Clinical Reference Systems: Pediatric Advisor 10.0
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Description (Diagnosis must be confirmed by a physician.)

A urinary tract infection (UTI) is an infection of the bladder and sometimes the kidneys. If the bladder is infected, it is called cystitis. If the kidneys are infected, it is called pyelonephritis. It is important to treat UTIs so that the kidneys are not damaged.

Various symptoms are possible:

• painful urination
• an urgent need to urinate
• frequent urination
• daytime and nighttime wetting
• dribbling
• foul-smelling urine
• fever
• stomachaches (especially lower abdomen)
• vomiting.

Cause

Urinary tract infections are caused by bacteria. The bacteria enter the bladder by traveling up the urethra. In general, the urethra is protected, but if the opening of the urethra (or the vulva in girls) becomes irritated, bacteria can grow there. Common irritants are bubble bath and shampoos. Careless wiping after a bowel movement might also cause irritation. A rare cause of UTIs (1% of girls and 5% of boys) is obstruction of the urinary tract, which results in incomplete emptying of the bladder.

Expected Course

With treatment, your child's fever should be gone and symptoms should be better by 48 hours after starting the antibiotic. The chances of getting another UTI are about 50%. Read the advice on preventing UTIs to decrease your child's risk.

Home Treatment

1. Antibiotics

   Your child needs the antibiotic prescribed by your physician. This medicine will kill the bacteria that are causing the UTI.

   If the medicine is liquid, store it in the refrigerator and shake the bottle well before you measure a dose. Use a measuring spoon to be sure that you give the right amount.

   Try not to forget any of the doses. If your child goes to school or a baby sitter, arrange for someone to give the afternoon dose. Give the medicine until all the pills are gone or the bottle is empty. Even though your child will feel better in a few days, give the antibiotic for the full 10 days to keep the UTI from flaring up again.

2. Extra fluids

   Encourage your child to drink extra fluids to help clear the infection.

3. Fever and pain relief

   Give your child acetaminophen or ibuprofen for the painful urination or for fever over 102 degrees F (39 degrees C).

4. Medical follow-up

   Two days after your child begins antibiotics, it is important to contact your child's physician to find out the results of the urine culture and make sure that your child's symptoms are responding to the antibiotic.

   About 2 weeks after your initial visit your physician will want to see your child for another urine culture. Because the chances are high that your daughter will develop a second infection (50% of cases), your physician will probably also want to check her urine 1, 4, and 12 months after the first infection has cleared up.

5. Instructions for collecting a midstream, clean-catch urine specimen at home

   If you are asked to bring a urine sample to your physician's office, try to collect the urine when your child first urinates in the morning. Use a jar and lid that has been sterilized by boiling for 10 minutes.

   Wash the genital area several times with cotton balls and warm water. Your child should then sit on the toilet seat with her legs spread widely so that the labia (skin folds of the vagina) don't touch. After she starts to urinate into the toilet, place the clean container directly in line with the stream of urine. Remove it after you have collected a few ounces but before she stops urinating. (The first or last drops that come out of the bladder may be contaminated with bacteria.)

   Keep the urine in the refrigerator until you take it to your physician's office. Try to keep it chilled when you bring it to the office (that is, put the jar in a plastic bag with some ice).

Prevention of Urinary Tract Infections

• When your child bathes, wash the genital area with water, not soap.
• Don't use bubble bath before puberty; it's extremely irritating. Don't put shampoo or other soaps into the bathwater. Don't let a bar of soap float around the tub.
• Keep bathtime less than 15 minutes. Your child should urinate after baths.
• Teach your daughter to wipe herself correctly from front to back, especially after a bowel movement.
• Try not to let your child become constipated.
• Encourage your child to drink enough fluids each day to keep the urine light-colored.
• Encourage your child to urinate at least every 3 to 4 hours during the day and not "hold back."
• Your daughter should wear loose cotton underpants. Discourage wearing underpants at night.

Call Your Child's Physician Immediately If:

• Your child has back pain.
• Your child starts acting very sick.

Call Your Child's Physician During Office Hours If:

• Fever or painful urination lasts more than 48 hours after your child starts taking an antibiotic.
• You have other concerns or questions.