Signs and Symptoms
Babies with a urinary tract infection tend to be fussy and often have vomiting and/or a fever. Older children may complain of pain when they urinate, have smelly urine, blood in the urine, lower belly pain, and/or may be needing to urinate more frequently. A previously potty-trained child may start wetting themselves or the bed at night. If the urinary tract infection has progressed to the kidneys the child often has a high fever, looks ill, may have back or side pain and/or vomiting.
What is happening in the body?
Large blood vessels carry blood to the kidneys. The kidneys are two bean shaped organs that sit against the back wall just above the pelvis on each side of the spine. Their job is to filter all the blood and pull out the substances your body doesn’t need and turn it into urine while keeping the fluid and nutrients your body does need. The kidneys play an important part in regulating blood pressure. The urine that is created in the kidneys travels from each kidney down to the bladder in tubes, called ureters. The urine is stored in the bladder until you urinate. As the bladder fills up, you get the urge to urinate. The urethra is the little tube that carries urine from the bladder out of the body. As children get older, they gain control of the muscle in the urethra, allowing them to hold their urine until they are ready to use the toilet.
This whole system is very clean. In fact, it’s not normal to have bacteria in the urinary tract. A urinary tract infection occurs when bacteria enters this system through the urethra and travels up to the bladder. Girls are more likely to get urinary tract infections because the urethra is shorter and bacteria has a shorter distance to travel than for boys. More severe infections occur when the bacteria travels all the way up the ureters into the kidneys. Sometimes there is something wrong with the shape of the ureters or kidneys that cause urine to back up into the kidneys. Urine sitting in the kidneys can increase the chance of recurrent and more severe urinary tract infections.
- For babies frequent diaper changes help.
- Avoid harsh soaps and bubble baths that can cause irritation of the urethra that can allow bacteria to travel up the urethra.
- Teach girls to wipe from front to back. When they wipe from back to front they are pulling the bacteria from the poo poo to the urethra, increasing the chance to get urinary tract infections.
- Drink plenty of water.
- Teach children to go to the toilet as soon as they get the urge to go.
Diagnosis and Treatment
It’s important to take your child to the doctor if you suspect she has a UTI:
- Blood in the urine or foul-smelling urine
- Potty trained child wetting themselves or the bed
- Complaints of abdominal pain, back pain, or pain with urinating
- For babies: Fussy, vomiting, or generally acting ill
The clinician will collect a urine specimen.
Ideally for babies we would collect a catheter specimen. Unfortunately, supplies are rarely available for this in Malawi. We can wipe the area very well and place a urine bag (if available). I have also put a cotton ball in the diaper. Once it’s wet, I remove the plunger off a 5 ml syringe and put the cotton ball inside. Then, I put the plunger back in and am able to squeeze out a small specimen. Once again, it’s not the ideal way to collect the specimen, but in a limited resource setting it works for me. I don’t use cotton ball specimens for urine cultures.
To help a potty-trained child collect a urine specimen ask them to start urinating, then put the cup under the stream. This way the bacteria on the skin, gets washed away from the urine and you get a clean catch.
A urinalysis is a simple test performed at even the most basic clinics that will show if there is a urinary tract infection.
Clean catch specimens can be sent to the lab to test for a urine culture and sensitivity (Urine C&S). The UNC lab is the only lab I know of in Lilongwe that performs urine cultures. For a urine culture the urine is put on a Petri dish in an environment that grows bacteria. After a couple of days, the lab will be able to report what type of bacteria is growing. Next, they will test different antibiotics on the growing bacteria to determine which antibiotics will effectively kill the bacteria. This is the sensitivity part of the test. It’s important to collect the urine culture before you have started antibiotics so that it doesn’t interfere with the results. For some reason, there is a lot of antibiotic resistance with UTI’s, so it is helpful to know which antibiotic is not resistant to the type of bacteria found in the urine.
Recurrent UTI’s require more diagnostic tests. Let your clinician know if your child has had many UTI’s.
UTI’s are treated with antibiotics. Usually your child will start an antibiotic based on the urinalysis, but it could be changed if the C&S indicates. More severe infections may require hospital admission and IV antibiotics.