Children’s health: Urinary tract infections

Urinary tract infections (UTIs) are fairly common in children, particularly in girls. But while they may make your little one feel under the weather, they’re usually easily treated.
 
Experts from the National Institute for Health and Care Excellence (NICE) say around one in 10 girls and one in 30 boys in the UK will have had a UTI by the time they reach their 16th birthday (i). Younger girls and boys are affected more equally, with 2.1 per cent of girls and 2.2 per cent of boys having a UTI before the age of two years. UTIs are also more common in white children than black children.
 
Depending on your child’s age, however, a urinary tract infection may not be easy to spot. Knowing what to look for means they could get the treatment they need quicker, which could help prevent any discomfort they’re experiencing as well as reduce the likelihood of their developing any long-term problems, such as damage to their kidneys.
 
The good news is that in most cases, where a UTI is diagnosed and treated, infections usually clear quickly and children make a full recovery.
 

What is a urinary tract infection?    

 
Often simply called a urine infection a UTI is caused by bacteria getting into the urine, which can cause an infection in one of the various parts that make up the urinary tract:
 

1. The kidneys: most people have two kidneys found on each side deep within the abdomen. The kidneys filter the blood, removing toxins and turning waste materials into urine (each kidney produces between one to one and a half litres of urine each day, with a pair filtering 200 litres of fluid between them every 24 hours (ii)).

2. The ureters, which are tubes that carry urine from the kidneys into the bladder.

3. The bladder (this is where urine is stored until it is passed out of the body during urination).

4. The urethra: this is the tube that carries urine from the bladder out of the body during urination.

 
If the infection affects the kidneys or the ureters, it’s classed as an upper UTI. Another word for a kidney infection is pyelonephritis. If your child has a kidney infection it needs to  be diagnosed and treated as quickly as possible otherwise it can lead to kidney damage, especially in younger children.
 
A lower UTI, on the other hand, is an infection of the bladder – also called cystitis – or an infection of the urethra. Children and adults can also develop asymptomatic bacteriuria, which is when bacteria are growing in their urine but they have no symptoms other than smelly or cloudy urine. This isn’t harmful and doesn’t lead to kidney problems, so it doesn’t usually need any treatment.
 
While UTIs are common in children and most aren’t serious, it’s still important to get them treated. So if you think your child may have a UTI, get in touch with their GP as soon as possible.
 

What are the symptoms of urinary tract infections in children?    

 
The problem with UTIs in children is that they can be quite vague and are often difficult to spot, especially in very young children and babies who can’t communicate how they feel.
 
Here are the most common symptoms to look out for:
 

• General appearance of being tired, irritable and unwell

• Poor sleep, restlessness

• High temperature (fever) [LINK TO ARTICLE ON CHILDREN’S HEALTH: FEVER WHEN PUBLISHED]

• Vomiting

• Lack of appetite, going off their feeds

• Unpleasant smelling or cloudy urine

• Blood in their urine

• Changes in their normal toilet habits (wetting the bed, for example, or having daytime accidents in children who are toilet trained)

• Unwillingness to urinate

 
Some of these symptoms can be signs of other conditions. But if your child is unwell and has a high temperature with no obvious cause, their doctor will usually check for a UTI so that it can be either confirmed or ruled out. However if your child is older they may be able to tell you about some of their symptoms themselves, such as:
 

• Pain, burning or a stinging sensation when they pass urine

• An urge to suddenly urinate or to urinate more frequently, with just small amounts or no urine produced

• Abdominal or lower back pain, or a pain in their side

 

What causes UTIs in children?

 
In the majority of cases, UTIs in children are caused by bacteria from the bowel getting into the urethra. This can happen after a child goes to the toilet and passes a stool: if any bacteria are left around the anus (back passage), they can travel from the anus to the urethra and into the bladder and possibly also the kidneys (this explains why girls are more likely to develop UTIs than boys, as their urethras are closer to their anuses).
 
In babies, for instance, tiny particles of stool can transfer from their nappies to their urethra, especially if they tend to move around a lot while having their nappies changed. Some of these bacteria then multiply quickly in urine, causing an infection. The bacteria that cause UTIs in children include:
 

• E.coli (this is thought to cause up to 90 per cent of cases of UTIs in children (iii))

• Proteus mirabilis

• Staphylococcus saprophyticus

• Klebsiella aerogenes

• Enterococcus species

 
Doctors still don’t know why some children develop UTIs while others don’t, but they do know there are certain things that may make some children more susceptible. This includes not emptying their bladder completely during urination, causing residual urine. Some of the things that can cause residual urine include:
 

• Constipation (this can put pressure on the bladder, which means a child may fail to empty theirs fully when they go to the toilet)

• Dysfunction elimination syndrome (when a child doesn’t urinate when they need to but deliberately holds it in – this is a relatively common childhood complaint)

• Neurological or spinal disorders that affect bladder emptying or bladder sensation – though these are rare in children

 
Some children are also born with a structural problem that affects their urinary tract, which  increases their risk of developing UTIs because it stops urine flowing normally. These abnormalities aren’t common, with the best-known example being a condition called vesicoureteric reflux. This is when there’s a problem with the valves in the ureters where they enter the bladder, making urine leak back up the ureters and the kidneys from the bladder. According to NICE, approximately 25 per cent of children under the age of six having their first UTI have vesicoureteric reflux, with the condition affecting around one to three per cent of the general population (iv).
 
