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Definition
- A bacterial infection of the bladder
- Also called cystitis
Health Information
Symptoms
- Pain, burning or stinging when passing urine
- Suspect pain if a young child starts to cry while passing urine
- The feeling of "can’t wait" to pass urine may occur. This is called urgency.
- Passing small amounts of urine at a time. This is called frequency.
- New onset of day or night -time wetting
- Pain in the lower abdomen may also be reported. If the kidney is infected, the pain is in the flank. The flank is the side right below the ribs.
- UTIs are a common cause of unexplained fevers in young children.
- The urine may be cloudy and have a bad odor. Sometimes, there is some blood in the urine.
Causes
- UTIs are caused by bacteria that travel up the urethra into the bladder. The opening of the urethra is just above the vagina.
- Irritation of the vulva may be the underlying cause. Common irritants are bubble bath and soaps. Stool that gets on the vulva is another big factor. This can happen with careless wiping or with constipation.
- A rare cause is not emptying the bladder completely. Reason: Urine that stays in the bladder too long can become infected.
- Cystitis is more common in females than males. This gender difference may reflect the much shorter length of the female urethra.
Diagnosis
- A clean catch urine sample needs to be tested. A UTI is confirmed by finding white blood cells in the urine. A positive culture for bacteria is also required.
Prevention of Recurrent UTIs in Girls
- When your child bathes, cleanse the genital area with warm water. (Soap is not needed until after puberty)
- Don’t use bubble bath, shampoo or other soaps in the bath water. (Reason: They are irritants.)
- Keep bath time less than 10 minutes. Your child also should urinate right after baths.
- Teach your daughter to wipe herself correctly from front to back after a stool.
- Drink enough fluids each day to keep the urine light-colored.
- Urinate at least every 4 hours during the day and avoid ‘holding back.’
- Wear cotton underpants. (Reason: allow the skin to breathe.) Discourage wearing underpants during the night.
- Avoid constipation.
Care Advice
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Overview:
- Bladder infections are common in girls.
- In young girls, soap vulvitis is the most common trigger.
- Here is some care advice that should help.
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Antibiotic by Mouth:
- UTIs need a prescription for an antibiotic.
- The antibiotic will kill the bacteria that are causing the bladder infection.
- Give the antibiotic as directed.
- Try not to forget any of the doses.
- Give the antibiotic until it is gone. Reason: To keep the bladder infection from flaring up again.
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Pain Medicine:
- For pain when passing urine, give a pain medicine.
- Give acetaminophen (such as Tylenol) or ibuprofen.
- Use as needed.
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Fever:
- For fevers above 102° F (39° C), give acetaminophen (such as Tylenol) or ibuprofen. Note: Lower fevers are important for fighting infections.
- For ALL fevers: Keep your child well hydrated. Give lots of cold fluids.
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Give More Fluids:
- Give extra fluids to drink. Cranberry juice may be helpful.
- Reason: Dilutes the urine so that it does not sting.
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Baking Soda Baths - Young Girls Only:
- Soak for 10 minutes to remove germs and to help with healing.
- Add 2 ounces (60 ml) baking soda per tub of warm water.
- Reason: Baking soda is better than vinegar for young girls.
- During soaks, be sure she spreads her legs. This allows the water to cleanse the genitals.
- Repeat baking soda soaks 2 times per day for 2 days.
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What to Expect:
- Fever is usually gone in 24 hours.
- Pain and frequency are usually much better in 48 hours.
- Bladder infections occur more than once in 10% of girls.
- For any unexplained fevers, be sure your child is seen for a urine check.
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Return to School:
- Even if your child has a bladder infection, it cannot be spread to others.
- Your child does not need to miss any school or child care.
Call Your Doctor If
- Pain when passing urine becomes severe
- Fever lasts over 48 hours after starting the antibiotic
- Vomiting and can’t keep down the antibiotic
- You think your child needs to be seen
- Your child becomes worse
Author: Barton Schmitt MD, FAAP
Copyright 2000-2020 Schmitt Pediatric Guidelines LLC