A urinary tract infection (UTI) is an infection that occurs when germs get into the urinary system (the bladder and the kidneys). UTIs are fairly common in children and require prompt recognition, treatment and investigation for underlying problems in the urinary tract.

How did my child get a UTI?

A UTI is usually caused by germs from the stools (which can stay on the skin) that had gone into the urethra (the passage from which urine passed out from the bladder). A UTI can occur in any child and is not entirely the result of poor washing or inadequate changing of diapers.

It is important for a medical assessment to evaluate for underlying risk(s) that could have predispose your child to UTI. For example, an underlying problem with the urinary tract, abnormal bladder function or existing constipation.

Symptoms are usually non-specific in a young child. Fever trends to be the only resistant symptom among young children. In some infants, there may be a poor feeding, increased irritability, vomiting, diarrhoea and bad smelling urine.

In older children, the symptoms are more specific to the urinary tract. They may have pain or a burning sensation on urination, increased frequency of urination, having the urge to urinate even after emptying their bladders, lower abdominal pain and uncontrolled wetting. Pain over the lower back and fever may suggest a more serious infection.

​UTI is diagnosed by testing a specimen of urine for the presence of white blood cells and bacteria.

A fresh urine specimen obtained via clean catch should be collected, avoiding contamination as far as possible. This can be done by collecting the mid-stream of the urine as the child urinates after cleaning his/her private area well. For infants, it may be necessary to collect urine by passing a fine tube into the bladder through urethra or putting a small needle into the bladder through the wall of the abdomen.

Using adhesive bags to collect urine specimens are not reliable as they are often contaminated by germs from the skin.

Urine specimens are usually tested with a dipstick to look for white blood cells, which can provide a clue to the presence or absence of UTI. A final diagnosis of UTI can only be made by sending the urine to the laboratory for urine culture. The culture results may take 48 to 72 hours to be ready.

Antibiotics are used in the treatment of UTI. Oral antibiotics are used for older children who are generally well. For young infants and older children who are unwell, they are admitted to hospital for intravenous (injection) antibiotic treatment.

Intravenous antibiotics are then converted to oral antibiotics when the fever has settled for 24hrs with improvement of clinical condition. The choice of antibiotics is based on the urine culture results.

The whole course of treatment for UTI usually lasts 10 days. For young infants, antibiotics at a low dose once nightly (prophylactic or preventive antibiotics) may be continued till further tests are completed.

What happens after an episode of UTI

Children with UTI will require regular reviews with the doctor after discharge. Imaging studies of the urinary tract are also necessary to access if there are any underlying abnormalities. The tests may include an ultrasound of the urinary tract, a nuclear kidney scan (DMSA scan) and a micturating cyctourethrogram (MCU).

Care at Home

Remember to complete the full course of antibiotics after discharge. Some children may need to continue treatment with a small nightly dose of antibiotic to prevent recurrent UTI while waiting to have further tests done. This small dose of antibiotic is safe and will have no long-term adverse effect on the child’s health.

There is a possibility that the child might get another UTI even if the child is on a small dose of preventive antibiotic. If the child develops any symptom suggestive of UTI or is unwell with a fever with no other obvious cause, please bring the child to the doctor for a urine test.

Good hygiene practices, avoiding constipation, regular bladder emptying and adequate fluid intake are some measures that may help deter another UTI.

Most children make very good recovery after a UTI and have no further problems. In a very small group of patients, there may be kidney problems or high blood pressure, which required long-term monitoring and follow-up with the paediatrician.