If you’ve ever had a urinary tract infection (UTI), you know it can be very painful and when it’s not painful it’s uncomfortable.  Pretty much anyone who has had one would say that it’s not very fun. In fact, 50% of women will have had a UTI before the age of 32, and pregnancy only increases a woman’s risk of having one. So if you’re a mom, chances are you know what I’m talking about. But believe it or not, urinary tract infections can occur at any age, even in kids, so it’s important for parents to know the signs of a UTI and what to do about it.

Before I go on I want to bust two big UTI myths:

  1. Some people think that a UTI is a sexually transmitted disease (known as an STD or an STI), this is not true. UTIs are not a sexually transmitted disease (STD). While sexual activity increases the risk of acquiring a UTI UTIs are not contagious and the primary vector for a UTI is not sexual activity.
  2. Some people think that if your child has a UTI it means they are sexually active. UTIs are the most common bacterial infection in humans and most UTIs aren’t associated with sexual activity. In fact uncircumcised boys under 3 months of age and girls under 12 months of age have the highest prevalence of UTI in childhood according to the NIH.  So parents of teenagers, relax. A UTI doesn’t necessarily mean that your teen is sexually active.

Urinary TractDefinition and symptoms
Dr. George Chiang, a pediatric urologist at Rady Children’s Hospital in San Diego, states that a urinary tract infection occurs “when bacteria start to cause inflammation, and potentially damage, to any part of the urinary tract system including the kidneys or bladder.” Most people more commonly know UTIs as bladder infections, as the bladder is usually involved. Dr. Chiang notes that it usually takes a large number of bacteria to cause a UTI, “but bacteria can grow quickly.”

Older children and teens may report pain when urinating, increased urgency to urinate, increased frequency, bedwetting, pain in their lower abdomen, fever or foul smelling urine. In toddlers and babies, however, it’s harder to determine the symptoms. In babies, the only symptom of a UTI may be a fever, so it is important to discuss a fever with your pediatrician if there are no other symptoms or cause for the explain the fever.  Sometimes babies present with failure to gain weight, irritability or vomiting.

How do urinary tract infections occur?
According to Dr. Chiang, “50% of babies with a UTI have vesicoureteral reflux”, a condition in which urine flows backwards from the bladder up to the kidneys. Other risk factors for UTIs in babies may include “birth anomalies such as kidney obstruction or bladder obstruction, severe constipation, and excessive washing of the female genitalia, since it can alter the normal bacteria flora in that area”, says Dr. Chiang. “Boys who are uncircumcised and less than 1 yr of age may also have a higher likelihood of UTIs.  Dirty diapers and bubble baths are not known to cause an increase in UTIs.”

Kids : “Aside from a late presentation of a birth anomaly such as kidney or bladder obstruction, or vesicoureteral reflux, UTIs in kids are usually from problems in which kids don’t empty their bowel and bladders well, also known as bowel/bladder dysfunction. Kids these days can get very busy so they may not pee to completion or pee on a good schedule throughout the day.”  When urine stays in the bladder too long, bacteria start to grow. “Another rare cause of UTIs in kids is kidney stones, which usually presents with pain on urination or flank pain, but a UTI can also be a presenting symptom.” Furthermore, kids are frequently constipated.  Stool build up pushes on the bladder which causes urine to build up in some parts while also pushing urine out of other parts, thus causing accidents.  This urine build up in the bladder allows for bacteria to grow. Therefore, just as failure to fully urinate can cause infection, as Dr. Chiang stated above, so does constipation.

Teens : Teens develop UTIs for similar reasons as stated above, “although teens usually don’t have as much bowel/bladder dysfunction [as infants and children], kidney stones are a more common [cause] in teens versus kids”, according to Dr. Chiang.

Girls are at particular risk for UTI because they have a shorter urethra than boys and the opening is close to the rectum.  It is usually bacteria from the gastrointestinal tract that causes UTI, so this proximity is a set up for infection.  These bacteria can easily crawl up to the bladder, especially if there is friction in the area.  Therefore, wiping back to front and sexual intercourse are 2 factors implicated in UTIs.

How are UTIs treated?
Babies :
 Any baby who has possible symptoms or risk factors for a urinary tract infection should be seen by their pediatrician.  Dr. Chiang recommends “a catheterized urine specimen and then a full course of antibiotics” for culture positive infections. Following an infection, some babies may require “additional imaging such as an ultrasound of the kidneys or a VCUG.” A VCUG, voiding cystourethrogram, will look for reflux from the bladder to the kidney.  Dr. Chiang says that if the imaging studies are abnormal or your baby has more than one UTI, a referral to a urologist may be needed.

Kids : Kids who can pee in a cup do not need to have a catheter.  A “clean catch” urine sample can be checked for signs of an infection.  “If a urine culture is positive for bacteria, the child should receive a full course of antibiotics and then additional imaging may be required dependent upon the child’s history”, says Dr. Chiang.

Teens : Kids in this age group can easily give a clean catch specimen and, again, a full course of antibiotics would be required to treat a culture-positive infection. It is also important to talk to teen girls about hygiene and also about the risks of sexual intercourse including UTI, as well as pregnancy and sexually transmitted infection.

With regards to non-antibiotic treatments, Dr. Chiang says, “there are some reports in the adult literature regarding liberal fluid intake washing out bladder infections, but that has not been repeated in children. Since it can be difficult to control how often and how effectively children void, non medical treatments are not known to be effective.”

How can UTIs be prevented?
Certainly good bowel and bladder habits, as well as good hygiene, is the most important way to prevent infections in children with normal anatomy.  Congenital anatomical anomalies and also vesicoureteral reflux would need to be treated appropriately by a pediatric urologist in order to prevent infections.  Preventing infections in these patients helps to protect the kidneys, which can be damaged from repeated infections.

Many people believe that cranberry juice is helpful in both treating and preventing infections and Dr Chiang says that cranberry juice is no replacement for the appropriate use for antibiotics to treat a UTI. He says, “Specifically proanthocyanidins within cranberry juice, can [help] prevent UTIs through interference with binding of bacteria to the bladder.” Another common myth is that a more or less acidic bladder environment will treat or prevent UTIs. Sometimes this is mistakenly associated with the use of cranberry juice to prevent UTIs. Dr. Chiang says the bladder acidity theory is a myth, “Historically people have thought that acidification of urine [accomplished by drinking acidic beverages] can treat UTIs,” but he says there’s no clear connection between the pH of the urine and the prevention or treatment of UTIs. Recently probiotics and the supplement D-mannose has become a popular at-home treatment for UTIs, but again Dr. Chiang councils caution, “studies have also shown that probiotics and D-mannose can be helpful in preventing UTIs and in adults, but not kids.”

 As always, if you have concerns about your child or think he/she may have a urinary tract infection, see your pediatrician.

A version of this post originally appeared on Dr. Jaime Friedman’s blog.

Categories: Ages + Stages, Infectious Disease + Vaccines, Science 101 + Mythbusting