Urinary Tract Infections in Babies

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1 yr. old with first time UTI
Baby boy urinary tract infection
Bladder Reflux in 2.5 month old

1 yr. old with first time UTI

March 2005

A friend of mine has a 1 year old daughter who was diagnosed with her first urinary tract infection. Her lab results showed E.Coli which I don't think alarmed them but proved that her infection was from feces entering her urethra. She was referred for a renal ultrasound to make sure everything was where it should be. This wasn't painful, but of course, her baby screamed and cried from being held down, and looked quite betrayed. Now they are referring her for a 6 week follow up to get a VCUG catheter so they can inject dye up her ureters to see if they're straight enough to allow things to flow in the right direction. This will be quite an invasive and miserable procedure for this little one year old, and my friend wondered if this recommendation was typical for a baby that's only had one UTI. Is her pediatrician being overly cautious and conservative? Have any of you had an infant with a UTI and is this what your pediatrician recommended as well? Johanna

To answer your question, I do believe it is a pretty standard response to first UTIs, but that said, I don't know that it is the right or only way to go (although I don't have any concrete alternatives, sorry).

My daughter had a UTI when she was 9 months (she is now 7 years old). She had the VCUG procedure which indicated stage 1 and stage 2 levels of dialation (fairly minor, but indicating the ureter tubes had slight openings in which the urine could travel up instead of down).

At the time, the advice was to put her on prophylactic antibiotics for 1 year until the ureter tubes matured, ''in case'' she developed another UTI, which could send the offending bacteria up through the ureturs and into the kidneys, brain. We were terrified of that scenario so of course, we followed the doctor's orders.

However, after noticing her immune system weakening (she started getting tons of ear infections), talking with other folks about the dangers of antibiotics, and the low levels of dialation, we decided to take her off the antibiotis and trust that if she got another UTI, it would be evident and that we could get her treated in time.

AT the time we also had a family doctor, not a pediatrician and looking back I don't think their office had the experience to deal with this major pediatric issue.

We did have her rechecked with the VCUG as recommended about 1 year later and her ureter tubes were normal. However, I regret having done both of these procedures. It is super invasive and they do strap your little darling down and it is agonizing. I guess I do not beleive it was totally necessary or that she was at a high risk, but this is just my opinion.

I hope your friend gets responses from folks who may know of alternatives to the procedure. anon

Our daughter had a UTI at 7 months or something like that ... I can't remember. We too were concerned about the VCUG (I think that's what it's called...) Anyway we did a bunch of research on it (and were highly skeptical about it's necessity) so we met with our doctor to talk about why she recommended it. We also didn't like the fact that we had to keep her on antibiotics while it took two months before we could be seen at Children's Hospital.

Anyway, we decided after the research and discussion with our doctor that it was the responsible thing to do. The chances were 30% that there was a problem and if there was a problem we should know about it because it could cause some long term damage to her kidneys. I decided that a miserable afternoon for my daughter (which it was!) was better than a life of dialysis. Of course that is the extreme but I didn't want to live with that. We did the test at Children's and I think everybody cried (except the technician.) But looking back it was much better than other procedures she's had to endure. Kids are so resilient and at that age they don't really remember much. I'm not trying to downplay the horror of seeing your child in so much discomfort and strapped to a table, but it's the small price we pay I think for having access to healthcare which for the most part extends many many lives and protects us from things that used to kill.

In the end my daughter did have a mild mild case of stage one renal reflux. Not enough to warrant keeping her on antibiotics long term. She hasn't had a UTI since and we've been VERY careful about wiping since. I'm glad we did the test. And I'm glad we live in a place that we have access to it. And I'm glad I have access to healthcare insurance so we could have it. And mostly I'm glad that we found out everything was ok rather than waking up at night wondering if there were things I didn't know about my daughters health that I could help prevent.

