Urinary tract infections in children

What is it?

Urine is produced by the kidneys, collected in funnel-shaped cavities called renal territories or pelvis, and flows into the ureters, long tubes that carry urine from the kidneys to the bladder. When the bladder is full, it contracts and pushes the urine out through the urethra.

Causes and risk factors

Infections are more common in boys in infancy and in girls between the ages of 3 and 6.

Urinary tract infections can be caused by:

·         weakening of the defense mechanisms of the urinary apparatus, which leads to the multiplication of bacteria;

·         anatomical anomalies of the urinary system. The most common is vesicoureteral reflux, a congenital malformation consisting of abnormal exit of the ureters into the bladder with subsequent upward movement of urine from the bladder to the kidneys.

 

Which are the symptoms?

Symptoms depend on age.

In the newborn and infant, you may observe:

·      temperature over 38.5°C;

·      slow growth and poor appetite;

·      vomiting;

·      diarrhea;

·      grayish or yellowish complexion;

·      irritability or intensity;

·      constant sleepiness.

For a child, symptoms may include

·      pain or burning when urinating;

·      frequent urges to urinate with small amounts of urine;

·      involuntary and unconscious loss of urine during sleep (enuresis).

If an infection is suspected, urinalysis with urine culture should be performed to assess the actual presence of bacteria in the urine, as well as the number and type of bacteria detected.

A child has a urinary tract infection if he or she has at least one symptom and a positive urinalysis at the same time.

How is it diagnosed?

An infection is a sign of an anatomical and functional problem in the urinary tract. For this reason, once the disease is diagnosed, additional investigations are necessary, such as

·      ultrasound of the urinary tract to check for anatomical anomalies;

·      if there are anatomical anomalies, a visit to a pediatric urologist to evaluate further investigations;

·      urinary cystourethrography, indicated only in isolated cases and when vesicoureteral reflux is suspected. This involves placing a bladder catheter, filling the bladder with contrast agent, and taking several x-rays while the bladder is filling and emptying. This is an outpatient examination that allows you to examine the anatomy and function of the bladder and urethra.

Suggested exams

How is it treated?

Usually, when an infection affects the lower urinary tract (bladder and urethra), the child is not hospitalized and is treated with medication.

If the infection affects the upper urinary tract (kidneys and ureters), hospitalization may be necessary.

If the infection is supported by an anatomical abnormality of the urinary tract, surgical correction of the abnormality is required.

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