Herbal Health

Infections of the urinary tract are common in children, especially amongst girls. Cause

Urinary tract infections are caused by germs which infect the urethra (the urinary opening) and sometimes the bladder. Infections are more common where there are abnormalities of the kidneys or urinary tract (such as vesico-ureteric reflux — see p. 278) where the urine collects, thereby encouraging the growth of germs.

Clinical features

Older children usually complain of classic symptoms such as pain or stinging on passing urine, or a frequent urge to run to the toilet. Sometimes they pass small amounts of urine often and have difficulty in getting started. These symptoms can be accompanied by fever, abdominal pain and blood may be present in the urine. The younger the child the less specific are the symptoms; he may have an unexplained fever, irritability and bouts of crying, go off his feeds and even vomit.

Investigations

It is impossible to diagnose a UTI on symptoms alone. It is always necessary to back up any suspicions with a urine test, performed before the child has started taking antibiotics prescribed by the doctor. Once a course of antibiotics has commenced, it is impossible to identify the germ in the urine, and this makes treatment more difficult.

If there is a chance that the cause of your child’s UTI is an underlying structural abnormality of the kidneys or urinary tract, such as vesico-ureteric reflux, then further investigations such as a micturating cystourethrogram, or a renal ultrasound may be recommended by your doctor and your child may be referred to a paediatric specialist. Most children who have a urinary tract infection need to have these tests to make sure there is no underlying abnormality.

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A one-week course of antibiotics, given by mouth, is usually effective in treating most UTI’s. The urine should be checked again after treatment to make sure the infection has cleared up completely. If tests reveal an underlying abnormality, it may need to be treated — your doctor will explain this to you.

• if your child complains of any of the symproms described above;

• if the urine is pink, red or brown in colour;

• if your child has a high, unexplained fever or is generally unwell.

Prevention

Teach your daughter to wipe from front to back, so that germs are not spread forward from the bowel. Make sure your child always drinks plenty of fluids. Only buy cotton underwear for your child, as it allows a better air flow which helps to keep the area cool, making it difficult for germs to multiply. Encourage frequent emptying of the bladder every 3-4 hours and before bedtime.

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Cause

The cause of pain on urination is most commonly a urinary tract infection. Irritation of the vulva and urethral opening by soaps or shampoos can also occasionally cause stinging and burning on urination.

Clinical features

Urination stings, burns or is painful. The child will have a frequent urge to urinate, but will find starting difficult, or will only pass small amounts even though he feels he has a full bladder.

Treatment

Encourage your child to drink a lot of fluids to help dilute the urine and ‘flush out’ the kidneys and bladder. Urinary tract infections should be treated appropriately by your doctor and followed up carefully.

When to see your doctor

Always consult your doctor if your child complains of pain on urination.

Prevention

As for urinary tract infections.

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Vesico-ureteric reflux is one of the commonest causes of urinary tract infections in children, and if not detected early can lead to scarring of the kidneys.

Cause

Vesico-ureteric reflux is due to a defect in the valve mechanism where the tube from the kidney (the ureter) joins the bladder. Normally urine flows in one direction away from the kidneys, down the ureters, into the bladder and then down the urethra to the outside. If your child suffers from reflux, whenever he passes urine, a small amount escapes backwards from the bladder and flows towards the kidneys. The stagnant urine can also lead to infection. The degree of reflux can vary from minor to severe.

Clinical features

There are no specific signs of vesico-ureteric reflux. It is usually discovered when a child is being investigated for urinary tract infections.

Investigations

A micturating cystourethrogram and a renal ultrasound are usually performed to determine the degree of reflux, and whether there has been any kidney damage.

Treatment

In mild cases, any urinary tract infections resulting from the reflux are promptly treated, and your doctor may advise a long-term course of antibiotics in small doses to prevent recurrence of infections. The kidneys and urinary tract are monitored regularly via urine tests, follow-up X-rays and ultrasound, to make sure that the situation is not worsening. Most mild cases of vesico-ureteric reflux will resolve spontaneously with age. In more severe cases surgery may be indicated. Your doctor will explain to you the preferred treatment and follow-up plan for your child.

Prevention

There is no way to prevent vesico-ureteric reflux.

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