Other conditions that can increase the risk of UTIs in children include having diabetes or a weakened immune system (children having chemotherapy, for instance, may have a poorly functioning immune system).
 

Are there any complications?

 
While there are some potential serious complications of UTIs in children, they are quite rare:
 
Kidney scarring/damage   This is more common in children who have vesicoureteric reflux. However, not all cases of upper UTIs cause kidney scarring.
 
High blood pressure   There is a small risk of a child with UTIs developing high blood pressure later in life, but it usually only affects those who develop severe kidney scarring.
 
Pre-eclampsia   Women who have kidney scarring as a result of having UTIs in childhood may have an increased risk of pre-eclampsia as well as high blood pressure during pregnancy.
 
Kidney failure   Children who have UTIs may have a very small increased risk of kidney failure both during childhood and early adulthood.
 
Children who have a UTI may also have a higher risk of recurrent infections – according to NICE, 78 per cent of girls and 71 per cent of boys who have a UTI before their first birthday are more likely to have further infections. Meanwhile 45 per cent of girls and 39 per cent of boys who have a UTI when they’re one year or older have recurrent infections (iv).
 

1. NICE defines recurrent UTIs as (v):

2. Two or more episodes of kidney or upper urinary tract infection

3. One episode of kidney or upper urinary tract infection plus one episode of cystitis or lower urinary tract infection

4. Three or more episodes of cystitis/lower urinary tract infection

 
Girls are more likely than boys to have recurrent UTIs, plus they tend to have more recurrences as they get older. Children with vesicoureteric reflux also have a higher risk of having recurrent UTIs than others, and can sometimes be prescribed low-dose antibiotics in the long term to help prevent further infections. Children who have repeated UTIs but haven’t been diagnosed with urinary tract problems such as vesicoureteric reflux may need tests to check for urinary tract abnormalities.
 
 

How do you know if a child has a UTI?

 
If your child has a suspected UTI, their GP will need a sample of their urine to confirm it. Urine can be tested for bacteria as well as the effects of infection in the urine. However, it’s not always easy for parents to collect a usable urine sample, especially from babies and younger children, and also because urine samples can easily become contaminated (by touching the open rim of the bottle with your fingers, for instance).
 
Parents of young children who are already toilet trained are usually asked to collect a sample using a sterile bottle provided by their GP. There are a few different methods for collecting urine samples from babies and young children who aren’t toilet trained, including using a special pad that you place in their nappy (again your GP will provide one).
 
Sometimes, however, children have to give a urine sample at a hospital, where a small plastic tube (catheter) is inserted into their urethra.
 
In most cases, treatment can start soon after the sample has been tested. But occasionally children need further tests, especially if they are younger than six months old, if they have any unusual symptoms or if they don’t start to get better within a day or two of treatment. These other tests include scans, such as ultrasound scans and x-rays.
 

How do you treat a UTI in a child?

 

Antibiotics and pain relief

 
Most UTIs in children are treated successfully at home with antibiotics, though in some situation a child may need to stay in hospital with a UTI for a few days.
 
If your child has a lower UTI (cystitis), they usually need a three-day course of antibiotics. An upper UTI, however, needs to be treated for a while longer, usually seven to 10 days. You can also give your child paracetamol to treat a high temperature or to soothe their discomfort – always check with the pharmacist that you have the right paracetamol product for your child’s age (according to the NHS you should avoid giving children with an UTI ibuprofen for pain relief, as ibuprofen can affect the kidneys (vi)).
 
It’s also important to make sure children take antibiotics correctly:
 

• Always give them their antibiotics at regular intervals, as their GP has advised.

• Make sure they take their antibiotics for as long as their doctor recommends, even if they feel better sooner. If they stop taking their antibiotics too soon, there’s a chance their infection won’t have been fully treated and they may become ill again.

 
The good news is that most cases of UTIs in children clear up within a few days. However if they don’t show any signs of improvement this quickly, take them back to their GP.
 
Very rarely, a UTI in a child can cause a severe and potentially life-threatening condition called septicaemia. Be aware of the symptoms you should look out for by reading our guide to meningitis and septicaemia in children. [ADD LINK TO CHILDREN’S HEALTH: MENINGITIS AND SEPTICAEMIA WHEN PUBLISHED]
 
 

Can UTIs in children be prevented?

 
There’s often nothing you can do to stop your child having a UTI. Nevertheless there are a few things that may help reduce their risk of getting one, including:
 

• If you can, try to breastfeed your baby exclusively for the first six months. According to the NHS this can help improve your baby’s immune system and reduce their risk of constipation (vii).

