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  Children's Health

July 2012
Hey Child! Just Pee
Dr Mehul A Shah
 
Children risk urinary infections when they do not use the bathroom or do not empty their bladder at regular intervals. Voiding dysfunction, a behavioural condition, and misconception about infections picked up from dirty bathrooms, are both the culprits. The affected child is in need of help - your patience and re-training to empty the bladder completely .

Urinary Tract Infection (UTI) is a common problem in children and it affects three to five per cent of children by 12 years of age. While structural abnormalities of the kidney and the urinary tract are the most common causes of UTI in children below three, voiding dysfunction is responsible for the large part of UTI in older children.

Common Features
  • In infants, the common features of UTI include unexplained high fever, persistent vomiting and inadequate weight gain.
  • The typical symptoms of pain while urination, frequent urination, leakage of urine into the clothes, and lower abdominal pain, can be observed only in children aged above three years.
  • UTI in children is associated with discomfort to the child, increased medical costs, parental anxiety and loss of school days. Occasionally, there is serious infection of the blood in children aged below one.
Long-term Complications Of UTI In Childhood
  • High blood pressure
  • Protein loss in urine
  • Kidney failure at 10 to 30 years of age

All children start life by being incontinent of urine, both by day and night. Voluntary control of the bladder is gained first by day then by night. Daytime control usually occurs by the age of three and nocturnal control by age five in 85 per cent of children. Regular and complete bladder emptying is an important defence mechanism that protects us against developing UTI. Bacteria are present in every one’s bladder. With regular bladder emptying, we not only remove the urine, but also flush out any bacteria that may be present in the bladder. If urine is retained in the bladder for long periods, the bacteria multiply and cause bladder infection.

Dirty Bathroom Is No Excuse
A common misconception among parents is that children will contract UTI if they use “dirty” bathrooms. UTI is due to bacteria that are present within our body and on skin; it is not acquired from outside agents. Children may get urinary infection when they do not use the bathroom or hold on to the urine for long periods. Often, there is associated constipation too. The treatment centres on bladder re-training programme, to empty the bladder completely at regular interval.
  • The child has to be “taken” to the bathroom first thing in the morning after waking up and then every two hours during the day (both in school and at home).
  • It is NOT sufficient to ask the child to go to the bathroom. A parent has to accompany the child to ensure that the child is relaxed and empties the bladder completely.
  • The child should be encouraged to drink more water and have at least 2-3 fruits per day (not fruit juices).
  • Treatment of constipation with medications and dietary modification is also important. Include more vegetables in the child’s diet to provide fibre. Ensure that the child wakes up at least an hour before time for school and is through with the bowel movements before leaving for school.
  • It usually takes 3-6 months to retrain the bladder and bowel. Good behaviour of the child should be rewarded. Patience, perseverance, and consistency on the part of parents, are the key words for successful re-training.
Dr.Mehul A Shah is a Consultant Paediatric Nephrologist,Apollo Health City, Hyderabad.

    
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