Urinary Tract Infections in Children: Diagnosis and Treatment

Urinary Tract Infections in Children

Urinary tract infections (UTIs) are a common and potentially serious bacterial infection in children. They affect both boys and girls, but girls are more commonly affected due to their shorter urethral length. UTIs are more common in children between the ages of 2 and 5 years and in babies under 1 year.

Children with UTIs may experience symptoms such as fever, chills, and pain in the lower abdomen or back. They may also have signs of pyelonephritis, such as flank pain, vomiting, and lethargy. If the infection is confined to the bladder or urethra, symptoms may include pain or burning on urination, urinary frequency, and urgency.

Diagnosis Methods

The diagnosis of UTI in children requires a urine sample for laboratory examination. This sample should be collected using an appropriate method for the child's age and condition. In children who are not toilet-trained, urine may be obtained using a clean, sterile bag placed over the genital area. In older children, a midstream clean-catch urine specimen is usually sufficient.

Urinalysis and urine culture are the primary methods for diagnosing UTI. A positive leukocyte esterase test or the presence of white blood cells in the urine, along with significant bacterial growth, is indicative of a UTI. The recommended minimum colony-forming units (CFU) per mL of urine for a UTI diagnosis vary by guideline. For example, the AAP recommends 50,000 CFU/mL, while the ESPU uses lower criteria for midstream clean catch in toilet-trained children.

Treatment Options

Prompt treatment with antibiotics is essential to prevent complications, such as sepsis and renal scarring. The choice of antibiotics should be based on local antibiotic resistance patterns, and initial antibiotic selection should be adjusted based on culture results. For severe cases, intravenous antibiotics may be necessary.

Prevention Strategies

Preventive measures include maintaining good hygiene, such as wiping front to back in girls and ensuring proper toilet training. Children with recurrent UTIs may benefit from prophylactic antibiotics, but their use should be guided by local guidelines.

Complications

UTIs can lead to serious complications if not treated promptly. These include sepsis, renal abscess, acute kidney injury, renal scarring, recurrent infection, impaired renal function, hypertension, end-stage renal disease, and preeclampsia.

UTIs in children require careful diagnosis and appropriate treatment to minimize morbidity and prevent long-term complications.