My Doctor Online The Permanente Medical Group

Causes

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Urinary tract infections (UTIs) are caused when bacteria enter and multiply in the urinary tract. The most common type of bacteria that causes UTIs is Escherichia coli (E coli), which is present in the bowels. Bacteria can enter through the opening of the urinary tract (urethra) from the skin surrounding the rectum.

There are a variety of factors that can make it easier for bacteria to reach the urinary tract in infants and children.

Bathroom habits

Children who are constipated or do not urinate frequently due to "holding it" or dehydration are at greater risk of developing a UTI. So are children who do not completely empty their bladders when they urinate. Often this is caused by delaying urination. A child may work so hard at holding back from urinating that the sphincter muscle forgets how to relax at the right time to urinate.

A child's risk for developing a UTI also increases when wiping from back to front after a bowel movement, which can place bacteria from the bowels into the urinary tract. You and your child should wipe his or her bottom beginning in the front and moving to the back to avoid a UTI.

Physical issues

Children may be prone to UTIs if they have an abnormality in the urinary tract, such as vesicoureteral reflux (VUR), which is the backward flow of urine from the bladder to the kidneys. Another UTI risk factor is a urinary obstruction, such as kidney stones.

Catheterization, which is done in the hospital for children who are unable to urinate on their own, can increase the risk of UTI. Finally, if your son has an uncircumcised penis, the foreskin can trap bacteria that can then enter the urethra.

If your child has a history of UTIs, he or she can be more prone to repeat infections.

Symptoms

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Recognizing a UTI early in children is important because untreated UTIs can lead to serious kidney problems. The symptoms of a UTI may be less noticeable in children who are too young to communicate how they feel. They include the following:

Infants and young children

• Strange-smelling urine
  
• Unexplained fever
  
• Vomiting
  
• Not eating
  
• Acting fussy 

Older children

• Pain or burning with urination
  
• Feeling the need to urinate more often
  
• Loss of bladder control, especially in a child who is potty trained
  
• Cloudy, pink, or strange-smelling urine
  
• Pain in the lower back or lower abdomen 

Complications
Complications from a UTI can occur, especially when proper treatment is delayed. Your child can develop high blood pressure or a kidney abscess, kidney swelling, or even kidney failure.

The main risk from a UTI is permanent kidney damage and scarring if not treated early. If a UTI progresses into a kidney infection, it might produce the following symptoms:

• Fever and chills
  
• Pain in the side, back, or belly area
  
• Nausea and vomiting 

Infants and children are the most at risk for this complication. Premature infants and infants with urinary tract obstructions are also more at risk for abscesses in the urinary tract, acute kidney failure, and widespread infection in the body (sepsis).

Early diagnosis and proper treatment can help prevent serious complications of UTIs. If you suspect your child has a UTI, please call the Appointment and Advice line to schedule an appointment, so we can evaluate your child.

Diagnosis

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To diagnose a UTI, we will assess your child's symptoms and perform a physical examination. We may order a urinalysis and urine culture to look for signs of a UTI. Because test results might take a couple of days, we may prescribe an antibiotic in the meantime if we strongly suspect a UTI.

There are several ways to collect your child's urine sample for a urinalysis and urine culture.

Infants and young children. We may attach a bag around their genitals until your child urinates. Unfortunately, this method is less reliable since it is easy to get other substances in the urine that might contaminate the urine sample.

Another option is for us to insert a catheter (a thin flexible tube that drains urine from the bladder) through the urethra and into the bladder to collect urine. In very rare cases, we may insert a needle through the abdomen directly into the bladder to obtain a urine sample.

Older children. We will provide a container or cup that your older child can use to catch their urine. If you need to assist your child, be sure to wear disposable gloves when helping catch their urine and then wash your hands thoroughly afterward.

Other tests
If your child does not improve with antibiotic treatment or we suspect that the infection has traveled to the kidneys, we may order additional tests to look for unusual bacteria or signs of kidney failure.

In some cases, especially in very young children, we might include a kidney ultrasound or scan, an X-ray of the bladder taken while your child is urinating (voiding cystourethrogram), or a scan to see how well the kidneys are functioning.

Early diagnosis and proper treatment can help prevent serious complications of UTIs. If you suspect your child has a UTI, be sure to call the clinic so we can evaluate your child.

Prevention

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There are a variety of measures available to prevent your child from developing a UTI. For instance, breastfeeding for the first 6 months of life can help prevent UTIs in infants. In addition, have your child:

• Avoid bubble baths.
• Use the bathroom several times a day.
• Wear loose fitting underpants and clothing. 

Encourage your potty-trained child to completely empty his or her bladder so that bacteria do not build up in the urinary tract. Offer your child water throughout the day so he or she urinates regularly. Feed your child a high-fiber diet so he or she has regular bowel movements.

It is important to teach your child how to properly wipe his or her bottom from front to back when using the toilet. This helps prevent bacteria in the stool from getting into the urinary tract.

If your child has frequent UTIs or if there is a known abnormality in the urinary tract that makes infection more likely, we may recommend long-term antibiotic treatment to prevent future UTIs.

Treatments

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Typically, UTIs are treated with oral antibiotics, such as a cephalosporin.

Infants. If your baby is less than 3 months old, antibiotics are sometimes given through a vein (IV). If this is the case for your baby, it may require a brief hospital stay until treatment is completed. 

