Urinary Tract Infection

What is it?

The "urinary tract" is the system the body uses for getting rid of liquid waste. It begins with the kidneys, which filter waste from the blood. It ends with the "urethra," the tube that passes urine out of the body. When doctors speak of a "urinary tract infection," or "UTI," they usually mean only an infection of the lower parts of this system. Those are the bladder and the urethra. Most people who are not doctors refer to this kind of an infection as a "bladder infection," which is a good way of describing it. UTIs are usually only uncomfortable. They usually get better quickly with treatment. Infections of the upper parts of the urinary tract, especially the kidneys, are much more serious. Doctors treat UTIs seriously in order to prevent them from spreading upward towards the kidneys.

People with UTIs have different symptoms depending on their age and sex. UTIs are much more common in girls and women than in boys and men. Most adult women have had at least one UTI. They are usually familiar with the symptoms: stinging or burning during urination, often with lower abdominal pain that is worse while urinating. Sometimes a person with a UTI also feels "urgency," as if they have to get to a bathroom quickly or they might loose urine. They also often have "frequency." That means that they seem to have to urinate all the time, even when there’s only a little urine. The combination of germs and infection-fighting cells in the urine often makes it look cloudy and sometimes dark. Infected urine also often has a strong or unpleasant smell.

School age and pre-school children may also complain of burning or stinging with urination. Sometimes, especially if they are shy about talking about bathroom things, they may not complain of pain. Often, younger children just seem to need to use the bathroom frequently when they have a UTI. They also very often complain of having abdominal pain. Occasionally a UTI will cause a younger child to have an "accident," which can be very embarrassing for them. In fact, if a toilet-trained child suddenly starts having "accidents" during the daytime, one of the first things doctors think of is a UTI.

In toddlers and babies, who can’t complain in words, a UTI can be very hard to recognize. At these younger ages, children may only seem fussy, or may cry during urination. They may feed poorly, or have vomiting or increased "spitting up." Often parents will notice a different smell to the urine when changing the diaper. If the infection continues for long, the baby may begin to run a fever.

In adults, teens, and older children, the biggest concern is to kill the germs that cause the infection, and to make the person more comfortable. Older children and adults normally have strong immune systems. They are not very likely to get a more serious infection if they get prompt treatment. Babies and toddlers, and especially newborns, don’t have as strong an immune system as older children and adults. This means that a simple UTI can also cause them to have fever, to be fussy or irritable, and to have other symptoms like vomiting and diarrhea. A UTI in a baby can also spread fairly quickly up to the kidneys, and can even cause blood poisoning, or "sepsis." For these reasons, doctors often do more tests in babies than they do in older children or adults. Most doctors do both urine and blood tests if they are worried about a serious infection in a baby. Sometimes doctors will admit a baby to the hospital if there is any concern about a serious infection.

A special concern arises the first time any child has a urinary tract infection, regardless of the age. With any first-time UTI, doctors want to be sure that the urinary tract itself is normal. They want to be sure that there are no hidden birth defects that would make the child prone to having infections, or to having kidney damage. Doctors usually do special x-rays, ultrasound, and other "imaging" tests soon after a child’s first UTI.

The most important treatment for a UTI is an antibiotic to kill the germs. When doctors are reasonably certain that a person is having symptoms of a UTI, they will usually prescribe an oral antibiotic right away. In some cases, if the diagnosis is less clear, doctors may prefer to do a urine culture first. It will take a day or two to confirm the infection and identify the germ. This can help prevent unnecessary treatment. Doctors usually do this only if the symptoms are not severe, and if the patient is not a very young child or an infant. In teens and adults some doctors prescribe treatment for a very short period, sometimes even for only 1 – 3 days. In younger children, infants, and anyone with a first-time UTI, the treatment course is usually longer, for 5 – 10 days. Regardless of how long your doctor chooses to treat your child’s infection, please be sure to give the medicine for every dose and for the whole length of time. This is especially important in UTIs, because children who get one UTI often get another. It is important to prevent the germs from becoming resistant to antibiotics, in case your child needs the medicine again. One way to do this is to give the whole prescription exactly as written. Please read our Aftercare Instruction on Giving Oral Medications.

Toddlers and younger children often become afraid of urinating during a UTI because it hurts. This can cause them to retain urine, which will make them even more uncomfortable. If that happens to your child, you might try having him or her sit in a warm bath and try to "pee" right there in the water. You can wash your child off and just clean out the tub afterwards (even infected urine isn’t dangerous in the face of soap and water).

In older children and teens, doctors often prescribe a medicine called phenazopyridine (fen-az-oh-peer-i-deen, Pyridium® and others) to help control the stinging, burning, and urgency. This drug works very well as an anesthetic drug, which means it helps kill pain. It does not kill germs, and will not make the infection go away. If your doctor prescribes it, please be certain that your teen or child also takes all of the antibiotic. This medicine makes urine turn a reddish orange color. This is a harmless change, but your child or teen should be prepared for it. The drug can also stain soft contact lenses the same color, so it is smart to choose not to use soft contacts during treatment with this drug.

You can also give your child acetaminophen (Tylenol®) or ibuprofen (Advil® or Motrin®) as directed for up to 72 hours to help relieve the pain and discomfort of a UTI.