Good luck with your decision. Anon

The same thing happened to our son when he was 5 months old. He had the ultrasound and then the VCUG. That showed that he did have some urinary reflux that was causing some urine to get pushed back up into the kidneys. That's good to know because every infection can cause scarring and damage to the kidneys, so you don't want to keep having them. He had one more infection a few months later and then at 18 months a repeat VCUG showed that he had outgrown the problem (pretty common, I hear) and he's is a healthy 8 year old now. Good Luck

AT the time we also had a family doctor, not a pediatrician and looking back I don't think their office had the experience to deal with this major pediatric issue.

I hope your friend gets responses from folks who may know of alternatives to the procedure. anon

Yes, it is part of the work-up to have the VCUG test. My daughter had a UTI at 6 months and the VCUG showed that her ureters (the tubes from the kidneys to the bladder) weren't strong enough to push the urine down completely and that there was some back flushing up the ureters to the kidney. The problem arises when infected urine flushes back up, then you can have a kidney infection with scarring and damage that can affect kidney function later in life. The primary treatment is preventive antibiotics for some time (this is very variable depending on the doctor, but is usually for 6 months or more!). This is a not uncommon condition and kids usually grow out of it by having stronger ureters by age 3, otherwise surgery may be in order. So the main thing is to prevent infection by antibiotic use. When your daughter is older they may use urinalysis and culture for any unexplained fever to catch an infection if you don't use preventive antibiotics. Sharon

My pediatrician also recommended the renal ultrasound and VCUG after my then 2 1/2-year old daughter had her first UTI. Her reasons were these:

1) The type of bacteria found was very plentiful, and very unusual. It wasn't E-Coli, but I'm afraid I don't remember what precisely it was (this was 2 years ago).

2) My daughter had a history of withholding bowel movements, and my ped. thought that she might have had other, ''silent'' UTI's that were masked by the withholding behavior.

Further, this seems to be the protocol. According to the AAP book, ''Caring for Your Baby and Child,'' ''most specialists now feel that after your child's first serious urinary tract infection, further tests should be done (ultrasound, X rays, or renal scanning examinations).''

And you are right, it is invasive and very painful, or at least highly unpleasant. My daughter screamed the entire time. The insertion of the catheter was bad enough, but what was truly horrible was when they filled her bladder with fluid. It was heartbreaking.

As soon as they removed her catheter, she felt fine (though she needed about 10 minutes to recover emotionally). The tests also showed that her body was functioning normally, and all she needed were antibiotics.

In a way I was relieved that we had done this test and it proved definitively that there were no problems. However, I also felt it was over- cautious, and questioned whether the pain and trauma involved was worth it. I'm still conflicted to this day about whether it was the right thing, but as a different doctor friend reminded me, kidney function is too serious to risk. Christine

Dear parents dealing with UTIs and their daughters,

I just had to respond and let you all know that the procedures that they perform on your daughter which are invasive CAN have lasting and very detrimental mental and physical ramifications. I myself had chronic urinary tract and kidney infections as a little girl (started at 4 and finally self-corrected at 11). I had some ''flap'' missing that allowed urine to travel back up.

My urologist at the time repeatedly performed (over 7 years) extremely invasive procedures while I was strapped down and awake. Those were different times and my mother wasn't allowed in the room with me. I had no one to comfort me or hold my hand and because of this treatment I have been unable to have a normal, enoyable sex life--I am so tight and terrified. To the person who thinks children don't remember much, we do. Our bodies do. I wasn't able to see on ob until I was 23 and finally got the courage up to do so because I knew it was important. Pelvic exams are beyond terrifying to me. I've been to a lot of therapy because of this and finally found a progressive urologist who treats people with pelvic disorders. My entire pelvic floor muscles had to ''re-trained'' to release the trauma and tightness. This has been without a doubt one of the most horrible and debilitating issues of my life.

I have a daughter now and have talked with her pediatrician about my issues and asked him if things are done differently now. He told me they were, but when I read that children are still strapped down like that and that the treatment is ''agonizing'' as some of you wrote, I just don't know. I'm not advocating not doing treatments or the VCUG if it's necessary, but please be aware that it can have long term detrimental effects. Be AWARE of any procedures performed on your daughter in treating UTI and BE IN THE ROOM to hold her hand and comfort her in this very scary and vulnerable time.

