MUST READ: Protect your child from urinary tract infection

Tade is a two-month old baby boy with two-day history of vomiting, fever and mild abdominal distention.

He was sent for an abdominal scan and X-rays by the doctor at the primary health centre. The scan result suggested that his abdominal distention was from a full urinary bladder and big kidneys (hydronephrosis). The bladder was compressed with......

warm towel and the baby passed urine.

He had a recurrence and was then referred to a teaching hospital. At the teaching hospital, diagnosis of urinary tract infection secondary to posterior urethral valve (congenital problem) was made and was said to be responsible for all the symptoms. The parents were told the boy would need to be operated on at a later time. They left to the village for local intervention. Tade died after about a month after from renal failure.

The father said the son died as a result of ignorance because he felt that a baby could never have urinary tract infection.

This piece is put up simply to educate the public that UTI is as common in children as it is in adults, though largely due to congenital abnormality and poor hygiene in children.

The diagnosis of UTI in young children is important as a marker for urinary tract abnormalities. It may be associated with life-threatening infection in the newborn. UTIs are the most common bacterial infection in children under two years old.

Many children who have UTI have normal kidneys and bladders. But if a child has an abnormality, it should be detected as early as possible to protect the kidneys against damage.

Dysfunctional voiding: Some children develop a habit of delaying a trip to the bathroom and holding their urine because they don’t want to leave their play. They may work so hard at keeping the sphincter muscles tight that they are unable to relax them at the right time. These children may be unable to empty the bladder completely.

Again, some children may strain during urination. Persistent straining may cause increased pressure in the bladder that forces urine to reflux into the urethras.

Signs and symptoms

Not one specific sign or symptom can be used to identify UTI in infants and children. Fever may be the sole presenting symptom in children younger than 24 months.

Newborn: Neonates and infants up to age two months who have UTI usually do not have symptoms localised to the urinary tract. UTI is discovered as part of an evaluation for neonatal sepsis. They may display symptoms such as jaundice, fever, failure to thrive, poor feeding, vomiting and irritability.

Infants less than a year: May display the following symptoms: poor feeding, fever, vomiting, strong-smelling urine, abdominal pain, irritability.

Children aged 2-6 years: Preschoolers with UTI can display symptoms that include vomiting, abdominal pain, fever, strong-smelling urine, enuresis (bed wetting), urinary symptoms (dysuria, urgency, frequency)

Children older than six years and adolescents: School age children with UTI can display the following symptoms: fever, vomiting, abdominal pain, flank/back pain, strong-smelling urine, urinary symptoms (dysuria, urgency, frequency), enuresis, incontinence.

Investigations

Collecting the urine sample: A urine sample should always be taken prior to starting any antibiotics. This can be obtained in various ways, depending on the age of the child and also the clinical presentation.

Dipstick testing: Dipstick tests for UTI include leukocyte esterase, nitrite, blood, and protein. Evidence of these substances may suggest UTI.

Urine culture: Mid stream urine sample should be sent for urine culture. Full blood count should also be done to check for infection.

Prevention

If a child has a normal urinary tract, parents can help the child avoid UTIs by encouraging regular trips to the bathroom. They should make sure the child gets enough to drink if infrequent urination is a problem.

The child should be taught proper cleaning techniques after using the bathroom to keep bacteria from entering the urinary tract, i.e. cleaning from front to back in young girls after defecating.

Choose cotton underwear instead of nylon undies. This is because loose-fitting clothes and cotton underwear allow air to dry the area.

Treatment: Antibiotics, surgery for correctable congenital disorders.

- Rotimi Adesanya [Doctoradesanya.blogspot]

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