Urinary Tract Infections

If your child does have a urinary tract infection, he will need treatment with an antibiotic for seven to fourteen days. More serious infections, especially if they are thought to involve the kidneys (pyelonephritis) may require hospitilization and intravenous antibiotics. Your doctor may obtain another urine sample in a few days to make sure the infection has been cleared, especially if your child is still having fever or other symptoms, or he may wait until the end of the antibiotic treatment.

Most children with urinary tract infections, especially if they are younger than five years old will need some testing done to make sure that they do not have urinary reflux, or vesicoureteral reflux (VUR). This is a condition that causes urine to move backwards from the bladder up to the kidneys. It is especially important to test children under 2-5 years old with a UTI and older children that have more than one infection. Up to 50% of children with a UTI may have reflux on further testing. The tests that are done include a sonogram (ultrasound) of the kidneys (to look for hydronephrosis) and another test called a VCUG (voiding cysto-urethrogram) that involves placing a catheter in to the bladder and then injecting a dye. X-rays are then taken to see if the dye moves up towards the kidney.

Vesicoureteral reflux is an important cause of renal scarring and reflux nephropathy, a type of kidney damage that can lead to hypertension and even kidney failure. Reflux may be mild (Grades I - III), or moderate to severe (Grades IV - V). Most cases of reflux will go away with time, especially the mild grades in younger children. More severe forms of reflux, or children who have a lot of UTIs may need surgery to correct the problem that is causing the reflux.

If your child has reflux, he will need to take a prophylactic antibiotic each day to prevent more urine infections (prophylaxis). Testing with a VCUG and sonogram is then repeated every six to twelve months until the reflux has cleared. It is important to test for and treat urinary reflux, because if it is undiagnosed and your child has repeated urinary tract infections, it can lead to kidney damage. Fortunately, most children with reflux will outgrow it without developing any trouble with their kidneys.

Reflux does seem to run in certain families, and if one of your children is found to have reflux, your doctor will consider testing your other children. About 40% of siblings of children with reflux also have reflux, even though they may never have had a urinary tract infection.

It is important to obtain a good urine sample when testing for a urinary tract infection. The skin has a lot of bacteria on it, and this bacteria can contaminate a urine specimen if it is not obtained properly. Older children who are potty trained should be able to perform a clean catch urine collection. If possible, you should try and collect the first voided urine specimen in the morning. You will need a leakproof sterile container to place the specimen in.

For boys, you should gently cleanse the tip of the penis with water and a wash cloth or paper towel. Next, have your child urinate into the toilet and then pass the sterile specimen cup into the stream. This is a midstream collection, and it is the ideal way to test for a urinary tract infection. Place the lid on the container, being sure not to touch or contaminate the inside of the cup.

For girls, you should spread the labia apart and gently cleanse the area with water and a wash cloth or paper towel. Next, have your child urinate into the toilet and then pass the sterile specimen cup into the stream, collecting a midstream urine specimen. Place the lid on the container, being sure not to touch or contaminate the inside of the cup. Some girls find it easier to collect a specimen by sitting backwards (reverse position) on the toilet

Once collected, the urine specimen should be tested as soon as possible. Ideally, the urine would have been collected in the doctor's office and would be available for immediate testing. If there is going to be a delay in testing the urine specimen, then you should refrigerate it or place it in a cooler with ice and arrange for testing as soon as possible.

Important disclaimer: The information on keepkidshealthy.com is for educational purposes only and should not be considered to be medical advice. It is not meant to replace the advice of the physician who cares for your child. All medical advice and information should be considered to be incomplete without a physical exam, which is not possible without a visit to your doctor.