By age 5, about 8% of girls and 1-2% of boys have had at least one urinary tract infection (UTI). Most children who have one UTI will not have another. Anatomic factors, toileting habits, constipation, and other factors may contribute to an elevated risk of reinfection. If your child develops recurrent UTIs—two, three or more infections—he or she may be referred to a pediatric urologist who will look for potential causes.
Testing for UTIs
Every child is different, and UTI symptoms vary depending on the child's age. In babies, fever, fussiness, or tiredness may be the only signs of UTI. Older children may have fever, burning, frequent urination, lower abdominal pain, or back pain. Symptoms alone are not enough to diagnose a UTI. Most children who develop these symptoms have a different cause for them, such as a virus.
Pediatricians check for bacteria in the urine with a culture test. The test must be properly collected (usually with a catheter) to produce reliable results. A child with bacteria in the urine but no symptoms does not have a UTI; he or she may have a condition called asymptomatic bacteriuria, which usually requires no treatment.
To be diagnosed with a UTI, a child must have symptoms plus bacteria in the urine on a properly-collected culture. If a UTI is associated with high fever, it usually suggests an infection involving one or both kidneys.
Causes of Recurrent UTIs
Recurrent UTIs are taken seriously, because the risk of health problems increases with each subsequent infection. Here are some of the potential causes:
Bladder & Bowel Problems
Many children hold urine too long, don't relax fully when urinating , or don't empty their bladder completely. Regular urination helps flush away bacteria; holding urine helps bacteria to grow. A child who doesn't drink enough fluid may not make enough urine to flush away bacteria. This often goes hand in hand with bowel dysfunction such as constipation. These problems increase the risk of UTI. Sometimes, your pediatrician will request a voiding diary (a recording of daily urination and bowel movements) to help understand your child's bathroom habits.
Urinary Tract Abnormalities
Children may have correctable bladder or kidney problems that contribute to UTIs including partial blockages, dilated segments, stones, or elevated bladder pressures. Your pediatrician may order an ultrasound of the kidneys and bladder to look for these issues. Depending on the ultrasound result, he or she may recommend more specialized tests.
Some children have backflow of urine from the bladder to kidneys, a congenital (present at birth) condition that can contribute to kidney infections. Urine reflux, together with infections, poses a threat to kidney health. If it's infected with bacteria, it can lead to pyelonephritis (a urinary tract infection involving the kidney). Pediatric urologists may request a special x-ray called a voiding cystourethrogram (VCUG) to look for this condition. Sometimes reflux improves, or resolves altogether, as children grow up.
Treatment for Recurrent UTIs
Every child's UTI treatment is individualized and based on the underlying cause of his or her UTI. To address bladder and bowel problems, for example, your pediatrician may recommend constipation treatment and scheduled bathroom trips. Preventative antibiotics are helpful in some patients with recurrent UTIs and urine reflux. Sometimes, urinary tract abnormalities are addressed with surgery. In many children with recurrent UTIs, no treatment is needed―only careful monitoring.
What are the long-term concerns for children with recurrent UTIs?
Most children who have multiple UTIs do not develop long-term health problems. However, repeated infections can cause kidney damage, or scarring. Not all children who have infections develop kidney scars. Sometimes, specialized scans are recommended to look for kidney scarring in children with a history of multiple UTIs. In a small percentage of cases, patients may develop chronic kidney disease or high blood pressure. Pediatric urologists do their best to help prevent these issues in children. Children who have a history of recurrent UTIs should have blood pressure checks and urine tests annually.
Will my child need preventative antibiotics?
Preventative antibiotics can help reduce recurrent UTIs in some children. Children with bladder and bowel dysfunction, severe urine reflux, or urinary tract abnormalities may benefit the most. In children with a lower risk of additional infections, antibiotics may not be best, as they can reduce healthy bacteria and increase the risk that a future infection might be caused by a resistant strain.
Recurrent UTIs are common in children, and there are many effective treatments available. Some simple things you can do to help prevent UTIs in your child include drinking lots of fluids, encouraging frequent urination, preventing constipation, keeping the genital area clean, wearing cotton underwear, and wiping from front to back after a bowel movement or urination. See Prevent Urinary Tract Infections in Children for more information and tips.
Additional Information from HealthyChildren.org: