Urinary tract infections (UTIs) rank just behind unexpected wetting as the top urinary problem in children. In fact, according to the National Institutes of Health (NIH), more children may have UTIs than statistics show. Researchers believe that the number of UTIs may be underreported because younger children are unable to describe their symptoms. In infants and young toddlers, these symptoms may be so vague that parents don’t even suspect a problem.

What is a UTI?
A urinary tract infection is an infection of the bladder or kidneys. The most common UTI is bladder infection (cystitis); kidney infections (pyelonephritis) occur much less often but generally are more severe. Untreated kidney infections can lead to permanent damage or even the loss of a kidney.

According to the NIH, one of the major causes of a UTI in children is bacteria getting into the urinary tract (usually from the skin around the rectum or genitals), thus the advice to "wipe front to back" after a child uses the toilet. Even if your young child insists "I can do it myself," you may want to help out after bowel movements until you’re sure that the child really has the hang of it.

The other major cause of UTIs is an abnormality somewhere in the urinary tract. In the case of these abnormalities, UTIs may recur frequently. Other children get UTIs because they are predisposed to them in the same way that some children are to colds or ear infections. And still others may get UTIs from a certain type of bacteria that has a special ability to cause urinary tract infections.

What Are the Symptoms?
While very young children cannot communicate to their parents that they are experiencing the symptoms of urinary tract infections, Dr. Gregory E. Dean, associate professor of urology and pediatrics at Temple University Children’s Medical Center, says signs of an infection may include fever or poor feeding habits.

Children who are old enough to tell their parents they’re not feeling well may name a variety of symptoms. According to Dr. Dean and Dr. Craig B. Langman, professor of pediatrics and head of kidney diseases at Northwestern University, some of the most common symptoms include:

• Difficulty starting to urinate
• Pain and burning during urination
• Frequent urination
• Cloudy urine
• Blood in the urine or on underwear
• Foul-smelling urine
• Back pain or fever
• Increased frequency of urination (though the quantity of urine may not increase)

Wearing disposable absorbent underpants while working on the problem can be helpful. Children save face if they have an accident, avoiding the telltale wet bottom or odor. This may even improve a child’s self-esteem, and save you from frequent laundering.

Does your child’s bedwetting mean that she may have a urinary tract infection? Not likely, according to Dr. Langman, who says that fewer than one percent of children who wet the bed have a urinary tract infection. "When [bedwetting and UTIs] are related, it generally is from infection in the bladder or kidney, from a structural problem with the kidney or more rarely, from chronic kidney disease or diabetes mellitus," says Dr. Langman.

Dr. Dean agrees and says that while daytime wetting or bedwetting can signal a urinary tract infection, "the vast majority of nocturnal enuresis (bedwetting) is unrelated to infection. Nonetheless, children being evaluated for nocturnal enuresis routinely undergo urinalysis to rule out signs of infection," he says.

Diagnosis and Treatment
Diagnosis of a UTI is easy and non-invasive, Dr. Langman says. "Testing of the urine with a modern urine 'dipstick' will detect the presence of blood, protein (several different dipsticks detect subtle levels, an early indicator of kidney function problems), white blood cells that may be related to an infection, the concentration or diluteness of the urine and a substance called 'nitrites' that indicates the possibility of an infection."

Dr. Dean suggests that children with a confirmed UTI undergo testing to determine its cause. "I think its important that parents know that pediatric urologists recommend that all children with documented urinary tract infections undergo a thorough evaluation including a renal-bladder ultrasound as well as a voiding-cystourethrogram (VCUG)," he says. "This is because a significant number of children with infections have structural issues including vesicoureteral reflux, which can be detected by these tests."

UTIs are treated with antibiotics; however, how the antibiotic is administered and the number of days that it must be taken depend in part on the type and severity of the infection. Usually, the antibiotic is in liquid or pill form or given through injection. If a child is very sick or unable to drink liquids, the antibiotic may be given through an intravenous tube in the hand or arm.

While it is commonly believed that children with UTIs should drink as much liquid as possible, experts differ on whether this is necessary. The NIH says children should have as much liquid as they want, but that adults shouldn’t push them to drink large amounts. The American Academy of Pediatrics, however, feels strongly that ingesting a certain amount of liquids is useful in treating UTIs.