The urinary tract is a system of various organs in which urine, one of the body's waste products, is produced, stored and removed from the body. Urine production takes place in the kidneys and is then transmitted by the ureters (urinary tube) to the bladder (urinary bladder), which is the organ where urine is stored. After waiting here for a certain period of time, it is excreted from the body through the urethra.

Briefly, the urinary tract consists of the following anatomical structures; kidney, renal pelvis, ureter, bladder (urinary bladder) and urethra.

 

Unlike adults, urinary tract infections (UTIs) in children are very important because they can cause permanent kidney damage.

‘Children with urinary tract infections have an underlying surgical problem until proven otherwise.’ This statement shows us the importance of this disease in children.

!!! Urinary tract infection should be investigated if there is fever in children whose cause cannot be found.

What is Urinary Tract Infection (UTI) in Children?

Normal urine produced by a healthy body is sterile and contains no bacteria. However, infection in one or more of the anatomical structures listed above for any reason is defined as Urinary Tract Infection (UTI).

What is the Incidence of UTI in Children?

Every year, 1.5% of newborns (first month of life) and 3.5% of children get urinary tract infections. While it is 2 times more common in boys in the newborn period, it is 10 times more common in girls in the 1-3 age group, with girls coming to the forefront after 6 months.

Can Urinary Tract Infection in Children be Classified?

Yes, it can be classified. It can be classified in different ways according to the characteristics of UTI.

Uncomplicated UTI; These are infections without any structural and functional pathology.

Complicated UTIs are infections with anatomical and physiological pathologies that prolong the duration of treatment or increase treatment failure. The two best examples of these in children are Vesico Ureteral Reflux and Neurogenic Bladder diseases.

Again anatomically;

• Lower urinary system (bladder) infection (cystitis)
• Upper urinary system (kidney and pelvis renalis) infection (pyelonephritis).

On the other hand, it can also be classified as acute, chronic and recurrent UTI.

What are the Symptoms of Urinary Tract Infection in Children?

Symptoms of urinary tract infection in teenagers and older children are often characteristic and include a feeling of severe urgency, frequent urge to urinate, difficulty urinating, pain and burning, frequent but small amounts of urine.

In some cases, pelvic pain (groin pain) may occur due to urinary tract infection. High fever, back pain, nausea and vomiting, diarrhoea can also rarely be seen among the symptoms of urinary tract infection and often indicate more serious infections that can also affect the kidneys.

However, it should be kept in mind that the clinical findings will vary in each age group since children aged 18 years and under, including newborns, are in this age group, and that it requires special knowledge and experience to differentiate UTI from other system (gastrointestinal, respiratory tract infections, etc.) infections under 2 years of age, especially in newborns, because clinical findings and symptoms may be the same.

Clinical findings in children according to age are summarised in the table below.

Symptoms of Urinary Tract Infection in Children

In addition, the nomenclature of these clinical symptoms is also important for diagnosis and treatment. These include

• Pain during urination (dysuria)
• Frequent urination (pollacuria)
• Inability to start urine flow
• Sudden need to urinate (Urgency)
• Blood in urine (haematuria)

Where is urinary tract infection usually transmitted?

The microorganism responsible for urinary tract infections is known as Escherichia Coli (E. Coli), which is often found in the normal flora of the digestive tract. Various bacteria other than E. Coli can also cause urinary tract infections. These bacteria can be listed in order of frequency as Klebsiella, Proteus, Enterobacter. Many of these organisms are also naturally present in the intestines, reproductive organs and skin of children.

What are the Causes of Urinary Tract Infection in Children?

Main causes of UTI in children;

• Constipation
• Holding urine for too long
• vesicoureteral reflux (VUR)
• Causes of urinary obstruction; Posterior Urethral Valve, Uretero Vesico Stenosis etc.
• Foreskin
• Labial Fusion
• Urinary system stones
• Neurogenic bladder
• Foreign body in the urinary system; long-term catheter and catheter insertion

What Should be Considered to Prevent Urinary Tract Infection?

• Children should be taught the habit of drinking enough water.
• Babies should not be taught to urinate before the age of 2.5 and pressure should never be applied during training.
• Children should be taught correct genital area hygiene.
• Children should be taught the habit of urinating regularly and urine should be prevented from staying in the bladder for a long time.
• Especially girls should not wear tight pants and cotton panties should be preferred.
• Boys should be circumcised as early as possible.
• Children should wash their hands before and after using the toilet.
• In kindergartens and primary schools, children should wear clothes that are easy to put on and take off, otherwise children will have to hold the toilet at school.
• Likewise, in kindergartens and schools, the size of the toilets should be suitable for children, the number should be sufficient and they should be clean.

