Small child

Your child has recurrent urinary tract infections - what could this mean?

Your child has recurrent urinary tract infections - what could this mean?

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Urinary tract infections (UTIs) are among the most common infectious diseases in children (more often only respiratory infections occur). In most toddlers they have luck episodic in nature and do not require in-depth diagnostics (except for children before the age of two - each UTI with them is an indication for implementation abdominal ultrasound). However, it should be remembered that a small percentage of children, especially those under the age of one, are struggling with recurrent urinary tract infections (the risk of recurrence of UTI within 6-12 months ranges from 12% to 30% and is much higher in children who have urinary tract defects). It is this group of small patients that requires special attention from parents and doctors.

When do we say that a child's urinary tract infections are recurrent?

In accordance with the recommendations of the Polish Society of Children's Nephrology (PTNFD) we can talk about recurrent urinary tract infections in a child when:

  • The child had 2 or more UTIs in the upper urinary tract upper urinary tract infection is also called pyelonephritis.
  • The child had 1 UTI in the upper urinary tract and 1 or more UTI in the lower urinary tract - lower urinary tract infection means bladder infection and urethra infection.
  • The child had 3 or more UTIs in the lower urinary tract.

What are the risk factors for recurrence of UTI?

As we have already mentioned, the recurrence of urinary tract infection is affected 12% to 30% of small patients (subsequent relapses occur more frequently - the second relapse at a frequency of approximately 50% and the third relapse at a frequency of approximately 75%). Among them, the following pathologies are common, which predispose to such a recurrence of infection. Here they are:

  • The presence of a urinary tract defect - mainly talking about vesico-ureteral reflux, which consists in the withdrawal of urine from the urinary bladder to the ureters and the renal calico-renal system.
  • Positive family interview towards ZUM - children whose parents or siblings have had recurrent urinary tract infections are more likely to develop them and therefore require more careful monitoring.
  • Positive family history of urinary tract defects - children with such an interview must also be checked more often.
  • Urination disorders inter alia, urinary incontinence, too frequent or too rare urination and urgency.
  • Gastrointestinal worms - pinworm is one of the risk factors for recurrent urinary tract infections.
  • Constipation and stool incontinence - like worms, these conditions increase the risk of recurrence of UTI.
  • Lack of proper hygiene regarding the child's external genitalia - in the first years of life, this may be due to neglect and lack of adequate knowledge of parents about the proper care of the toddler.

Recurrent UTI - diagnostics

Any child with whom we suspect UTI he should have had a urine test (general and bacteriological), which aims to confirm the infection and implement appropriate therapy. Moreover, in some small patients this diagnosis should be deepened by Abdominal ultrasound and voiding cystography.

Indications for ultrasound of the abdomen:

  • Each toddler who has undergone UTI before reaching the age of 24 months.
  • Every toddler over 24 months of age who has had acute pyelonephritis or has risk factors for recurrence of UTI.
  • Each toddler who has recurrent UTI.

Indications for miction cystography:

  • Each toddler who has been found to have any abnormalities in the ultrasound image.
  • Every toddler who has had UTI and has a positive family history of urinary tract defects.

Such diagnostics allows in most cases to detect possible causes of UTI relapses and eliminate them. This is especially important because such a recurring infection may lead to irreversible damage to the child's kidneys and the development of kidney failure later in life.

To sum up, recurrent urinary tract infection should never be underestimated and you should always make sure that it is properly diagnosed if it appears to your child.

Bibliography:Pediatrics by Wanda KawalecRecommendations of the Polish Society of Pediatric Nephrology (PTNFD) regarding the management of a child with urinary tract infection