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Urinary Health
UTIs in children

Urinary tract infections (UTIs) are the most common reason why children might need to see a urologist.  UTIs in children are caused when bacteria from the colon and rectal area enter the urethra, the tube that carries urine out of the body. UTIs happen when that bacteria then makes its way up into the bladder. Bacteria are normally present in the bowel, but in most cases, the flow of urine normally flushes out these bacteria. 

In this article, we will share some of the basics about UTIs in children. 

Symptoms of UTIs in Children

With young children, it can be difficult to determine if they have a UTI. In children, UTI symptoms may be different than in adults, and sometimes there are no symptoms. 

In children younger than 2 years old, the child may have a fever, which could be the only sign. The child may also be irritable, fussy, have a poor appetite, or be vomiting or have diarrhea. 

In children over 2 years old, if the child is potty trained, he or she may start having wetting accidents. The child may also have pain in the lower abdomen or back. Their urine may be cloudy, bloody, dark urine, or foul-smelling. They may also have fever, intense or frequent urges to urinate or pain or burning when urinating. 

How to Diagnose UTIs in Children

If your doctor suspects a UTI, he/she may order a urine test. For babies, your doctor may use a catheter to get a urine sample. Your doctor may also place a sterile bag around your child’s diaper area. 

For older children, parents can help get a clean catch urine sample. It’s important to follow the directions carefully.  Clean the skin surrounding the urine opening right before collecting the urine. Parents should wait for the child to start urinating, ask the child to stop briefly, and then start again.  Finally, they should collect this urine sample into the sterile collection container provided. 

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Causes of UTIs in Children

Girls are likely to get UTIs because the female urethra is shorter, so there is less of a barrier for the entry of bacteria into the urinary tract. Boys who are uncircumcised are at increased risk due to the bacteria that may colonize beneath the foreskin and enter the urethra. Children with dysfunctional voiding or vesicoureteral reflux are also more prone to UTIs. 

Dysfunctional voiding

Dysfunctional voiding is a condition marked by poor bladder emptying and is more common in girls. Urine that remains in the bladder can cause bacteria to grow and cause UTIs in children with dysfunctional voiding. 

Some children with dysfunctional voiding benefit from biofeedback, which may involve collecting information about your child’s habits and developing personalized techniques to improve urination habits. Your pediatric urologist can advise you about this. 

Constipation is a common reason for dysfunctional voiding. Large amounts of stool in the colon may press on the bladder making it hard for the child to fully empty the bladder. 

How to treat constipation in children

Children with constipation can see improvement with increased fluid and fiber intake. To increase fluid intake, have your child drink a glass of water with meals and keep in mind that soups, milk, juice and fruits and vegetables also contribute to fluid intake.

Here are the guidelines for fiber intake per day for children:

Age 1-319 grams19 grams
Age 4-825 grams25 grams
Age 9-1331 grams26 grams

Picky eaters usually don’t get enough fiber, but by making a few small changes in your child’s food selection you can increase fiber and help alleviate constipation.

  • Offer chickpeas, black beans or kidney beans mixed into dishes. One-half cup of most types of beans supplies 7 grams of fiber.
  • Raspberries have 4 grams of fiber in one-half cup. During the summer you can serve them fresh. When they are not in season, add plain, frozen berries to a smoothie or thaw them and add them on top of yogurt.
  • All types of vegetables and fruit contain fiber. If your child is a picky eater serve the produce they will eat.

Here are some other foods to include to increase fiber:

  • One medium pear has 5 ½ grams of fiber.
  • One-half cup of cooked whole wheat pasta has 3 grams of fiber.
  • One-half cup of Raisin Bran cereal has a little over 3 grams of fiber.

See a registered dietitian for more advice on making diet changes that will work for your child.

Vesicoureteral reflux (VUR)

VUR is a condition that causes the urine to reflux back up into the ureters towards the kidneys while the child is urinating. When urine flows backward, bacteria can grow more easily and lead to a UTI.

Most children with VUR have the type called primary VUR. This can be due to being born with abnormal ureter(s) causing the valve between the ureter and the bladder to not close properly. Most children will eventually outgrow this condition.

Secondary VUR can be caused by a blockage or narrowing in the bladder neck. It can also be caused by nerves in the bladder not working properly which keeps the bladder from relaxing and contracting normally to release urine.

Once your pediatric urologist determines the type and severity of VUR, he/she may consider various treatments including long-term, low-dose antibiotics to treat UTIs, injections, surgery or at-home catheterization. Although you may not be able to prevent VUR, some children see improvement from preventing constipation, consuming enough liquids and practicing good bathroom habits such as urinating regularly.

It can be helpful to increase your child’s fluid and fiber intake to help alleviate constipation that may cause a UTI. If your child has had one or more UTIs, see a pediatric urologist. Follow your doctor’s advice about how to treat the infection and, if necessary, the condition that may increase the risk for UTIs, such as VUR or dysfunctional voiding. 

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