Urinary Tract Infections In Children
Sedentary lifestyle, poor toilet hygiene and improper toilets at schools are some of the reasons for urinary tract infections (UTI) in children, according to MN Sudheer Kumar, consultant pediatric nephrologist at Rainbow Hospital for Women and Children.
In a press communiqué, he said, “UTI is a common bacterial infection in infants, children and young people. UTI is defined by a combination of clinical features and the presence of bacteria in urine. The bladder stores the urine until it is emptied through the urethra, a tube that links the bladder to the skin, when you urinate.
The urethra opens at the end of the penis in boys and in front of the vagina in girls. The kidneys also balance the levels of many chemicals in the body (sodium, potassium, calcium, phosphorous and others) and check the blood’s acidity. Certain hormones are also made in the kidneys. These hormones help control blood pressure, boost red blood cell production and help make strong bones.”
Dr Sudheer Kumar also said, “Urinary tract is the most frequent site of occult and serious bacterial infections owing to decrease in the incidence of bacteraemia and meningitis by the introduction of effective conjugate vaccines against Haemophilus influenza type B and Streptococcus pneumonia. Around 1 in 10 girls and 1 in 30 boys will have had a urinary tract infection by the age of 16 years.
The rate for uncircumcised boys is 4-20 times higher than that for circumcised boy. The prevalence of UTI among febrile infant girls is more than twice that among febrile infant boys.” The pediatric nephrologist explained that, “Making the diagnosis of UTI can be difficult as the presenting symptoms or signs (fever, irritability and vomiting) are non-specific and commonly seen in many childhoods viral illness.
There is a small subgroup at risk of significant morbidity and renal scarring, which later can lead to hypertension and end-stage renal disease. Although early intervention can prevent late complications, we have to avoid unnecessary, expensive and potentially risky invasive tests. Prompt and accurate diagnosis of urinary tract infection is essential and it is important to recognise and treat recurrent infection.”
He added, “We suspect when children with age less than 12 months have temperature of at least 39°C, lasting for at least two days, and lasting beyond three days with absence of another source of infection. In neonates, it is part of septicemia and presents with fever, vomiting, lethargy, jaundice and seizures.
Infants and young children may present with recurrent fever, diarrhea, vomiting, abdominal pain, foul smelling urine, Hematuria and poor weight gain. Older children may have burning, urgency, frequency, flank pain, turbid or foul smelling urine or a recent onset of enuresis/incontinence, Hematuria.
Risk factors include poor urine flow, history suggesting previous UTI or confirmed previous UTI, recurrent fever of uncertain origin, antenatally diagnosed renal abnormality, constipation, poor growth and high blood pressure,” he concluded.