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Pediatrics - Urinary Tract Infection, Bladder Infection 

Introduction
Urinary Tract Infections (UTIs) are a common condition.  Most UTIs result from infection caused by bacteria that enters the urinary tract system.  UTIs can be quite uncomfortable and lead to problems with urination.  Fortunately, most UTIs respond well to prescription medication in a short amount of time. 

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Anatomy
Your child’s urinary tract system consists of his or her kidneys, ureters, bladder, and urethra.  The kidneys are a pair of bean shaped organs located around the lower back.  They filter waste products and extra fluids from the blood and turn them into urine.  Urine is composed of mainly water and metabolic waste products.  The urine travels through two tubes, called ureters, to your child’s bladder.
 
Your child’s bladder holds and collects the urine from his or her kidneys.  When a certain level of urine has accumulated in your child’s bladder, his or her body signals your child to urinate.  The urethra is the tube that carries the urine from the bladder to outside of the body.  The female urethra is shorter than the male urethra.

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Causes
Bacteria that enter the urethra cause the majority of UTIs.  Bacteria normally live in your child’s colon or bowels.  They are also in your child’s stools or bowel movements.  The bacteria can move from your child’s anal area to the opening of his or her urethra.  This can occur because of poor hygiene.
Usually, if bacteria enter the urethra, they are flushed away and removed during urination.  However, if there are too many bacterium, they may not be removed, but instead remain and grow.  The bacteria may cause an infection and travel throughout the urinary tract system.
 
An infection in the urethra or bladder is termed a “lower urinary tract infection.”  An infection in the urethra is called “urethritis.”  An infection in the bladder is called “cystitis.”  The infection may spread through the urinary tract to the ureters and kidneys.  An infection in this area is termed an “upper urinary tract infection.”  An infection of the kidneys is called “pyelonephritis.”  In general, the higher the location of the infection, such as the kidneys, the more serious it is.
 
UTIs are categorized as simple infections or complicated infections.  Simple infections can be treated with medications.  They do not spread to other parts of the body.  They may be caused by an abnormality in the urinary tract system.  Complicated infections may spread to other parts of the body.  They can be difficult to treat.  The infection may be resistant to some medications.  

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Symptoms
UTIs can cause pain and difficulty with urination.  Your child may feel pressure or aching over his or her bladder in the lower pelvic area.  Your child may have low back and flank pain.  It may hurt, sting, or burn when your child urinates.  Your child’s urine may appear cloudy or have blood in it.  Your child’s urine may smell bad or have a strong urine odor.  Your child may feel like he or she needs to urinate very frequently; however, your child may only pass small amounts of urine at a time.  Your child may urinate several times during the night. 
Age can influence the type of UTI symptoms that people have.  Young children may only experience a fever or no symptoms at all.  In older adults, a UTI can cause mental confusion or behavioral changes.  Older adults with such symptoms should be tested to see if the infection has spread to their blood.
 
A bladder infection can progress to a more serious infection, a kidney infection.  Symptoms of a kidney infection include nausea, vomiting, fever, or chills.  Additionally, a kidney infection can cause sepsis, an infection of the bloodstream that can affect your other organs.  Your child should receive immediate medical attention if your child experiences such symptoms.  Further, pregnant females should contact their doctor immediately for a suspected UTI.  Pregnant females with kidney infections are at risk for delivering prematurely.

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Diagnosis
Your doctor can diagnose a UTI after reviewing your child’s medical history and his or her symptoms.  Your doctor will also conduct a physical examination and some tests.  In some cases, doctors may order additional tests to rule out other conditions that may cause symptoms similar to a UTI, such as sexually transmitted diseases, an enlarged prostate gland, or a kidney stone.
 
Your child’s urine will be examined for the presence of blood, abnormal cells, and bacteria.  This procedure is called a urinalysis.  The test is simple to conduct.  Your child will provide your doctor with a urine sample.  Your child’s urine will be tested, and your doctor will interpret the results.  In some cases, the urine may be cultured.  This additional test can specify the type of bacteria that is causing the infection and help determine the best medication to treat it. 

