Urinary tract infections (UTIs) are one of the commonest infections among children. They cause a lot of pain and discomfort to the child and in extreme cases might lead to kidney damage. UTIs happen when bacteria get into the bladder or kidneys.
According to Dr James Edward Kakugulu, a general practitioner from Lifemate Medical and Diagnostic Centre, there many causes of UTIs but the commonest is Escherichia coli commonly known as E. coli which causes up to 80 per cent of the infections. “E.Coli is normal flora in the gastro intestinal tract but when it crosses into the urinary system it causes a UTI,” Dr Kakungulu explains.
Dr Edward Mugisha, a paediatrician, says a baby with a UTI may have a fever, experience vomiting, or be fussy. Older children may have a fever, feel the urge to urinate frequently, fail to control the urine, feel pain when passing urine, have a whitish or colourless discharge, have lower belly pain, lower back pain, headaches and sometimes diarrhoea.
“Most UTIs happen in the lower part of the urinary tract but sometimes an infection can travel up the ureters to the kidneys. This infection, called pyelonephritis, is usually more serious. The child will look sicker and is more likely to have a fever, pain in the side or back, severe tiredness and vomiting,” Dr Mugisha adds.
Dr kakyngulu says girls have increased risk for urinary tract infections than boys because of their anatomy. “The opening to the urinary tract, known as the urethral opening, is close to the opening of the anus and the vagina, where a lot E.coli bacteria live. And it is shorter in girls (1.5 inches) compared to eight inches in men making it more likely that bacteria will get into the bladder for girls,” he explains.
Poor hygiene is one of the leading causes of UTIs. “E.coli congregates in dirty washrooms, children’s potties, diapers and panties from where they easily spread,” Dr Kakungulu says. He further identifies malnutrition which compromises the immune system thereby diminishing the body’s ability to fight bacteria.
Dr Mugisha says other lifestyle choices such as using soap to wash the vagina which alters its PH level and wearing very tight pants also contribute to the risk of getting infected. Prolonged use of antibiotics also may cause infection because it rids the body of all bacteria good or bad leaving it susceptible to infection.
“Girls are at even greater risk of UTI and recurrence because bacteria may be more likely to collect in the walls of their bladder and be particularly difficult to treat and destroy.
Since most UTIs are caused by poor hygiene, washing and disinfecting the washroom and children’s potties will go a long way in prevention.
“In infants and toddlers, frequent diaper changes can help prevent the spread of bacteria that cause UTIs. Girls should know to wipe from front to rear not rear to front to prevent germs from spreading from the rectum to the urethra,” Dr Kakungulu adds.
Panties should be changed regularly or most preferably buy new ones every six months. Dr Kakungulu advises that all panties should be disposed of when a child gets a UTI and replaced with new ones. “Panties should also be washed and sundried because the sun helps to kill bacteria. Eating a balanced diet and breastfeeding the babies up to at least two years is essential in boosting the immunity of the body thus giving it a fighting chance against infections,” he adds.
Dr Kakungulu says UTIs are easy to treat, but it is important to catch them early. Undiagnosed or untreated UTIs can lead to kidney damage. To diagnose a UTI, laboratory tests have to be done including urinary analysis to determine the presence of proteins in urine, increased PH, leukocyte esterase and white blood cells to be evaluated for infection. “Knowing what bacteria are causing the infection can help in choosing the best treatment,” he says.
UTIs are treated with antibiotics. According to Dr Mugisha, although amoxicillin has traditionally been a first-line antibiotic for UTI, increased rates of E. coli resistance have made it a less acceptable choice, and studies have found higher cure rates with trimethoprim/sulfamethoxazole (Bactrim, Septra). Other choices include amoxicillin/clavulanate (Augmentin) or cephalosporins, such as cefixime (Suprax), cefpodoxime, cefprozil (Cefzil), or cephalexin (Keflex).
“The medication usually lasts seven days after which tests may be repeated to confirm that the infection is gone. This is important because an incompletely treated UTI can come back or spread,” He says adding that diagnosis and treatment can only be done by a doctor.
According to Dr Mugisha, sometimes children with a more severe infection may need treatment in a hospital so they can get antibiotics by injection or intravenously delivered through a vein right into the bloodstream. He concludes by saying that a parent must take their child to a doctor the moment they notice any symptoms so a diagnosis can be confirmed and treatment can begin.
Other risk factors
Dr Edward Mugisha, a paediatrician, other risk factors for a UTI include:
• A malformed kidney or a blockage somewhere along the tract of normal urine flow.
• An abnormal backward flow (reflux) of urine from the bladder up the ureters and toward the kidneys. This is known as vesicoureteral reflux (VUR), and many children with a UTI are found to have it.
• Uncircumcised male infants appear to be at increased risk of UTIs in the first three months of life. In a study of 100 otherwise healthy infants ranging in age from five days to eight months and admitted to the hospital because of a first known UTI, most of the UTIs in infants younger than three months were in males, but female infants predominated thereafter.
• Babies can be born with a wide array of urological irregularities that ultimately lead to easy contraction of infection.