A urinary tract infection (UTI) is an infection of the bladder (cystitis) and sometimes the kidneys (pyelonephritis). It is important to treat UTIs so that the kidneys are not damaged.

Symptoms of UTI include:
• Painful urination
• Bladder frequency or urgency
• Daytime and night-time wetting
• Dribbling
• Foul-smelling urine
• Fever
• Stomachaches (especially lower abdomen)
• Vomiting

UTI Causes  |  Home Treatment  |  Prevention of UTIs  |  When to Call Your Pediatrician

UTI Causes

Urinary tract infections are caused by bacteria. The bacteria enter the bladder by traveling up the urethra. In general, the urethra is protected, but the opening of the urethra (or the vulva in girls) is irritated, bacteria can grow there. Common irritants are bubble bath, shampoo, or fecal soiling. A rare cause of UTIs (1% in girls and 5% in boys) is obstruction of the urinary tract that leads to incomplete emptying of the bladder.

Expected Course. With treatment, your child's fever should be gone and symptoms should be better by 48 hours after starting the antibiotic. The chances of getting another UTI are about 50%. Read the advice on preventing UTIs to decrease your child's risk.
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Home Treatment

Antibiotics Your child will be given an antibiotic and you will receive dosage instructions. This medicine will kill the bacteria that are causing the UTI.

If the medicine is liquid, store it in the refrigerator and shake the bottle well before measuring each dose. Use a measuring spoon to be sure that you give the right amount.

Try not to forget any of the doses. If your child goes to school or a babysitter, arrange for someone to give the afternoon dose. Give the medicine until all the pills are gone or the bottle is empty. Even thought your child will feel better in a few days, give the antibiotic for the full 10 days to keep the UTI from flaring up.

Extra Fluids. Encourage your child to drink extra fluids to help clear the infection.

Fever and Pain Relief. Acetaminophen or ibuprofen may be given if your child develops a fever over 102°F (39°C) or if urination is quite painful.

Medical Follow-up. Two days after your child begins antibiotics, it is important to contact us to find out the result of the urine culture and make sure that your child's symptoms are responding to the antibiotic.

About two weeks after your visit we will want to see your child for another urine culture. Because the chances are high that your daughter will develop a second infection (occurs in 50% of cases), we would like to recheck the urine at the following times: 1, 4, and 12 months after the first infection is cleared up.

Instructions for Collecting a Midstream, Clean-Catch Urine Specimen at Home. If you are told to bring in a urine sample, try to collect the first one in the morning. Use a sterile jar.

Wash off the genital area several times with cotton balls and warm water. Have your child then sit on the toilet seat with her legs spread widely so that the labia (skinfolds of the vagina) don't touch. Have her start to urinate into the toilet, and then place the clean container directly the line with the urine stream. Remove it after you have collected a few ounces but before she stops urinating. The first or last drops that come out of the bladder may be contaminated with bacteria.

Keep the urine in the refrigerator until you take it to the office. Bring it in chilled (put the jar in a plastic bag with some ice).
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Prevention of UTIs

• Wash the genital area with water, not soap.
• Don't use bubble bath before puberty; it's extremely irritating. Don't put shampoo or other soaps into the bath water. Don't let a bar of soap float around in the tub.
• Keep bath time less than 15 minutes. Have your child urinate after baths.
• Teach your daughter to wipe herself correctly from front to back, especially after a bowel movement.
• Try not to let your child become constipated.
• Encourage her to drink enough fluids each day to keep the urine light-colored.
• Encourage her to urinate at least every 3 to 4 hours during the day and not “hold back.”
• Have her wear loose cotton underpants. Discourage wearing underpants at night.
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When to Call Your Pediatrician

Call your pediatrician immediately at the following signs:

• Back pain occurs.
• Your child can pass only very small amounts of urine.
• Your child starts acting very sick.

Call your pediatrician within 24 hours if fever or painful urination is not gone after your child has taken the antibiotics for 48 hours, or if you have other concerns or questions.

Adapted from Instructions for Pediatric Patients, 2nd Edition, 1999 by WB Saunders Company.
Written by Barton D. Schmitt, MD, pediatrician and author of Your Child's Health, Bantam Books, a book for parents.
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