Recurrent Urinary Tract Infections
Recurrent urinary tract infections (UTIs) are a common reason for emergency room visits and hospital admissions.
They can put families under a great deal of stress.
UTIs are a little different when they happen in little babies, and when they happen in older children. Read on to find out more.
What does a UTI usually look like?
In little babies, the first sign of a urinary tract infection (UTI) can be fever.
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They can also have:
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Increased fussiness
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Unexplained crying
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Blood in the diaper
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Some babies can have a change in their urine smell, but this is not a very reliable sign for UTI, and your doctor will look for other symptoms.
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Older children can also have fever and the above signs.
They may also complain of:
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Needing to go to the bathroom very often
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Pain when they pee
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Pain in the penis or vagina
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Not being able to pee everything they want to pee out
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Pain under the bellybutton or on their backs
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Poor control of peeing; wetting their underwear or their beds after they already grew out of diapers
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Weakness, feeling unwell
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It is well agreed that the most worrisome sign for a UTI is a fever, since this can mean that the infection has spread to the kidneys or to the blood.
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Depending on how severe your child's symptoms are, they may be treated with oral antibiotics (medications that are taken by mouth) or may need to be admitted to the hospital.
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All infants less than one year old with the above signs or symptoms should be checked closely to see if they need a hospital admission.
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Does your infant have recurrent UTIs?
It is very important that they be evaluated by a pediatrician and by a pediatric urologist.
UTIs that happen in the first year of life are very serious, even if they happen only one time. They may happen because of some abnormalities of the urinary tract.
Common reasons for these UTIs include:
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Blockages of the “lower urinary tract” or the bladder and urethra.
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Blockages of the “upper urinary tract” or the kidneys and ureters.
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“Reflux” of urine. This means that urine, instead of going out through the bladder, can go back up into the kidneys. Read more about reflux on this page.
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Abnormalities of the spine, which can cause problems with the nerves controlling the bladder.
Does your toddler or older child have new, recurring UTIs?
If your child did not have any urinary tract infections as an infant but are getting them as an older child, they can be getting infections for the same reasons above.
However, your pediatric urologist will investigate:
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Are they constipated? Bladder bowel dysfunction is a very common and important cause of UTIs. Visit this page for more information.
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Are they unable to contract and relax their muscles effectively? Sometimes kids, without meaning to, can hold their urine and make themselves prone to infections. This is called dysfunctional voiding.
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Do they have abnormalities of the genitalia?
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In little boys, problems with the foreskin can cause repeated infections. Click here to read more.
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In little girls, problems with the genitalia like labial fusion can cause urine to pool, making them prone to more infections.
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Most of the time, the pediatricians and pediatric urologists working together can find a solution that will decrease the chance of repeat UTIs.
Every child is different, and their risk factors are different. This means that what works to manage one child may be different from yours.
In labial fusion, parts of the labia in girls are abnormally attached, and can cause urine to pool inside. Image source here.
What happens next?
Most of the time, your doctors will start by testing your child's urine and doing an ultrasound to check your child's kidney and bladder.
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Depending on those tests, they can make decisions on what to do next, and if any more tests are necessary. .
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If your baby has an inborn problem of the urinary tract:
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your pediatric urologist will made decisions on whether the abnormalities will need surger or can just be observed.
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Sometimes, unfortunately, more invasive tests are needed. This can include a VCUG (Voiding cystourethrogram) to diagnose reflux of urine. Visit our VCUG page for more information.
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If your older child or toddler has bladder-bowel dysfunction or constipation:
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your doctor will start your child on a regimen to make sure they poop well and often. Pleases ee more on this page to read more about Bladder Bowel Dysfunction.
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In some situations, while there can be correctable problems in your child's urinary tract, your doctors may opt to not do surgery but to control the UTIs temporarily.
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This includes situations like VUR or vesicoureteral reflux. With reflux, some kids will need surgery, but some kids can grow out of the infections.
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To "grow out" of the infections, we can help them by making sure they don't get constipated, and/or by giving them "antibiotic prophylaxis."
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If your child is a boy, your doctor may talk to you about circumcision.
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Not all babies need circumcision. However, circumcision has been shown to decrease the rates of urinary tract infections in the first year of life, and this is important in children who have other inborn problems that can make them prone to UTIs.
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For more information, please visit our section on Foreskin Problems and Circumcision!
What is continuous antimicrobial prophylaxis? Is this OK to give to my child?
In very young children with UTIs that occur frequently and severely, sometimes it helps to place them temporarily on continuous antimicrobial prophylaxis (CAP).
This means that a small dose of a safe oral antibiotic is given to the child every day.
This often allows the child to have fewer infections while their other risk factors or causes are being corrected.
CAP is like a seatbelt—it can protect from many infections, but not all.
Like with all medicine CAP has its own benefits and side effects. Please make sure to discuss with your doctor!
The information in this infographic is for general information purposes only.
We encourage you to seek an individualized consult for the most appropriate management. You may book an appointment with us or with your preferred pediatric urologist or pediatric surgeon.
Please feel free to send us a message for questions on pediatric urologic health!
