It is estimated that, by the age of 7 years, at least 8% of girls and 2% of boys are diagnosed with a bladder infection. The common reason behind such high occurrence of urine infection or UTI in kids is Escheria Coli bacterium (or E.Coli as it is popularly known). Nearly 85% of UTIs can be attributed to this pathogen. In some cases, underlying structural or functional abnormalities of the urinary tract can also lead to bladder infections. Many guidelines have been published regarding management of UTI in pediatric cases. These guidelines have established one very important thing: recurrent UTIs in children should not be ignored and need to be investigated and managed thoroughly.
UTI diagnosis guidelines in children
Diagnosing UTI in kids must be done following strict pediatric guidelines and protocols. Doctors should start by taking the complete medical history of each patient. Additionally, parents or caregivers should tell the doctors observations they might made about bowel and bladder habits in the child. Doctor must even note the blood pressure of the child, and specifically examine its genitalia. In girls, labial adhesions can sometimes lead to UTI. The spine must also be examined as it can give important clues about infections of the bladder especially in case of recurrent ones.
High risk of UTI
If UTI is seen in very small infants, then the pediatric clinical guidelines for UTI management state that such cases be treated as high risks. Other high risk UTIs also includes symptoms like fever, severe pain, vomiting or septicemia. Higher blood pressure, severe constipation, spinal dysraphiasm etc are some other typical symptoms of high risk UTI in kids.
UTI Treatment guidelines in pediatric cases
Infants having severe loin pain, vomiting, jaundice, irritability or poor feeding etc must be admitted to the hospital for overnight stay. Those with less severity of symptoms may be treated as outpatients. Oral antibiotics must be given along with instructions for taking the medicines. Doctors can initially prescribe those classes of drugs based on local bacterial susceptibility patterns. If needed, urine culture must be taken and the drug must be changed once the results are out. In kids, the drug therapy should last for at least 10-14 days, especially in high risk or complicated UTIs. Slightly older kids with cystitis or UTI in adolescents may be treated using 7 day antibiotic treatment.In hospitalized children, hydration must be maintained using IV fluids. Analgesic medicines and antipyretic drugs may also be prescribed for managing pain or fever in the child.
Commonly the following oral antibiotics may be used:
- Cefixime- 8-10 mg/kg/day in 2 divided doses
- Ciprofloxacin- 10-20 mg/kg/day in 2 divided doses
- Ofloxacin 15-20mg/kg/day in 2 divided doses
For kids with cystitis, Nitrofurantoin can be prescribed for 7 days after taking urine culture. If severe vomiting is accompanying the UTI, phenazopyridine hydrochloride may be taken for no more than 2 days.
In case of infants suffering from UTI for the very first time, an Ultrasound, or DMSA scan may be recommended according to the pediatric clinical guidelines for UTI management.Additionally, a complete renal function test as well as a test for adequate electrolyte levels may also be done.
Precautions to follow to prevent UTIs in children
- Girls must be taught about importance of front to back wiping after bowel movement instead of back to front. School going girls must avoid bubble baths.
- Child should be made to drink plenty of water.
- Constipation must be strictly prevented by feeding child plenty of fiber rich foods.
- Breast feeding is of utmost importance to prevent UTIs in babies.
- Children should be taught not to hold urine for long periods and ‘go’ frequently.
By following these UTI treatment guidelines for children, one can prevent recurrent infections as well as other potential complications such as kidney infections.