Urinary Tract Infections in Children

Renee Warmbrodt, RN, MSN, CPNP, in pediatric urology, and Dr. Kevin Barton in pediatric nephrology, discuss urinary tract infections in children.

Talk about urinary tract infections in children.

Urinary tract infections are usually caused by an infection in the bladder. There’s bacteria introduced into the urine that then becomes very aggravating to the whole urologic system. Most often it happens in girls, but occasionally it does happen in boys as well and in children from a few days old to teenage years and beyond. We work with kids to figure out underlying causes. Common underlying causes for urinary tract infections are incomplete bladder emptying, where the urine is left behind and remains stagnant in the bladder. Other issues include anatomic issues where there’s actually some variance in how the kidneys and the bladder are connected, which is called reflux. They can have urine going up into the kidneys and that causes stagnation and bacteria. Sometimes it’s hygiene related. Most of the time, it’s some sort of emptying or hygiene concern.

What are the symptoms of a urinary tract infection?

Urinary tract infection symptoms can vary widely from just foul-smelling urine to pain with urination to fevers, back pain, and vomiting. Sometimes I have children coming to see me who have a history of recurrent urinary tract infections, and they don’t have urinary tract infections at all. A lot of times, children have what’s called dysfunctional voiding where they have urine withholding behaviors. They’re four or five and potty trained, but they get busy and don’t want to go to the bathroom so they hold their pee. Then it causes some bladder dysfunction. Really one of the easiest things I can do to help them and their parents is just tell them to drink more water, go to the bathroom, and try to urinate more often. A lot of times, that fixes the symptoms. That’s actually a lot more common than children who have actual structural abnormalities to their kidneys or the urinary tract and have true recurrent urinary tract infections.

What treatments are used for urinary tract infections?

We instruct kids on better voiding habits. We work on time-voiding schedules where they’re peeing every two to three hours. We make sure that they empty their bladder. We talk them through a series of exercises to relax all the muscles to make sure everything is working together, and they’re not just hopping off and going about their day without fully taking the time to focus on going to the bathroom. Sometimes we’ll use antibiotics. If there is an infection, we obviously want to protect the organ system, so we’ll use antibiotics to treat the infection. Every once in a while, we’ll use antibiotics to prevent infection while kids are relearning how to use their urinary system to empty more appropriately. In rare cases, there’s surgery that is indicated to help treat the infections due to the anatomic structures that may be variant.