Urinary Tract Infections

Urinary tract infections, overall, are a rather common ailment in a pediatric clinic.  But some kinds of urinary tract infections are more common and/or more serious than others.  The big differentiators between the common and more rare types have to do with the age/gender of the child and what part or parts of the urinary tract that are infected.  The urinary tract goes from the end of the urethra (where the pee comes out) all the way up to the bladder, up through the ureters (the tubes that take urine from the kidney to the bladder), and the kidneys (where urine is made). 

It is much more common and less serious for a lower urinary tract infection such as a bladder infection.  These are usually made apparent by a kiddo saying it hurts to pee.  The bladder usually does a good job at shielding the rest of the body from an infection and, most of the time, this type does not have a fever associated with it (but sometimes it does).  So, in clinic, if we have a kiddo saying it hurts to pee we will test the urine to see if there are signs of bacteria or infection and treat preemptively with an antibiotic while we send the pee off to the lab to see what exact type of bacteria is causing the infection to make sure the antibiotic we are using is the correct one.  The most common time for a urinary tract infection like this is when kids are being potty trained and continue through childhood, adolescence, and even adult hood.  Most commonly, these infections occur in females as their urethra is shorter and it is easier for bacteria to make their way up to the bladder compared to the longer urethra in boys.  

If we have a kiddo saying it hurts to pee and their urine test does not show signs of infection that kiddo could also have vaginitis in females or balanitis in males.  Where the vagina or the end of the penis/urethra is irritated for a number of reasons such as sweat, over drying, too much swimming, bath soap irritation etc.  A good way to help distinguish a urinary tract infection from just a bit of irritation where the pee comes out is to ask a kiddo to pee in a bath of just water.  If they still say it hurts when peeing then the urethra and bladder are most likely infected, whereas if peeing in water makes urination not hurt, then it is most likely irritation at the site where the pee comes out (the water dissipates the urine so quickly we don’t get the same irritation).

Now, for the more serious and concerning urinary tract infections.  Urinary tract infections in kids under 1 are rather rare and often due to a malformation in some aspect of the urinary tract.  These are serious in that they tell us there is an abnormality in how pee goes through the kidneys and out of the body, which means the kiddo is at higher risk for bacteria to make it to the kidneys, causing pyelonephritis (kidney infection).  This kind of infection can get into the blood quickly, especially in young kids/babies.  Kids with this type of infection usually have high fevers and are very sick looking with painful urination.  Often times we need to use IV antibiotics while monitoring these kiddos in the hospital until the infection improves.   

In older children kidney infections can happen but are often less severe and not often associated with urinary tract abnormalities.  And as kids who can talk and localize pain, they will let us know that something is going on with painful urination, fevers, and lower back pain, so we usually catch these early enough to treat with oral antibiotics and pain medications at home.