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Treatment
Most UTIs are treated with antibiotics.  There are several types of antibiotics.  The type of medication your child receives depends on the severity, type, and location of his or her infection.  Medication type and duration may also be dependent on your child’s other health conditions, such as diabetes or pregnancy.  In addition to treating the infection, your doctor can prescribe medication to relieve bladder pain and pain associated with urination.  It is helpful to drink plenty of water.  Most simple UTIs respond well to prescription medication in a short amount of time.

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Prevention
There are several ways your child can prevent UTIs.  Your child should keep his or her genital area clean and wear clean dry cotton underwear.  Your child should wipe from front to back after urinating or a bowel movement.  Your child should drink plenty of fluids.  Drinking cranberry juice may be helpful.
 
Women and girls should avoid bubble bath products.  Bubble baths do not cause a UTI, but they can irritate the urinary tract.  Women prone to UTIs should avoid using birth control methods such as a contraceptive diaphragm and spermicidal jelly.  Women should not douche or using similar feminine hygiene products. 

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Am I at Risk

 Is My Child at Risk?

Certain people appear more likely to get UTIs than others.  Females are more susceptible to UTIs than males because their urethra is shorter and located near their anal area.  Some children develop UTIs.  Girls tend to get UTIs around age three, during the toilet training period.  UTIs are especially common in women between the ages of 20 and 50 years old.  Sedentary or immobile people, such as people in a nursing home or some people of older age are at higher risk for developing UTIs. 

Risk factors may increase your child’s likelihood of developing a UTI.  People with all of the risk factors may never develop a UTI; however, the chance of developing a UTI increases with the more risk factors your child has.  You should tell your doctor about your child’s risk factors and discuss your concerns.

Risk factors for UTIs:

_____ During the toilet training years, children are at risk for developing UTIs, particularly females.
_____ Females that are pregnant are more likely to develop UTIs.
_____ People that are immobile or do not move much.  For example, people in a nursing home have an increased risk for developing UTIs.
_____ People with neurological conditions that affect the bladder’s nerve conduction including diabetes, multiple sclerosis, and spinal cord injuries are more prone to developing UTIs.
_____ People that use a catheter, a tube placed in the body that drains the urine from the bladder to a collection bag, are more likely to develop infections.
_____ People with a urine blockage, such as from a kidney stone, narrowed urethra, tumor, or enlarged prostate gland are prone to getting UTIs.
_____ People with bowel incontinence, the inability to control when they have a bowel movement, are more likely to develop UTIs.
_____ Not drinking enough liquids can lead to development of a UTI.
_____ Sexual intercourse can increase the risk of getting a UTI, especially in women.  Birth control such as a contraceptive diaphragm or spermicides can cause irritation. 
_____ People with HIV have a greater risk of getting UTIs.
_____ People with multiple sex partners or who get certain sexually transmitted diseases, such as Chlamydia and mycoplasma, have recently been linked with bladder infections.

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Complications

Complicated UTIs can cause a kidney infection.  Kidney infections can be serious and require prompt treatment.  In some cases, the infection can enter the bloodstream and cause sepsis.  Sepsis is a blood infection that can affect other organs.  This condition also requires prompt treatment.

UTIs can cause complications for pregnant females.  UTIs increase a woman’s risk of delivering her baby early.  Babies that are born early carry the risks associated with prematurity.  Pregnant women susceptible to UTIs may be tested regularly and are sometimes treated with preventative antibiotics.

Some people develop chronic or recurrent UTIs.  This is defined as UTIs that occur twice within a six-month period or at least three times in one year.  Some UTIs may be resistant to antibiotics and difficult to treat.  If your child experiences recurrent UTIs your doctor may order tests to help determine the best treatments for your child.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.