For many years people have recommended cranberry juice both for treatment and for prevention of UTIs. The scientific evidence suggests that cranberry juice may help prevent UTIs in adult women. There is no strong evidence that it helps in either treatment or prevention of UTIs in children. On the other hand, there are many good things about cranberry (and other fruit juices). If your child likes cranberry juice, there is certainly no harm in giving it. It is also a good idea in general to increase the amount of liquid your child drinks while s/he has a UTI. This helps to get rid of the infected urine faster.

Most UTIs clear up easily within a few days of starting antibiotics. Of course, as with any infection, younger children and those with weakened immune systems can get more seriously ill than otherwise healthy children. Here are some things to watch out for:

• Fever – any fever over 100.4 °F or 38.0 °C in a baby less than 3 months old is a reason to call the doctor, no matter what other symptoms the baby has. Between 3 months and 3 years of age, most doctors would like you to call if your baby or toddler has a temperature over about 102.4 °F or 39.0 °C, or if s/he has any of the other things in this list.
• No improvement in symptoms (such as pain with urination, or frequency) after 48 hours of antibiotic treatment.
• Complaint of back pain or worsening abdominal pain.
• Vomiting that gets worse rather than better.
• Diarrhea
• Inability to take at least fluids by mouth.
• Decrease in the amount of urine.
• Pus or blood or any other drainage from the penis or vagina.
• Shaking chills that last more than about 10 minutes.
• Extreme fussiness or irritability, or lethargy (hard to wake up) in an infant.

All infants and children should have an evaluation by their doctors within a few weeks after their first-ever UTI. This is because a UTI can be the first and often only sign that there is an abnormality in the urinary tract that could cause a problem later. Most of the problems that turn up on these tests are minor. Many don’t need treatment, or have easy solutions. A few of the problems can lead to long-term disability, including possibly kidney failure. Please be sure you and your doctor have a chance to discuss these questions soon after your child feels better. Some doctors prefer to do at least part of the evaluation while the child still has the infection. Boys get urinary tract infections after the age of six months very rarely. Doctors usually want to do a very thorough evaluation in boys over six months who get a UTI. On the other hand, teenage girls with a first-time UTI are unlikely to have a major abnormality in their urinary tract. Many doctors do not feel that these teens need the complete evaluation.

There is some scientific evidence that the germs that cause UTIs attach to some people’s bodies more easily than others. This could explain why some children just seem to get frequent UTIs. Doctors often recommend that children with frequent or recurrent UTIs take a regular dose of an antibiotic to prevent the infection. If your doctor feels that is necessary for your child s/he will be sure to explain both the pros and the cons to you carefully. S/he will want to re-evaluate your child every 6 – 12 months to see whether the treatment needs to continue.

There are several things that you and your child can do to help prevent UTIs if she seems to get them frequently:

• You can teach good toilet hygiene, wiping only from front to back, never back and forth or back to front.
• You can make sure she drinks plenty of fluids all the time, to keep a good strong flow of urine.
• You can help her remember to use the bathroom when she first notices that she needs to go. This can help avoid retaining urine for a long time in the bladder.
• You can avoid underwear made from synthetic materials like rayon and others, and use only cotton. Cotton is much better at absorbing moisture, which can prevent the germs from growing.
• You can avoid bubble baths, which can disturb the lining of the vagina and urethra, and create irritation.

Children and teens can have many of the symptoms of a UTI when they have irritation of their urethra, the tube that carries urine from the bladder out of their body. This tube is very short in girls. This is probably one reason that girls tend to get UTIs more often than boys. Girls, especially around the time of toilet training, often tend to wipe themselves a little too hard in an effort to be clean. This can cause irritation of the urethra. They might also tend to wipe from back to front, which can bring germs from their stool into the area. This can cause inflammation of the vagina. This is called "vaginitis," which also can cause stinging or burning with urination. Please see our Aftercare Instruction on Vaginitis. School-age boys are often curious about their penises, and it is not unusual for them to poke at their urethras, which can also cause some inflammation. This is not the same as masturbation, and is not a cause for concern unless it happens frequently. If you think your child has done this, it is best simply to say that you think it would be better if he didn’t do it, rather than becoming visibly upset. Chances are it won’t happen again.

Finally, though we never like to think about it, there are sadly times when older children or adults touch children in ways that are wrong. Sometimes children who are being, or have been, sexually abused will develop symptoms of a UTI, urethral irritation, or vaginitis. If you are worried that this might be happening to your child, first let him or her know that s/he is safe with you. Let your child know that s/he can talk with you if someone is hurting him or her. Then please make an urgent appointment with your doctor to talk about it. Please try not to pressure your child to talk about it, though. That can feel to your child as if you are angry with him or her. Your doctor will be able to put you in touch with a team of experts who can talk with you and your child and can get the important information as gently and respectfully as possible.

Having a sick child at home can be tiring and frustrating. As badly as you feel for your child, you yourself may feel out of control, inadequate, or even angry – these are normal feelings. Babies and children who are sick are often fussy and irritable, and parents often feel stressed to the breaking point, especially when there are other children or adults to take care of. One of the best things you can do for your child is to be sure you take care of yourself. If possible, try to have other adults take care of your child for an hour or two each day so you can get some rest or just some quiet time. If you get so stressed that you are worried about your child’s safety, call your local Parents’ Anonymous Hotline or visit the Parents Anonymous website to find a group near you.