by Dr. Dan Giap Liang
Urinary Tract Infections (UTI)
UTI can occur in children and infants, Bacteria in the urine and bladder can sometimes infect the kidneys and enter the blood. Potential complications can be serious in infants. Unlike adults, the symptoms in children can be rather vague and non-specific. In an older child, the common complaints are painful and frequent urination with worse cases having bloody urine, stomach pain and fever. Unfortunately in infants and toddlers, sometimes the parents will only notice irritability, loss of appetite, fever, diarrhoea and vomiting.
Diagnosis usually depends on urine tests. However, collecting urine from babies is very challenging. Sometimes, a urine bag is attached to the genitalia but the urine may be contaminated and so the results must be interpreted with caution. The best and most reliable is a clean catch mid-stream urine, as the risk of contamination is least. Pure cultures in significant amounts are most reliable and usually confirmatory of a UTI.
Treatment is with antibiotics. The type and duration of treatment usually depends on the age and severity of the infection. Very ill and young children, more so babies, will need injections and longer courses. Older and less sick children can be treated with oral antibiotics. Another important issue is to exclude any underlying kidney and bladder abnormalities. Hence, ultrasound examination is required and occasionally, more detailed radiological investigations carried out. A condition which is called vesico ureteric reflux can occur where infected urine in the bladder back flows up the ureters during the time of urination. This can potentially cause damage to the kidneys due to the infected urine. Children with reflux will need to be monitored carefully.