder to the ureter and kidneys (so-called vesicoureteral reflux ),
- urinary stones,
- anomalies and abnormalities of the urogenital tract : e.g. urethral valve, renal pelvis outlet obstruction , narrowing of the foreskin .
What symptoms can occur?
Typical symptoms of bladder inflammation ( cystitis ) are mainly:
- pain when urinating
- frequent urge to urinate,
- leakage of urine (including children who no longer wear diapers).
Young children are usually not yet able to correctly answer targeted questions about difficulties. Sometimes it is impossible not to notice unpleasantly smelling urine. The skin , especially in infants, is often grayish pale. If fever , flank and abdominal pain and/or vomiting are added , it is often an inflammation of the renal pelvis ( pyelonephritis ). Especially in infants, the temperature may rise, they may vomit, go through shock and sepsis ( blood poisoning ).
Note: Especially in girls, so-called asymptomatic bacteriuria (symptomless urinary tract infection) can occasionally occur , in which bacteria are present in the bladder for a long time, but do not cause any acute problems or subsequent manifestations.
What complications can occur?
Bladder inflammation has no immediate special consequences, apart from difficulty urinating. It can sometimes develop into bladder emptying disorder, when children hold back urine for fear of pain. This increases the risk of further urinary tract infection. Untreated severe inflammation of the renal pelvis, on the other hand, can have an acute severe course, lead to septic shock and leave permanent consequences.
Urinary tract infections have a tendency to become a chronic disease , or to return frequently. They can then also lead to tissue damage and scarring, especially on the kidneys. The result can be later health complications such as high blood pressure , chronic kidney damage and, in women, complications during pregnancy . Therefore, the urinary tract should always be treated for a sufficiently long time and the result of the therapy checked.
How is the diagnosis made?
Any child with a fever above 38°C should have a urine test. In the presence of a urinary tract infection, multiplied leukocytes ( inflammatory cells ) and bacteria can often be demonstrated in the urine, sometimes also blood, nitrite ( nitrite ), proteins ( proteins ) and cell cylinders. Ideally, morning urine is tested. The external genital area should be clean before collecting the urine sample. If the child can be allowed to urinate into a cup, a medium stream of urine should be collected.
Sometimes it is necessary to squeeze the bladder. Therefore, a pain-relieving patch is stuck on the skin of the abdomen. If necessary, urine must be collected using a catheter . In swaddled babies, a urine collection bag is attached to the urethral outlet. Alternatively, imaging methods – ultrasound or X-ray – can be used to detect, for example, congenital anomalies and hydronephrosis (enlargement of the pelvis and calices of the kidney due to urinary retention ) in newborns . In infancy, urinary tract infection should be investigated by ultrasound.
How is the treatment?
As a rule, antibiotics are used , for bacterial urinary tract infection without fever for 5-7 days, for infections with fever for 10-14 days. In case of high fever and indisposition, the child should be treated in hospital and should receive nutrition intravenously.
Other supportive measures that may serve in part to prevent further urinary tract infections include, among others:
- drink a lot: more frequent urination contributes to better cleansing of the urinary tract;
- local application of heat: containers of warm water, warm chamomile baths;
- bed rest, especially during fever;
- spasm- relieving and pain-relieving drugs ;
- prevention of colds;
- avoiding incorrect ways of cleaning after stool: always wipe from front to back;
- if necessary, antibiotic prophylaxis for several months;
- regular inspections;
- in frequently recurring urinary tract infections without fever, it is important to identify the cause; in the case of other urinary tract anomalies, further examination and selection of procedures for their removal is necessary.
Cranberry products can also be used for recurrent urinary tract infections (more than 5 infections per year). However, their action is not scientifically supported
