What would you think if your child, who had been toilet-trained for many years, began wetting the bed but was otherwise healthy and in no discomfort.
What would you think if your little girl, 2 1/2 years old, began refusing to sit on the toilet, had a low-grade fever, and was extremely irritable.
What would you think if your 15-year-old boy told you that he had pain on urination for the past four or five days and was now passing bloody urine.
What would you say if your 12 -year-old girl, who had had two or three urinary tract infections in the past, now complained of a backache and began having fevers and chills.
All of these cases represent some of the varied presentations of urinary tract infections in children.
The urinary tract is a wonderful waste-removal system. It is at once simple, effective and very sophisticated.
What we call the urinary tract begins with the little balloons of blood vessels in the kidney (glomeruli) which act like sieves excreting excess blood fluids and wastes into the collecting system.
Then as all of this fluid passes through the little microscopic tubules into larger and larger tributaries the "good parts" of the fluid are reabsorbed back into the blood stream.
This then leaves the waste material (urine) behind to descend down the ureter from each of the two kidneys into the bladder.
The ureter enters the bladder at an angle which tends to form a flap that acts like a valve to prevent backflow into the kidneys (neat, huh?)
The urine is stored in the bladder, which expands until a complicated set of different muscles both relax and contract in different sequences forcing urine out the urethra.
A urinary tract infection can be anywhere along this whole tract -- from the kidneys (nephritis) to the collecting ducts (pyelonephritis) to the bladder (cystitis) and to the urethra (urethritis).
Physicians classify the workup and treatment of urinary tract infections into four broad categories -- adult and child, which are totally different; and male and female, which are totally different.
In children (especially little girls) an infection can be totally asymptomatic (without symptoms). It is not uncommon to find an unsuspected smoldering urinary tract infection, even with late kidney damage, on a routine urine screening for preschool.
That is why pediatricians routinely screen children's urine at various times during childhood.
It is not uncommon for a little girl to have one or two urinary tact infections as she struggles to learn to remember to wipe from front to back, instead of back to front, following a bowel movement.
If she wipes in the wrong direction, stool contamination can result which can cause a vaginal or bladder infection.
Contamination from the bacteria of feces are the most common bacteria in all urinary tact infections. The problem is that there is a very large number of types of bacteria in the feces.
If your physician suspects a urinary tract infection, he will perform a urinalysis. If there are pus cells found, he will need to get a urine culture to see for certainty what bacteria is actually causing the infection.
This is especially true if the patient is a child; if it is not the first infection; or, if it's in a boy. Specialized cultures are obtained in older adolescents who might be sexually active.
An appropriate antibiotic is chosen by your physician (depending upon numerous factors) and treatment continues for about two weeks.
At the same time, symptomatic relief can be obtained by drinking extra amounts of fluid - to thin the urine; and drinking cranberry juice - to acidify the urine.
Little girls may use sitz baths twice a day if they have any vaginal symptoms.
In children, however, the most important part comes after initial treatment. They must be followed up according to the schedule your physician advises.
X-ray studies are almost always done after the first infection in boys, and after the second or third infection in little girls because an infection is much more likely to mean a significant problem in males.
Another problem is that urinary tract infections can return even without symptoms.
My recommendation is to obtain a urinalysis every month for six months after an infection and then at least every year for four or five years.
Other physicians use other schedules, but the principle is that the parent needs to remember to have the child periodically checked if you hope to avoid damage to the kidneys and other organs from a "missed" urinary tract infection. This is because the "second" infection may often be without symptoms, especially in girls.
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