Urinary Tract Infection

What is a urinary tract infection?

A urinary tract infection (UTI) is an infection of the bladder and sometimes the kidneys. If the bladder is infected, it is called cystitis. If the kidneys are infected, it is called pyelonephritis. It is important to treat UTIs so that the kidneys are not damaged.

Various symptoms are possible:

• painful urination
• an urgent need to urinate
• frequent urination
• daytime and nighttime wetting
• dribbling
• foul-smelling urine
• fever
• stomachaches (especially lower abdomen)
• vomiting.

What is the cause?

Urinary tract infections are caused by bacteria. The bacteria enter the bladder by traveling up the urethra. In general, the urethra is protected, but if the opening of the urethra (or the vulva in girls) becomes irritated, bacteria can grow there. Common irritants are bubble bath and shampoos. Careless wiping after a bowel movement might also cause irritation. A rare cause of UTIs (1% of girls and 5% of boys) is obstruction of the urinary tract, which results in incomplete emptying of the bladder. Children who start and stop their stream of urine while they are going to the bathroom are more likely to get a UTI.

How long does it last?

With treatment, your child's fever should be gone and symptoms should be better by 48 hours after starting the antibiotic. The chances of getting another UTI are about 50%. Read the advice on preventing UTIs to decrease your child's risk.

How can I take care of my child?

• Antibiotics

  Your child's antibiotic is ___________________________. Your child's dose is ________ given ____ times a day during waking hours for ____ days. This medicine will kill the bacteria that are causing the UTI.

  If the medicine is liquid, store it in the refrigerator and shake the bottle well before you measure a dose. Use a measuring spoon to be sure that you give the right amount.

  Try not to forget any of the doses. If your child goes to school or a baby sitter, arrange for someone to give the afternoon dose. Give the medicine until all the pills are gone or the bottle is empty. Even though your child will feel better in a few days, give the antibiotic for the full 10 days to keep the UTI from flaring up again.

• Extra fluids

  Encourage your child to drink extra fluids to help clear the infection.

• Fever and pain relief

  Give your child acetaminophen (Tylenol) or ibuprofen (Advil) for the painful urination or for fever over 102°F (39°C).

• Medical follow-up

  Two days after your child begins antibiotics, it is important to contact your child's health care provider to find out the results of the urine culture and make sure that your child's symptoms are responding to the antibiotic.

  About 2 weeks after your initial visit your provider will want to see your child for another urine culture. Because the chances are high that your daughter will develop a second infection (50% of cases), your physician will probably also want to check her urine 1, 4, and 12 months after the first infection has cleared up.

• Instructions for collecting a midstream, clean-catch urine specimen at home

  If you are asked to bring a urine sample to your provider's office, try to collect the urine when your child first urinates in the morning. Use a jar and lid that has been sterilized by boiling for 10 minutes.

  Wash the genital area several times with cotton balls and warm water. Your child should then sit on the toilet seat with her legs spread widely so that the labia (skin folds of the vagina) don't touch. After she starts to urinate into the toilet, place the clean container directly in line with the stream of urine. Remove it after you have collected a few ounces but before she stops urinating. (The first or last drops that come out of the bladder may be contaminated with bacteria.)

  Keep the urine in the refrigerator until you take it to your provider's office. Try to keep it chilled when you bring it to the office (that is, put the jar in a plastic bag with some ice).

How can I help prevent a urinary tract infection?

• When your child bathes, wash the genital area with water, not soap.
• Don't use bubble bath before puberty; it's extremely irritating. Don't put shampoo or other soaps into the bath water. Don't let a bar of soap float around the tub.
• Keep bathtime less than 15 minutes. Your child should urinate after baths.
• Teach your daughter to wipe herself correctly from front to back, especially after a bowel movement.
• Try not to let your child become constipated.
• Encourage your child to drink enough fluids each day to keep the urine light-colored.
• Encourage your child to urinate at least every 3 to 4 hours during the day and not "hold back."
• Your daughter should wear loose cotton underpants. Discourage wearing underpants at night.
• If your child starts and stops her urine stream while going to the bathroom, special training may help her to empty her bladder smoothly.

When should I call my child's health care provider?

Call IMMEDIATELY If:

• Your child has back pain.
• Your child starts acting very sick.

Call during office hours if:

• Fever or painful urination lasts more than 48 hours after your child starts taking an antibiotic.
• You have other concerns or questions.