Why UTIs are so Important in Children?

Unfortunately, urinary tract infections are the most important cause of kidney failure in childhood in our country as in developing countries. Therefore, even if a baby or child has UTI even once, the underlying cause must be investigated.

It is very important as it can cause permanent kidney damage. A urinary tract infection must be excluded, especially in children with fever of unknown origin. In children with urinary tract infections, vesicoureteral reflux (VUR, urine backflow to the kidney) (see our article on vesicoureteral reflux disease) is an important cause that should not be missed as it can cause recurrent infections.

Obstructions in the urinary tract, urinary stones, and especially voiding disorders and constipation in older children can cause UTI. These children mostly present with frequent urination, sudden feeling of urgency, urinary incontinence and urinary tract infection. In the majority of patients with voiding dysfunction, residual urine remaining in the bladder prepares the environment for UTI. In 1/3 of these children, there is back leakage of urine. In this group of children, tests such as voiding diary and uroflow (voiding flow test) are requested.

How is Urinary Tract Infection Diagnosed in Children?

Urinalysis and urine culture are performed to detect urinary tract infection. It is important how the urine sample is taken in children. In infants, it is possible to get contamination from the environment in the growths taken with a bag. If necessary, more reliable results are obtained by taking a sample directly from the bladder with a catheter.

In children with urinary tract infections, urinary system ultrasonography is performed to evaluate whether there is a structural problem, stones, enlargement of the urinary tract and the structure of the bladder. In patients deemed necessary, kidney scintigraphy and voiding cystography (medicated-after-medication urinary tract film) can be performed for further evaluation.

How to Obtain a Urine Sample in Infants?

Children who come to the doctor with symptoms or signs of UTI are diagnosed by urinalysis and urine culture. For this, the correct urine sample must first be collected. In older children who have completed toilet training, the correct urine sample is obtained by collecting midstream urine after cleaning the perineum.

In young children and infants who have no urine control, the sample for urinalysis is taken with urine bags.

 

For this purpose, after the genital area has been properly cleaned, the urine bag is attached to the genital area. If the baby does not urinate, it is appropriate to clean again every 30 minutes and attach a new bag. The urine should be taken to the laboratory as soon as possible (30 minutes).

It should be kept in mind that urine bags are not sterile and germs can easily be transferred from the genital area to the urine bag, which may cause erroneous results.

Instead, if culture is required in young children and infants who have not yet developed urinary control, a urine sample should be obtained by entering the urinary bladder with a urinary catheter or by entering the urinary bladder from the groin area with a syringe.

 

Taking urine cultures with these two methods is extremely important in terms of preventing both misdiagnosis and treatment and unnecessary further examinations. Both methods do not have any harmful effects on the baby.

However, since urine collection with catheter and suprapubic puncture is traumatic, urine should first be collected with a bag. If there is no growth here, we can be sure that there is no urinary tract infection. If there is growth, the result must be confirmed with a urine sample obtained with a urinary catheter or puncture.

What is the Treatment of Urinary Tract Infection in Children?

The treatment approach varies depending on the child's symptoms, age and general health status. The degree of infection, the presence of structural anomalies such as VUR, and response to medication are among the factors that can change the treatment approach. Especially in newborn babies and children, urinary tract infections can be life-threatening and usually require hospitalization. Although the main treatment for urinary tract infections is antibiotic therapy, a specialist physician should determine the most appropriate treatment approach and post-treatment care plan specific to the patient.

At what age does the infection affect children?

Infections can affect children of all ages. From newborn babies to adolescents, children can be exposed to various infections depending on their age and the strength of their immune system. Babies and young children in particular can be more susceptible to infections because their immune systems are not yet fully developed.

Can Urinary Tract Infection Recur?

Yes, urinary tract infections can recur. Urinary tract infections are caused by bacteria entering the urinary tract and these bacteria can cause reinfection. They recur more frequently, especially when there are underlying anatomical or physiological pathologies.

Which Departments Follow Pediatric Urinary Tract Infections?

Urinary tract infections in children are followed and treated by Pediatric Health and Diseases Specialist (Pediatrics Specialist), Pediatric Surgery Specialist, Pediatric Urology Specialists.

*** The information provided here, the content of the website is organized for the purpose of informing the visitor. No information should be considered as advice by visitors and should not lead to any decision or action. Families related to the subject should have their patient examined by a pediatric surgery specialist, consult with him/her and make a decision by consulting his/her one-on-one information.