Older children and teens. We will prescribe an oral antibiotic (liquid or pill form). It is important that your child take the medication exactly as prescribed. Even if your child starts to feel better, be sure he or she takes the complete dosage of medication prescribed. Stopping an antibiotic too early can cause more problems later because it may lead to antibiotic-resistant bacteria growth.

Home treatment
Home treatment focuses on flushing the bacteria out of your child's urinary tract. Antibiotics are still necessary to resolve a UTI. At home, your child may recover more quickly by drinking extra decaffeinated fluids and urinating frequently for 24 hours after UTI symptoms first appear. The fluids will dilute your child's urine and help flush bacteria out of the bladder.

Surgery
Surgery is used only to correct a structural problem in the urinary tract that leads to frequent UTIs. It is not used to treat a UTI.

When to Call Us

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Urinary tract infections in infants and young children can cause serious complications if not treated early. 

Infants or young children
Call us if your child has any of these symptoms:

• Strange-smelling urine
  
• Unexplained fever
  
• Vomiting
  
• Not eating
  
• Acting fussy 

Older children
Call us if your child has any of these symptoms:

• Pain or burning with urination
  
• Feeling the need to urinate more often
  
• Loss of bladder control after successful potty training
  
• Cloudy, pink, or strange-smelling urine
  
• Pain in the lower back or lower abdomen 

Delaying treatment can lead to more serious health problems, such as a kidney infection or even kidney failure. It is especially important that you bring your infant or young child in to be seen if you suspect a UTI, as your child is not able to communicate about symptoms.

Your Child's Care with Me

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If you are concerned about your child's symptoms and suspect he or she has a urinary tract infection, please contact our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or schedule an appointment for your child.

We will discuss your child's symptoms and medical history, along with any concerns or questions you may have. We can help you manage your child's UTI pain and understand what may be causing it.

Depending on your child's symptoms and medical history, the advice nurse will likely schedule an in-person appointment with me, or another doctor if I am unavailable.

During your child's visit, I will examine your child for signs of infection. If I suspect that your child does indeed have a UTI, I will ask you to help your child give a urine sample, and I will send it to the lab for a urine culture to check for signs of bacteria.

If I rule out other causes of infection and strongly suspect an uncomplicated UTI, I will prescribe antibiotics – usually for 1 to 2 weeks. Generally, your child will feel much better within 1 to 2 days, but it is important to make sure your child finishes all of the medication as prescribed to ensure that the infection is under control.  

Sometimes, the urine culture results will indicate that a different antibiotic may be more effective in treating the specific type of infection. If this is the case, I will contact you with a new prescription. 

You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

• For nonurgent questions or concerns, you can e-mail me using this site, once you have registered to use the Act for a Family Member feature. You can also schedule an appointment online to see me in person.
  
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or schedule an appointment for your child.

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Coordinating Your Child's Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting care for your child easier.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your child’s care to stay current on your child’s health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your child’s condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your child’s visit, you will receive information about when he or she is next due for a well child visit (checkup) and immunizations. We can discuss and schedule any preventive tests that may be needed. 
• At the end of your child’s visit, you may receive a document called the “After Visit Summary” that will summarize the issues we talked about during the visit. You can refer to it if you forget what we discussed, or if you just want to recheck your child’s height, weight, or vital signs. (If your child is under age 12, you can also view these summaries online, under Past Visits.)

If you schedule a telephone appointment

• In addition to in-person visits, we now offer the option of telephone appointments for certain common pediatric concerns. Depending on your child’s symptoms, you may have the option to schedule a telephone appointment with me or another pediatrician, if I am unavailable. We will call you at an agreed-upon time, at whichever phone number is most convenient for you.
• Many parents like this new option, but if you prefer to be seen in person, it’s always your choice. Just let the telephone staff know what type of visit you prefer.
• Telephone appointments are not appropriate for all health concerns. The advice nurse can help you decide what type of care is best for you and your child.

If I prescribe medications

We will work together to monitor and assess how your child’s medications are working and make adjustments as needed. 

Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically, in advance.

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your child’s medications at the pharmacy.
• If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, such as X-rays, we will schedule an appointment with the Radiology Department. 

When the results are ready, I will contact you with the results by letter, secure e-mail message, or phone. In addition, you can view most of your child’s laboratory results online, along with any comments that I have attached to explain them.

If I refer your child to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your child’s condition. In some cases, I may contact them during your visit, so we can discuss your child’s care together. If we decide your child needs a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

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Convenient Resources for You

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My goal is to provide high-quality care and to offer you choices that make your child’s health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available to help you manage your child’s care at any time that is most convenient for you. From my home page you can:

Manage your child’s care securely

You can begin to manage your child’s care online by requesting access through our Act for a Family Member feature. Once you have added your child to your account, you can:

• View and compose secure e-mail messages.
• Manage your child’s prescriptions and refills.
• Schedule well visit and nonurgent appointments.
• View your child’s Preventive Services to see whether your child is due for any immunizations or well visits.
• If your child is under 12, you can also view most lab test results and review information about past visits.

Learn more about your child’s condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your child’s condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Help your child stay healthy

• Sign up for our online newsletters for parents, customized to your child’s age.
• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you keep your child healthy.
• Check to see when your child is next due for immunizations and a well visit (checkup).

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