I wouldn't wish my situation on anyone. anon

Although I have responded to this post before, I feel compelled to answer or dispute some of the info in the last response signed ''I wouldn't wish my situation on anyone''. The details she relays about her own condition in the distant past are similar to mine. I had a supposed narrow urethra that was widened by sticking tubes up the urethra with alot of pain at the time (although no issues to date). That procedure is not effective and was one of probably many used at the time without any evidence of their therapeutic value. I may or may not have had the condition we are now discussing of having ureters that weren't strong enough to push the urine down without some backflushing.

First, the VCUG is not a ''treatment'' but a diagnostic test used in a limited manner to view the ureters and the kidney.

Second,my daughter was strapped in such a way to immobilize parts of the body that might interfere with the test if they were to be flailing around - it was not a gratuitous or mean spirited action. This is the way many tests work and I can't comment any more on this aspect. I could hold her hands and look in her face. YOU WOULD BE IN THE ROOM with her.

Third, this should not cause any long-term damage, either psychological or physical - this procedure is similar to putting a foley catheter in - a common procedure in adults to start urine flowing after surgery, etc. It is uncomfortable, but my daughter DOES NOT remember a thing from having this done 1 year ago. Your daughter will probably have this test done twice before she is four - not frequently.

Good luck, Sharon

Baby boy urinary tract infection

August 2002

My 18 month old boy has been diagnosed with a urinary tract infection. This is quite uncommon. He is uncircumsized. He is on antibiotics and will have to get an ultrasound and a procedure where they inject dye into his penis through his urinary tract to see if his anatomy is working well. Is there anyone out there who has had a similar experience with their boy? Are their any homeopathic remedies? Any prevention? Do you know what causes these UTI's? any advice would help.
Yancy

My son, now 6, had a UTI at 2 months. Because of his age, he was hospitalized overnight and then took the course of antibiotics. He's had no UTIs since. At that time they told me that though unusual, uncircumcised boys (he's uncircumcised) got UTIs four times as frequently as circumcised boys, but that the frequency of UTIs in boys was so small that statistically this was not enough of a reason to advocate circumcision. At that time, they said they would recommend circumcision for him (which is a much more major event than when the baby is a newborn) only if he had 2 more UTI's within a year's time, which never came to pass...
jb

It sounds somewhat similar to what our son had as a newborn (although he did not have an infection). The VCUG (the x-ray with the dye) is done to check if there is ''reflux'', i.e. if urine can flow back from the bladder to the kidneys which can cause kidney infections.

Here is our son's story: His kidneys were enlarged on the prenatal ultrasounds. So he had a follow-up ultrasound when he was 10 days old. As the kidneys were still slightly large he was put on antibiotics until the VCUG ruled out reflux (don't worry, it doesn't hurt them although he screamed bloody murder when they tried to put the catheter in; he just hated being touched there). We were told if he had reflux it could be fixed by a minimal invasive surgery (if I remeber correctly). We needed to follow-up with more ultrasounds as his kidneys were still enlarged (but getting better; the next ultrasound (the third after birth) will probably be the last one). We were always told that if he doesn't outgrow it, it is something that is fairly easy to fix.
Ina

My daughter has ureteral reflux that demonstrated on the dye exam that urine was back-flushing or back-flowing to the kidneys (very high up) when she was 6 months old (she had a urinary tract infection). She was on antiobiotics for only 6 months, and then we just monitored her for any unexplained fevers (which could indicate that she had an infection). Actually at any fever I would get a ''bag urine'' to get a urine culture done to check for infection just in case. An undetected infection with this condition could cause kidney scarring and would be VERY serious. She has never had an infection since the 1st one. This is an anatomical/functional problem that some children grow out of as the muscles get stronger where the ureters insert into the bladder and squeeze tight enough so that back-flow would not occur. I don't see how homeopathic treatment could be effective. It is very common for children to be on short-term antibiotics, although there is very little good evidence to show what the duration should be. Anonymous

