Monsoon surely relieves us from the scorching summers, but it also brings along several infections. Urinary Tract Infection in children is one of them. Dr Premila Paul tells you the symptoms to look out for
The Urinary tract infection(UTI) is the third most common infection in children after respiratory and gastrointestinal infections in India. Urinary tract is defined as infection in any part of the urinary system from kidneys, ureters, bladder and urethra. During the first year of life, the boys are affected three times more than girls, but beyond that girls are affected almost 10 times more. The prevalence of infection is five-seven per cent in children from two-24 months (AAP).When it affects the lower urinary tract it is a bladder infection (cystitis) and when it affects the upper urinary tract it is infection of the kidney (pyelonephritis)
Symptoms of a lower tract (urethra and bladder) infection include urgency, increased frequency, pain and burning with urination. Child may complaint of pain below or around belly button. Urine may smell foul or has blood in it. If upper tract is involved child generally looks sicker with significant fever and pain in the loin area. Urine may have blood sometimes. In the young infants, symptoms may be non-specific like feeling low, persistent diarrhea, vomiting and failure to thrive. Common terms used in UTI; Bacteriuria indicates presence of bacteria in urine which may be harmless. Infection is defined by the presence of harmful bacteria in urinary tract causing symptoms. Cystitis denotes infection of urinary bladder (Commonest). Pyelonephritis occurs when infection travels up to kidneys (Concerning)
Human urinary tract has some unique natural mechanism to prevent entry of microorganisms in the tract. UTIs are much more common in girls because their urethra is shorter and closer to the anus and Bacteria find easy access in the urethra. Cleaning diapers with direction from anus to front area adds to increased chances of infections. Other predisposing factors can be, chronic constipation, poor local hygiene and toilet training, children with wet diapers for long duration and holding urine for too long.
Poor intake of liquids making urine concentrated adds to the stasis of urine in bladder. Uncircumcised boys younger than 1 year have been noticed with higher incidence of UTI. Besides this one must try to find out any malformations and obstructions of the urinary tract, Indwelling urinary catheters (for some otherillnesses) High-grade vesicoureteral reflux (a type of defect where a part of urine travels in upward direction to involve kidneys)any many more for paediatricians to look forNeonates and young infants must be worked up for sepsis to avoid complications.
Escherichia coli infections are commonest (85-90 per cent) followed by klebsiella and proteus spp , staphylococcus and some others
Common investigations include a good urine analysis and for that collection of urine sample is of utmost importance. The clean catch method aims to prevent bacterial contamination from the skin around urinary orifice.
Preparation before collecting the sample: Cleansing the area around the urinary opening requires a simple wash, no antiseptics required. Clean your hands with soap and water. Open the sterile container and hold the cover in hand, do not keep it on any surface (another person can help do this job), hold the girl child little high with thighs bend toward abdomen. When child starts peeing let it go and collect second part in the sterile container and put the cap immediately on the container. A boy can pass urine in standing position, rest of the precautions are same.
Never collect urine in a container and then poured in sterile container provided for urine collection. Transport the sample to laboratoryimmediately. Other methods of collecting clean sample is by catheterization or suprapubic aspiration which can be done by trained personnel only. Early morning sample preferred but may not always be possible in a toddler.Other investigations like ultrasound, MCUG and nuclear scans will be decided by the treating paediatrician.
The paediatrics academies recommend that a well-appearing infant two-24 months of age with a UTI, good follow-up can be managed as an outpatient with oral antibiotics for seven to 14 days. A cephalosporin, such as first-generation cephalexin, is a reasonable first-line medicine. A sicker child with high fever and other constitutional symptoms requires admission and more elaborate work up.
How to prevent UTIs?
Change baby’s diapers frequently, keep the toddlers dry especially in damp seasons,start early toilet training, teach her good bathroom habits,and wipe girls from front to back. Advise children not to hold urine. Avoid bubble baths for girls, use cotton inner wears for good air circulation.
Advise to drink lots of water, take appropriate measure to treat constipation
Antibiotic prophylaxis should never be self-administered and given only when prescribed by treating doctor.
UTIs are easy to diagnose and treat, but it is important to catch them early if taken lightly and under diagnosed or left untreated there can be serious kidney damage
The writer is Senior consultant, Department of Pediatrics, Madhukar Rainbow Children's Hospital, New Delhi