Dana Reinke remembers well when her daughter Peyton, then three years old, came down with an unexplained fever. “There wasn’t anything identifiably wrong,” she recalls, “but her fever didn’t go away for a few days, and she was totally lethargic. So I took her to the doctor, and one of the first things he did was take a urine sample.”
It turned out Peyton had a urinary tract infection (UTI), which occurs when bowel bacteria make their way up into the urinary tract—sometimes as far as the kidney—causing an infection. While UTIs in older kids and adults typically announce themselves with a burning sensation while peeing, younger kids, who either can’t tell you it hurts or can’t distinguish where the pain is coming from, may only run a temperature. (Other possible clues include needing to pee frequently and urgently, and accidents by kids who are toilet-trained.) Consequently, children younger than three who get a fever without any other symptoms should have a urine sample tested for bacteria. While it’s sometimes considered OK to treat adults for a UTI based on symptoms alone, in kids experts recommend urine testing to confirm the presence of infection. There are two ways to quickly test for a UTI: dipstick and urinalysis both confirm the presence of some sort of bacteria. But the preferred test in kids is a urine culture because it identifies the specific type of bacteria, though it takes 24 to 48 hours for results to come back.
What makes some kids prone to UTIs? Age is one factor: They’re apt to occur before age two, perhaps due to a short urethra. Anatomical difference is another. “In all age groups, UTIs are way more common in girls,” says Joan Robinson, chair of the Canadian Paediatric Society’s Infectious Diseases and Immunization Committee. The urethra is far shorter in females than in males, meaning stray bacteria from stool don’t have far to travel in little girls. Constipation is also linked with UTIs, possibly because a buildup of hard poop inhibits emptying of the bladder, giving bacteria more time to multiply.
Despite what your mom told you, there’s no evidence wiping front to back after bowel movements reduces UTI risk. “There’s really no proof it makes a bit of difference,” stresses Robinson, noting if it did, most babies who sat in poopy diapers would develop UTIs. And here’s another UTI myth busted: Bubble baths don’t up the risk, though they can irritate the vulva and urethra, causing the kind of burning that mimics an infection.
If your kid’s symptoms strongly hint at a UTI and the dipstick or urinalysis is positive, a course of oral antibiotics will be prescribed. If the urine culture comes back negative, the antibiotics should be stopped, Robinson says.
Antibiotics will typically clear up the infection, and kids usually start feeling better pretty quickly. “After a few days on ‘the banana medicine’ (amoxicillin), Peyton was her usual spunky self.”
Getting the sample
Getting a sterile urine sample from kids in diapers typically involves inserting a catheter into the bladder, which can be traumatic and painful. However, a Spanish study has shown success with a non-invasive alternative using massage. The method involves two people making rapid finger taps over the bladder, then massaging the lower spine while baby is held under the arms, feet dangling. The technique prompted 86 percent of babies to pee on cue.
A version of this article appeared in our March 2015 issue with the headline, “UTIs SOS”, p.32.