Urinary infections in children

What are urine infections?

They are infections caused by bacteria (germs, or bugs) getting into the urine. They are very common. They are often called urinary tract infections, or UTIs.

How will I know if my child has a urine infection?

The symptoms vary a lot. Some children don't have any symptoms at all. Most older children complain of burning pain on passing urine, and pass urine more frequently. Some become unwell, and may have a high temperature, or vomiting. Babies may just become miserable, or stop feeding, or start vomiting.

Is there something wrong with my child's kidneys if they have a urine infection?

Usually not. Most children that have urine infections have normal kidneys. A small number do have a kidney problem, which is why we routinely investigate all children that have even just one urine infection.

Can urine infections damage my child's kidneys?

In a small number of children, urine infections do damage their kidneys. These children will require further care. This is another reason why we investigate children who have had a urine infection.

Why do children get urine infections?

In everybody, bacteria live around the hole that the urine comes out of (called the urethra). These bacteria can sometimes travel up the urethra into the bladder to cause an infection.

What routine investigations does my child need?

Two tests need to be done in all children after their first urine infection. Together they give us a good picture of your child's kidneys. Babies under a year need a bladder x-ray (cystogram) as well.

• The first is an ultrasound scan. This is like the scan pregnant women have. It will be done in x-ray. A doctor will put some jelly on your child's tummy and run a microphone over it - it gives a good picture of their kidneys. This test takes about 20 minutes and does not hurt.
• The second is called a DMSA scan. For this test your child has a small injection into a vein, which will show up the kidneys. After this, your child can run around and pla~ About an hour later, your child will have to sit very still for five minutes in front of a special camera in Medical Physics.

What is in the DMSA injection?

It contains a radioactive substance. But the amount of radiation is very small, much less than you get if you have an ordinary kidney x-ray.

Will it hurt?

It should not. We use local anaesthetic cream ("magic cream") to numb the skin.

Can my child drink and eat normally on the day of the tests?

Yes

How long will the tests take?

We usually do both tests on the same day, and you will need to stay for about 4 hours.

Should my child stay on antibiotics?

We recommend that children who are under 4 years should stay on a night-time only dose of antibiotics until the test results are known.

What should I do if I think my child has another urine infection?

Contact your family doctor, who will check your child's urine. Your doctor will tell the hospital as well, because the date of the tests may need to be altered.

When will I hear the results of the tests?

We will contact you by letter or telephone as soon as the results are available. This may take a couple of weeks.

How can I prevent my child getting urine infections?

There are several things that you can do to cut down the chances of more urine infections. These are -

• Avoid constipation, because this can stop the bladder emptying properly. This is best done by eating lots of fruit, vegetables, wholemeal cereals, and brown bread.
• Encourage your child to drink plenty.
• Remind them to go to the toilet regularly including when they are at school.
• Don't use bubble bath or scented soap, which may irritate the skin around the urethra.
• In girls, it is important to wipe from "front to back" after they have used the toilet.
• In boys, it is important to keep the area around the foreskin clean.
• Use loose cotton underwear, rather than nylon underwear.

What is a cystogram?

This is a picture of the bladder. It is taken by putting some dye into your child's bladder, and taking xrays to see its shape, and to see if any dye goes back up towards their kidneys. It is also sometimes called a micturating cysto-urethrogram, or an MCUG.

When do children need this test?

If they have a urine infection under a year old, or if they have has been shown to have kidney damage.

How is the test done?

A very thin, soft tube is slipped into the child's urethra (the hole they wee through). This is done by an experienced children's nurse. Your child will then go to the children's x-ray department. There they will run some dye through the tube, into the bladder. It will just make your child feel that they want to have a wee. After the x-rays have been taken, the tube will just slip out.

Will it hurt?

Your child may find it a little uncomfortable when the tube is slipped in, but only for a very short time.

What should I tell my child before the test?

If your child is old enough to understand, it is a good idea to explain to them simply what to expect.

Is there anything special I can do to help them?

Bringing a favourite toy or book should help to distract them.