our son had a uti when he was only 3 months old. he is also uncircumsized. in order to make sure it wasn't an anatomy problem we did all the procedures you described - - antibiotics, ultrasound and the uncomfortable dye injections. he loved talking the antibiotics (crazy kid!), but the other procedures were uncomfortable for all of us. thankfully all of the doctors (at Kaiser Oakland) that we interacted with were sensitive and kind. he has had no recurrances. we also had questions about the causes, and preventions. we were told that it was more common in uncircumsized boys, but all the numbers were very small. other than that and ''be more diligent about cleaning his foreskin'' we didn't get much info or advice. our guy wasn't eating anything but breastmilk at the time, so i don't know if there are any food/drink remedies for kids. good luck.
jolie

Hello
My 2 year old son went through the similar experience when he was 7 months old. Unfortunately, he had to have the dye inserted to determine whether he in fact had a UTI. The procedure only took about 30 minutes. The dye was inserted through a catheter which was inserted into his penis. The doctor assured us that it was more painful for us to watch that than what our son experiencing. He didn't cry at all when the catheter was inserted so I felt fairly comfortable that he was telling the truth. When he really started crying was when they began moving all the medical equipment around in the hospital room to view where the dye was flowing. That obviously was a frightening experience for him as he didn't know what was going on.

I was living in Australia at the time and the doctors there said that I could delay having it done but the sooner I found out whether he had a UTI the better. Depending on the various stages of the UTI a further operation may be required to fix the problem. I was told that if a UTI is not detected in time it will cause problems for the individual as their kidneys are effected. The problems may not surface until years down the road, but they will eventually surface. Unfortunately for you, they also recommended having it performed sooner so the experience was less traumatic for our son as he wouldn't be fully aware of what was going on. Therefore, I would definitely recommend you talk to him about it before hand so you can minimise any trauma the procedure may have.

Before I had the operation my pediatrician had another doctor review the results to ensure the procedure was absolutely necessary. They also told me that it was an uncommon thing for little boys to get UTI. My son is also uncircumsised and they assured me the UTI did not have anything to do with that fact. Apparently, it is not uncommon thing for little girls to have.

I was told there really wasn't any other way to detect with absolute certainty whether my son had a UTI. He had had many urine test and I became an expert at catching his pee in a cup during that time, but you don't know with certainty until you have this procedures (the exact name escapes me at the moment). They told me the effects probably wouldn't surface until he was a middle age man, but if he had a UTI they could fix the problem now rather than 40 years later.

Luckily, our son didn't have a UTI after all. It was a good feeling knowing with certainty that everything was okay.

Good luck to you and your son!! Florinda

My son who is also uncircumcised had a UTI at age 23 months. The infection wasn't treated long enough and recurred 3 days after we stopped the antibiotic. We switched to a different antibiotic which cured him. He is 3,5 years old now and hasn't had a UTI since. He is also out of diapers which might perhaps helps to prevent it. After the UTI we gave him cranberry juice for a couple of months.

He saw a Pediatric Urologist who recommended the IVP (insert a catheter, inject dye ,take an X-ray of the kidneys and urethers etc...) even though his ultrasound was entirely normal. The urologist told us that the insertion of the catheter could cause scarring of the urethra which might require surgery later. Also our son might need general anesthesia during the IVP if he wouldn't hold still and she recommended to do a circumcision at the same time. (Blaming the fact that my son is uncircumcised for the UTI.) I guess you can tell that we weren't pleased with her advice. We decided to be pleased about the normal result of the noninvasive ultrasound and forgo the 'trauma' of the IVP until he had at least a 2nd UTI which he never got. We did this in agreement with his Pediatrician. Good luck, Karin.

Hi Yancy,
This is not really uncommon. My son was diagnosed with the same thing at 7 days old. He had a very high fever -shy of 104- and we had to go through the VCUG's (dye by catheter), ultrasounds and everything. My son was born with a defect. One of the pipes that go from the kidney to the bladder does not close completely which makes the urine -at the time to empty out- shoot back up to the kidney creating a reflux. If the urine got into contact with bacteria, the kidney gets infected and

damaged. This doesn't mean that your son has the same thing. Sometimes the pipes connecting the kidney to the bladder have different distance from each other creating an imperfection; they can also be connected the wrong way. It can also mean that his urine was infected somehow and it will be his one-time experience and that would be the end of story. Which I truly wish it is.

