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Clinical e-News Blog - August

Written by Dr Anne Durkan, Paediatric Nephrologist

Children with UTIs – the questions often forgotten

Urinary tract infection is common in children with 8% of girls and over 2% of boys being diagnosed with at least one infection before starting high school. Whilst those children with recurrent infections are usually assessed with a renal ultrasound, it is less likely that a good voiding history is taken.

Most children will not have anatomical abnormalities, whereas, ​incomplete emptying is fairly common. Asking simple questions such as:
i) how often does your child empty their bladder
ii) describe their stools and stooling habits and
iii) is your child prone to dribbling or wetting, will often unmask potential contributing factors to recurrent UTIs.
Particularly in children with recurrent cystitis, constipation is a major factor. Parents will often deny constipation in their child but will then describe stools consistent with this diagnosis.

Young children should void at least 6 times per day and if they are not achieving this, the fluid intake should be increased. Those children with wetting will often benefit from bladder re-training, that it increasing fluid intake and using timed voiding, whereby children have an alarm at 120-150 minutely intervals to remind them to go to the toilet.

Of course some children will have anatomical abnormalities that may also put them at increased risk of UTIs but in all children basic toileting habits should be assessed, as frequently correction of these habits will result in the most long-term benefit. Finally an awareness of asymptomatic bacteriuria is also important to avoid over-treatment of children who have positive urine cultures but no symptoms. There is no evidence that treatment of these children is beneficial but the risk of developing antibiotic resistance increases.

Dr Anne Durkan is a Paediatric Nephrologist at The Children’s Hospital at Westmead in Sydney.
She was previously a consultant at Guy’s and St Thomas’ NHS Trust in London, after completing nephrology training in the UK, Australia and Canada.
Anne has an interest in medical education and is the immediate past chair of the Advanced Training Committee in nephrology, and is currently on the
Nephrology Curriculum Review Committee. Her clinical interests included transplantation in children and antenatal/neonatal kidney issues.

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