• Treating constipation can help because it helps keep urine flowing normally – find out more about constipation in children in our guide to its causes, symptoms and treatments. [ADD LINK]

• When they’re old enough, teach your child good bathroom hygiene – this includes encouraging girls to wipe from front to back after each bowel movement, which can help reduce the chances of bacteria finding their way into the urethra.

• Also try to make sure your child goes to the toilet regularly and doesn’t hold in their urine. Keeping them supplied with plenty of drinks may help (drinking frequently will also increase urine flow and help to flush infections out of the body).

• If possible, consider changing nappies more frequently in babies and young children.

• Choose loose-fitting cotton underwear for your child and avoid underwear made from synthetic fabrics, as they may promote bacteria growth.

• Some advisers also recommend avoiding or limiting the use of bubble baths and other scented bath products at bath time, as they may irritate the opening of the urethra and lead to the development of an UTI – though there’s currently no solid evidence to back this idea up (viii).

 
It may be a good idea to make sure your child has as healthy a lifestyle as possible to help keep their immune system strong and primed to fight off infections. Regular exercise is important for kids’ immunity, plus try to give them a healthy nutritious diet. You may want to try giving them some supplements that supply the nutrients they need for a strong immune system too, such as:
 
Multivitamin and mineral   Ideal for fussy eaters, these are also useful for kids who don’t always eat as healthily as they should. There are several multivitamins available for children and young people, so try to choose one for your child’s age group as it will have all the right vitamins and minerals they need in the right amounts. If your child has difficulties swallowing tablets, try a chewable multivitamin or one that dissolves in water to make a tasty fizzy drink.
 
Vitamin D   Getting the right amount of vitamin D can help support normal immune function. Your child can get the vitamin D they need in a good multivitamin and mineral supplement, or you may want to give them a separate vitamin D supplement (vitamin D drops are handy if they don’t like taking tablets).
 
Public Health England recommends all children from birth to four years old take a daily vitamin D supplement throughout the year, while children over four years should take vitamin D during the autumn and winter months (or all year round if they don’t spend much time outdoors during the spring and summer or they usually wear clothes that cover up most of their skin when they’re out and about) (ix). Children with dark skin may also not get enough vitamin D from sunlight.
 
Vitamin C and zinc   A good children’s multivitamin and mineral will also give your child vitamin C and zinc, which they need for immune function support (x). As with vitamin D, you can also give your child separate vitamin C and/or zinc supplements – just check any supplement gives them the right amount of each nutrient for their age.
 
Fruit concentrates   Other supplements that may help keep your child’s immune system strong include natural concentrates such as elderberry, blackcurrant and rosehips, Not only are they good sources of beneficial antioxidant plant compounds, but elderberry, blackcurrant and rosehip concentrates taste delicious too – so you shouldn’t have any arguments from your child about taking them. Look for products that are naturally sweetened, as children may find these more palatable than ones that include artificial sweeteners.
 
If, however, your child does get a UTI, encouraging them to drink plenty of fluids – but not fizzy or caffeinated drinks – can help them feel better if you’re treating them with antibiotics at home. Giving them a hot water bottle or heated pad to hold against their stomach may also make them feel more comfortable.
 
 
A UTI can make your child feel really under the weather, but if you know what to look for urine infections can be treated quickly and highly successfully. There are also a few things you can do to try and help prevent UTIs in children, including making sure their immune system is as strong and healthy as possible. Find out more about a wide range of children’s and adult’s health issues in our pharmacy health library.

References:

1. Available online: https://cks.nice.org.uk/topics/urinary-tract-infection-children/background-information/prevalence/
2. Available online: https://www.nhs.uk/Livewell/Kidneyhealth/Documents/kidney%20guide.pdf
3. Available online: https://cks.nice.org.uk/topics/urinary-tract-infection-children/background-information/causal-organisms/
4. Available online: https://cks.nice.org.uk/topics/urinary-tract-infection-children/background-information/risk-factors/
5. Available online: https://cks.nice.org.uk/topics/urinary-tract-infection-children/background-information/definition/
6. Available online: https://www.nhsinform.scot/illnesses-and-conditions/kidneys-bladder-and-prostate/urinary-tract-infection-uti-in-children#treating-urinary-tract-infections-in-children
7. Available online: https://www.nhsinform.scot/illnesses-and-conditions/kidneys-bladder-and-prostate/urinary-tract-infection-uti-in-children#about-urinary-tract-infections-in-children
8. Modgil G, Baverstock A. Should bubble baths be avoided in children with urinary tract infections? Arch Dis Child. 2006 Oct; 91(10):863-865. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2066009/
9. Available online: https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/
10. Maggini. S., Wenzlaff. S., Hornig. D. Essential role of vitamin C and zinc in child immunity and health. J Int Med Res. (2010 Mar-Apr). 38(2):386-414. Available online: https://www.ncbi.nlm.nih.gov/pubmed/20515554

 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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