Toddlers and Urinary Tract Infections
According to the American Academy of Pediatrics, urinary tract infections (UTIs) are a common childhood problem. A UTI is an infection of the urinary tract caused by bacteria. They can frequently occur in toddlers for a variety of reasons. There are certain symptoms of urinary tract infections in toddlers to be aware of. Typically, bacteria are flushed out of the body during urination. In some cases, bacteria may get caught in a part of the urinary tract and multiply.
The Urinary Tract
Composed of two sections, the urinary tract allows urine to exit the body. The first section is the upper urinary tract, which includes the ureters and the kidneys. The ureters are fragile tube-like structures that connect the kidneys to the bladder.
The second section is the lower tract. The lower tract consists of the bladder and the urethra. The urethra is what funnels urine from the bladder to the outside of the body. Almost all UTIs are caused by bacteria that come from outside the body and enter through the urethra. Then, the bacteria multiply and travel upward through the urinary tract.
What Are the Symptoms of Urinary Tract Infections in Toddlers?
The symptoms of urinary tract infections in toddlers can be different for each child. Often, toddlers are not able to articulate their problems well. So, parents need to be on the lookout for the following symptoms:
- Pain when urinating (dysuria)
- Having to urinate often
- Feeling the urge to urinate often
- Loss of urinary control (bedwetting, urinating in their clothes)
- Low fever
- Cloudy or dark urine
- Abdominal tenderness or pain
- Foul-smelling urine
For the following symptoms, seek immediate contact with a healthcare provider:
- High fever
- Side or back pain (flank pain)
- Blood in urine
For toddlers, the most common UTI symptoms are fever, vomiting, diarrhea, abdominal pain, or foul-smelling urine.
Causes and Risk Factors for UTIs in Toddlers
Constipation may also lead to UTIs. When stool accumulates within the body, it can block the normal flow of urine within the body. The disturbance in flow can trap bacteria, leading to the development of a UTI. When a toddler holds in their urine instead of going to the potty, frequent dehydration and prolonged urine retention can lead to a UTI.
In very young toddlers, it is typically males who frequently become infected with UTIs. Uncircumcised male infants are at an increased risk for these types of infections. However, in older toddlers, females are more often infected with UTIs. Females have a shorter urethra than males, making them more susceptible to bacterial infections in the urinary tract.
Premature toddlers are also more prone to UTIs because of delays in their internal development. Several congenital urinary tract abnormalities may occur, which can increase the chances of urinary infections.
For very young infants who develop a UTI, the cause is typically a structural abnormality within the urinary tract. An abnormality of the ureters, or any condition that can change urine flow, may cause a UTI. In about 50% of newborns and 30% of toddlers who have a UTI, a urinary tract abnormality is typically found as the cause.
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How Are UTIs Diagnosed?
Urinalysis and Urine Culture
To diagnose a urine infection, healthcare professionals often do a urinalysis. A urinalysis requires a toddler to urinate into a jar or cup. The urine sample is tested for bacteria. A UTI diagnosis is obtained depending on the symptoms a toddler may have, plus the presence of a specific amount of bacteria.
A urinalysis depends on obtaining a "clean" amount of urine. Toddlers need help from their parents to get urine that does not have any germs or substances that might be on a toddler's skin. Contamination of the urine may affect the results of a urinalysis, so a clean urine sample is essential.
A healthcare professional may also decide to obtain a urine culture, using a urine sample from the urinalysis, to see what types of bacteria are involved in the infection. Knowing the type of bacteria can help determine the most appropriate treatment for your toddler.
Imaging tests may be necessary to find the cause or extent of your toddler's infection. An imaging test can show any abnormalities of the urinary tract or display any kidney damage. Imaging tests are painless, though they can be frightening for toddlers. Typically, a toddler will lie on a table and a wand (transducer) is waved over the toddler's abdomen and back. No medication or anesthesia is necessary for these tests.
Your healthcare professional may choose to request an ultrasound if your toddler is younger than the age of 2, has an infected bladder, and a fever. Toddlers who have recurring UTIs, high blood pressure, slow growth, or are not responding to medical treatment may also require an ultrasound. An ultrasound utilizes soundwaves to check for structural abnormalities or scarring.
A voiding cystourethrogram (VCUG) involves x-rays of the urinary tract to follow how urine flows. A special dye is used to identify and display the flow of urine. An x-ray is obtained before and after a toddler urinates. A VCUG helps find any abnormal flow of urine within the bladder, ureter, or kidneys.
What Are the Treatment Options?
The treatment for a UTI includes antibiotic treatment. The most common antibiotics used for a UTI are amoxicillin, cephalosporins, or nitrofurantoin. Most cases of UTI can be treated at home, with a cycle of antibiotics and pain medication. If the antibiotics do not seem to be working, or pain and fevers persist, parents should call their pediatrician for further instructions. Very rarely, hospitalization or surgery may be required.
UTI Complication: Kidney Infection
Almost 50% of toddlers with a fever and a UTI typically have infections of both the bladder and the kidney. Kidney infections, especially if the infections are recurring, may lead to scarring of the kidneys. Scarring of kidney tissue can lead to blood pressure problems and impair their kidney function later in life. A toddler with a kidney infection, also called pyelonephritis, may display a high fever, fatigue, pain in their lower back or sides, and chills. Kidney infections can be treated with antibiotics and pain medication. Though not often, hospitalization for treatment may be required.
Preventing UTIs in Toddlers
In some cases, as in abnormalities within the urinary tract, a UTI can not be prevented. However, parents and children can take the following precautions to avoid having a UTI.
Although drinking liquids often leads to more potty visits, it is a good thing! Staying hydrated helps to dilute urine, keeping it from accumulating too much bacteria. Hydration also flushes the urinary tract frequently, keeping the system clean. Drinking an adequate amount of liquids also prevents constipation, one of the common causes of UTIs.
Avoid Tight Clothing
Tight clothing can prevent air circulation, especially during warm summer months. Tight and form-fitting clothing can provide the right environment for bacteria to grow because moisture occurs. Change clothing as soon as possible if a toddler wets their pants and do not allow them to sit in damp clothing.
Proper Potty Habits
Teach toddlers not to hold their urine. Often, toddlers may be shy or afraid to ask to use the restroom. More likely, they probably do not wish to take time away from their fun playtime to use the bathroom. Take children to the toilet often, even if they say no. More likely than not, they will have to urinate.
Toddlers and young children should empty their bladders often, about every two to three hours. Their bladders are small and still developing, and they consume a large amount of liquids. Keeping urine in their bladders only gives bacteria the chance to multiply, leading to infections.
Clean wiping habits are valuable for everyone, especially for toddlers. They're often in a rush and do not understand how germs work. Remind toddlers not to reuse toilet paper, especially if they are wiping feces. Toilet paper used to wipe their bottom should not be used to wipe the area their urine exits (urethra). Remember to always wipe from front to back.
Teaching children good potty habits early in their development can lead to lifelong prevention of urinary tract infections.