Kids catch lots of bugs in their first few years of life such as colds and other respiratory infections are common as well, but\u00a0kids can get Urinary Tract Infections (UTI) too. Sometimes the symptoms of this infection can be very hard to spot in kids. It is important to get your child treated because a UTI can turn into a more serious kidney infection. For this episode, we have Dr. Nada Sudhakaran, a Paediatric Surgeon from Pantai Hospital Kuala Lumpur to explain in detail about this infection. Q1: What is Urinary Tract Infection? Dr Nada: Urinary Tract Infection happens when there are bacteria in the urinary system. Anything from the kidneys down to the bladder. If you have bacteria in the urine within the system, that is considered a Urinary Tract Infection. Q2: How does my child get UTI? Dr Nada: Bacteria that usually cause infection derives from anything outside of the body that enters through the water pipe whether it is a boy or a girl. It\u2019s more common in girls because the urinary tract, the external part from outside to the bladder is shorter in girls compared to boys. So, girls are more predisposed to getting Urinary Tract Infections compared to boys. So the source of the infection is usually in the groin area, nappy area or underpants area. So they should always change their diapers? Yes, if you have a dirty nappy, you would want to change it early. You don\u2019t want to leave it festering for hours. The longer you allow it to fester, the more chances of bacteria entering the waterpipe. The source of Urinary Tract Infection, bacteria is predominantly from the faeces. So a lot of Urinary Tract Infection is usually due to something called E.coli, which is a common bacteria in the gut. Whether you wash the groin area 100x a day or once a day, there is still bacteria lingering around the underpants area. So that bacteria can enter the waterpipe. Of course, if you keep it clean, there are less amount of bacteria around the area and there is less chance of getting a Urinary Tract Infection. For the boys, you can wash the retracted penis inside the foreskin gently with running warm water. When you\u2019re showering, just pull the foreskin back gently and rinse with your finger. This can reduce the bacteria load in the area that can potentially go up the water pipe and into the bladder. Q3: What are the signs and symptoms of UTI? Dr Nada: If it is quite severe, the common symptom would be fever. It can be variable, so anytime that there is a Urinary Tract Infection, you may not have fever. It may come off later, but the early signs may be tummy pain, a burning sensation when urinating, and (a very rarely) discoloured urine or cloudy urine. The frequency of urine is also possible. So anything that irritates the bladder makes you want to pee more frequently, makes you feel pain symptoms in the lower part of your tummy and when the infection has moved on to your bloodstream become more serious, you can get a fever. It is a systemic response. Fever is more of a later sign. Q4: What kind of treatment and medications would my child receive if he got UTI? Dr Nada: UTI symptoms for boys \tInflammation of the foreskin \tNot wanting to pass urine \tBurning sensation when peeing UTI symptoms for girls \t\u00a0Irritation on the external area\/genitalia \tSensitive to passing urine So to diagnose a true Urinary Tract Infection, you need a urine sample. The best one would be a midstream urine, where you only get the sample of the urine in the middle of that stream and then, the doctor will need to analyse it. UTI for Babies\u00a0 It is the same thing. Often, when they come to the hospital, we get parents to undress them, hold a pod and get ready to catch the urine midway through peeing. Treatments of UTI We don\u2019t always like to assume that it\u2019s a Urinary Tract Infection. So, once it is confirmed as Urinary Tract Infection, of course, we need antibiotics. Some of them are not ill enough to require hospitalisation. Sometimes they are unwell with the fever and so on or they don\u2019t have an appetite or poor intake of fluids which is essential to clear out the system as well. So if they are not taking enough fluids, we will need to admit them to the hospital and give them some fluids through the intravenous line and give some intravenous antibiotics. Most children will be able to be treated as an outpatient with lots of fluids orally or some antibiotics. If they are having difficulties or discomfort passing urine, just let them sit in a bath with warm water and a handful of salt. Just let it dissolve and get them to sit for 10 mins then they would be able to pass urine easily. But once we have confirmed it is Urinary Tract Infection, we then have to confirm that there are no other issues in the Urinary Tract System. So I am referring more to the kidney to the bladder and the bladder itself. Sometimes children who present very early under 5 years of age with Urinary Tract Infection. Until I know there are no other abnormalities, there is no reflux of urine, where it goes back up to the bladder. So, identifying them early\u00a0would mean that we would treat and prevent significant kidney infections or damage. We want to preserve the function of the kidney. One of the key features of children who have Urinary Tract Infection and identify an abnormality in what we call the upper tract which is the kidney to the bladder, is to do an ultrasound scan. So that we can deal with the preventative potential kidney damage. Q5: How can I prevent my child from getting UTI? Dr Nada: \t Food and fluid intake Food and fluid intake are essential. For preventative measures, make sure that the bowel and urine function are okay. Understandably, lots of kids don't like to drink too much water and they refuse to take too much fibre. So eating fruits and vegetables are essential. If you have a good bowel function, then the bacteria won\u2019t grow as much. It is also advisable to take some probiotics or food supplements such as yoghurt for your kids. Probiotics can help with the population of bacteria in the gut. So if your kids got good bacteria in their gut, there will be fewer bacteria that can cause infection. Thus, it is important to eat fruits and vegetables and drink lots of water and supplement them with probiotics. \t Cleaning method For the cleaning method, generally, rinsing is good enough. Using soap in the gentle area is not advisable. You can just wash it with warm water and then dry it with tissue. Even for the boys who come to my clinic, I taught them how to retract the foreskin if they have it, to clean their gentle area. Pulling the foreskin back gently to teach them when they are able to do that and pass urine. Then get tissue paper to dap dry it and return the foreskin back to its normal position. That will also reduce the irritation under the foreskin and also reduce the amount of bacteria that is growing in there. How about going for a bath or shower? Does it affect anything? Yes, so whenever you are in the shower or bath, just remember to wash the gentle areas and underpants area. So you will reduce the amount of bacteria in that area. Don't use soap at the tip of the penis as it is quite sensitive in that area. Q6: Is it true that uncircumcised boys younger than 1 year also have a slightly higher risk for a UTI? Dr Nada: Boys generally don\u2019t get Urinary Tract Infections unless there is a problem. In my practice, there are no uncircumcised boys under 1-year-old have a high incidence of UTI. So there are also pros and cons to early circumcision. I am an advocate for waiting for boys to be around 10 years plus before they circumcise. There is no evidence that shows uncircumcised boys under the age of 1 have a higher risk for UTIs. Generally, as parents, when you\u2019re washing your child, you gently pull back the foreskin as much as possible and gently use your finger to rinse with water. That will reduce the bacteria load. There is no difference between an uncircumcised boy to a circumcised one. Unless they have an upper tract abnormality. As I mentioned to you, if they have a Urinary Tract Infection, there must be something going on with the upper tract. Mainly the system between the kidney and the bladder. So for a child, especially a boy, who has proven UTI by urine test, they must undergo an ultrasound scan. Then only we can find out why there is a UTI and it is not just because they are uncircumcised. https:\/\/www.youtube.com\/watch?v23GsrYE_sdw All in all, feed your child well\u2014it is essential for them to eat a high fibre diet with lots of water. Water is cheap and cheerful, it flushes the system both their urinary tract and poop pipe. Stay tuned to the next episode of AskMeDoctor! only at Motherhood Story.