Recurrent Urinary Tract Infections
A Guide for Parents to help manage UTIs in Children
Recurrent urinary tract infections (UTI’s) are a more common problem in young girls as the urethra (the tube connecting the bladder to the outside world) is much shorter than in boys.
As children grow, the urethra becomes longer (and cleaner) and the natural defences around its opening mature. Most children stop having UTI’s with time.
Children who have many UTI’s can develop scarring of the kidneys. Scarring can contribute to high blood pressure later in life and if severe can reduce kidney function.
This handout discusses the methods we can use to reduce the episodes of UTI.
GOOD BLADDER HYGEINE
- Drink adequate amounts of water.
Your doctor can advise on how much water your child should drink each day. This helps to keep the urinary system flushed out and clean. Many parents have difficulty getting their children to drink at school. Try to get three quarters of this target in during the time your child is at home. They will often take the rest at school.
Avoid sugary and caffeinated drinks. Water is best. - Control constipation.
The rectum (lower bowel) sits behind the bladder and when it is overstretched, stops the bladder from emptying completely. The stagnant urine can then grow bacteria. A long-term, low-dose laxative is used (eg. Lactulose, Parachoc, Osmolax). - Pass urine at least 5-6 times a day.
Regular voiding (or passing urine) makes sure that any bugs that get into the bladder get flushed out before they can establish an infection. Make sure your toilet is a comfortable place to do (provide a heater if cold, decorate with posters). Reward your child with a sticker chart for sitting on the toilet, regardless of whether they pass urine or not. - Double voiding (passing urine twice each time).
Some children don’t completely empty their bladder the first time when they do a wee. If this applies to your child, your doctor will suggest that after their first wee, get your child to count to ten and try again. - Wipe front to back.
Teach girls to reach around and wipe themselves from front to back. Whilst there is no evidence to support this, it is easy, doesn’t cost anything and common-sense. - Avoid harsh soaps and bubble bath.
Harsh soaps and bubble bath destroys the natural skin defences around the opening to the urethra (the tube that drains the bladder) making it easier for bugs to get in. We do not need soap to stay clean – water alone does an excellent job of cleaning sweat, dirt and germs from our body. If you feel strongly about a cleaning agent – try a moisturising bath oil. In babies, use cotton wool and water rather than baby wipes during nappy changes. - Don’t clean too aggressively.
Splash some water around the area of the vagina but don’t rub or scrub it (even without soap). The vagina has built in mechanisms to clean itself and maintains a careful balance of good bacteria to prevent overgrowth of disease causing bacteria. This balance can be disturbed by over-washing. - Cotton underwear in older children.
To avoid the groin area getting too sweaty and warm, make sure your child wears breathable cotton underwear. This reduces bacterial overgrowth and stops your child from itching, which may contaminate their bladder. Skirts in girls also allows for air to circulate. - Avoid wearing wet bathers or tight lycra for too long.
If your child goes swimming, be sure to get them out of their wet togs and pat dry the area quickly after getting out of the pool or surf.
THINGS THAT ARE EXPENSIVE AND PROBABLY MAKE LITTLE DIFFERENCE
- Cranberry juice.
- Probiotics.
There is no conclusive evidence that these treatments make a difference in reducing UTI’s in children. They can get expensive and people don’t like taking them for long periods.
ANTIBIOTIC PROPHYLAXIS
Some children with recurrent UTI may benefit from a low dose of antibiotics taken every night. This often helps break the cycle of infection. Some children stop having UTI’s altogether, some have less frequent UTI’s and for others it makes no difference.
We try to avoid antibiotics in the long term because it increases the chance of antibiotic resistance, but they can be useful to break the cycle of UTI.
SYMPTOMS OF UTI
For some children, it can be difficult to tell if they have UTI. Symptoms include fever, stinging urine, smelly urine, pain in the tummy or back and vomiting.
If you are worried that your child has another UTI, take them to a doctor with a urine sample. (Keep the sample in the refrigerator if there is a delay).
This handout originally prepared by:
Dr Tom Forbes* (Paediatric Nephrologist)
Dr Chris Smith (General Paediatrician)
Dr Tom Forbes and Dr David Metz are Paediatric Nephrologists consulting at Melbourne Paediatric Specialists.