My son is still on antibiotics and that would be until he has surgery. He is schedule for his third VCUG at the end of this month. Is sad but is the only way he can keep his kidney growing.

Hopefully this information will be useful for you. If you have any questions please feel free to email me.
grecia

We took our daughter to the emergency room when she was nine months old- she had a high fever and projectile vomiting. They determined she had a UTI and admitted her to Children's Hospital. She had to stay for 3 days until they could culture the urine and determine the exact strain of infection. This was done to determine the appropriate antibiotics. I was told that she would have to undergo a procedure to determine if she had ''ureter reflux'' a condition where the ureters are dialated and urine shoots back up towards the kidneys. The fear is that another UTI could send a baterial infection up to the kidneys and ultimately the brain if there is reflux. We scheduled the procedure for the dye, xray, etc. If was very traumatic for all of us and broke our heart to see our baby girl in so much fear/pain. The result was she DID have a very minor reflux- stage 1 in one ureter and stage 2 in the other. Stage 5 is where the ureter is quite dialated (I am not a doctor or medical professional, so my description may not be entirely accurate, but I think it's close).

Anyway, the ''treatment'' for the reflux was to put her on prophalactic antibiotics until she outgrew the reflux, thus in case she got another UTI, the antibiotics would kill off the infection before it got to the kidneys. As new and concerned parents, we followed the doctor's orders at first. Then, of course, it seemed she was getting sick alot with colds and ear infections. We decided to take her off the antibiotics and ''wait and see,'' feeling we would know the symptoms of another UTI and could act accordingly. Of course, she never got another UTI. After about a year or so, her immune system recoved and now she rarely gets colds (she's 4.5). Unfortunately, she has had some weird disharge from her vagina and know one could figure it out. We took her back to the uroligist who said we should first rule out the reflux (we were supposed to have rechecked her anyway after about a year, but we hadn't). Again, we were afraid so we did the test . It was just as horrible the second time and my husband and I are now furious that we submitted to the pressure of retesting her.

Anyway, it is hard to know what to do in these situations when your child is ill. My only advice is to do what you think is best. I just wanted to share my story in the event it might help. I would love feedback from others on this issue.
ariel

Bladder Reflux in 2.5 month old

July 2002

My son was born with a condition called bladder reflux, he is now 2.5 months old and without infection. Does anyone else have experience with this? We found this out serendipitously through a VCUG (looking for PUV which didn't exist) days after he was born. He is currently not on any antiobiotics and we don't want to circumsize. I would love to hear your story and what worked and didn't work. So far, we are doing nightly baths and he is taking a homeopathic remedy to boost his immune system overall. I've also tried cranial-sacrial work for the same reason. We are working with a great doctor through UCSF named Dr. Nguyen whom I would highly recommend. w

My son was born with the same condition. Doctors talk about several levels of it. My son is in the higher ones. Some kids repair themselves as they grow. My son is 20 months old and he will be rescheduled for another VCUG in august. His doctor is Dr. Paul Lee from Kaiser. He is an excellent doctor, he is the head of the Urology department at Kaiser and he also teaches at Stanford. He says that there is another way of treating this reflux. This is a Laser operation that inserts cartilage (previously grown from the recipient) into the bladder creating a smaller hole that would be able to close to avoid the reflux. But it is only a research that is going on at Stanford and they do not know the risks. He says they have been doing it in England for years but in USA is more difficult to go ahead because of these unknown risks.

My son has had two infections. The first one, when he was seven days old after his circumcision. The second one when he was three months old. He was not on antibiotics, now he is on them everyday. He has two scars in his left kidney (the reflux occurs on the left side of the bladder) which had make the kidney smaller. One more bacterial infection and he has to go to surgery. We are really tired of the whole VCUG and antibiotics dosages but it is the only way to avoid surgery and maybe a miracle can happen. g