Such in­fec­tions are com­mon, yet eas­ily missed in ba­bies and tod­dlers who are still in nap­pies. EVELINE GAN finds out what you should know about such in­fec­tions and why it is im­por­tant to catch them early.

Young Parents (Singapore) - - Contents -

Here’s why it is im­por­tant to catch th­ese com­mon in­fec­tions early.

1 The symp­toms aren’t al­ways clear-cut.

Does your lit­tle one cry or com­plain about pain while uri­nat­ing, or seem to be wet­ting more di­a­pers than she usu­ally does? Or has she stayed dry for much longer than usual?

Th­ese could be signs of a urinary tract in­fec­tion (UTI) and you should take her to the doc­tor, says the The Amer­i­can Academy of Pe­di­atrics (AAP).

You should also look out for episodes when she passes urine that is cloudy, bloody or has a strong foul smell, or wets her­self if she al­ready knows how to use the toi­let. Other signs in­clude fever, vom­it­ing, tummy pain and lethargy, as well, says Dr Oh Meng Choo, a pae­di­a­tri­cian at Kids Clinic, a Sin­ga­pore Med­i­cal Group pae­di­atric clinic.

But many of the signs can be eas­ily missed in young chil­dren. About one in 20 ba­bies can have fever with­out other com­mon UTI symp­toms. This lack of signs is why this in­fec­tion of­ten goes un­de­tected in in­fants, the AAP notes.

2 A soiled soggy di­a­per is the ideal breed­ing ground for germs.

Many types of bac­te­ria that cause UTIs are also found in the colon (large in­tes­tine), the most com­mon one be­ing Escherichia coli (E Coli), says Dr Leo Deng Jin, a pae­di­a­tri­cian at Thom­son Pae­di­atric Cen­tre (Bukit Pan­jang).

He ex­plains that most UTIs are due to “as­cend­ing” in­fec­tions – the bac­te­ria along the lower part of the urinary tract, like the ure­thra (the pas­sage­way that car­ries urine from the blad­der out of the body), climb and in­vade the up­per parts, caus­ing an in­fec­tion.

Ba­bies and tod­dlers are vulnerable to UTIs be­cause they are in di­a­pers most of the time. They also tend to uri­nate more fre­quently than adults be­cause their blad­ders are smaller.

Wet dirty di­a­pers en­cour­age bac­te­ria to breed on the skin within the groin area, so change nap­pies reg­u­larly, Dr Leo says.

3 Girls gen­er­ally have a higher risk of get­ting UTIs than boys.

Girls have a shorter ure­thra and this al­lows bac­te­ria from the bowel to move to the blad­der eas­ily.

Such in­fec­tions are also com­mon dur­ing the potty-train­ing years, par­tic­u­larly if your tod­dler holds back stools for pro­longed pe­ri­ods. Con­sti­pa­tion can in­crease UTI risk, Dr Leo says.

UTIs can oc­cur due to other rea­sons, too, such as if your child has urinary tract ab­nor­mal­i­ties.

4Boys get it, too, par­tic­u­larly if they have not been cir­cum­cised.

Com­pared to in­fants who have had their pe­nis’ fore­skins sur­gi­cally re­moved, those who’ve not face a four- to 10-fold risk of get­ting UTIs, Dr Leo says. The hy­poth­e­sis is that bac­te­ria may hide and build up un­der the fore­skin and en­ter the urinary tract. A study by McGill Uni­ver­sity’s re­searchers cal­cu­lated that the risk of in­fec­tion may be 88 per cent lower in boys who have been cir­cum­cised.

Dr Leo says cir­cum­ci­sion can im­prove gen­i­tal hy­giene in boys, but the pro­ce­dure “is not with­out risks”.

Dr Oh says the pro­ce­dure is un­nec­es­sary un­less Ju­nior keeps get­ting re­cur­rent episodes of bal­ani­tis, an in­fec­tion of the head of the pe­nis which can cause an itchy red rash.

Dr Leo sug­gests con­sult­ing with your baby’s pae­di­a­tri­cian or sur­geon to weigh the po­ten­tial risks and ben­e­fits.

If your son hasn’t been cir­cum­cised, re­tract the fore­skin to clean his gen­i­tals. This should be done daily as part of the usual shower rou­tine, Dr Leo ad­vises.

“Some­times, this may be dif­fi­cult to do for some boys with a tight fore­skin. In such cases, grad­u­ally stretch back the fore­skin dur­ing a warm shower when the skin is softer and more sup­ple,” he adds.

5For a proper di­ag­no­sis, a urine sam­ple is re­quired.

The only way to con­firm if your child has UTI is to send a urine sam­ple for test­ing. In older kids and adults, this usu­ally in­volves col­lect­ing some mid-stream urine in a ster­ile con­tainer.

With ba­bies and tod­dlers who are not toi­let-trained or are very sick, the doc­tor may per­form a pro­ce­dure known as the in-out catheter­i­sa­tion to get a proper urine sam­ple, Dr Leo says.

This in­volves us­ing a soft, ster­ile sil­i­cone or rub­ber catheter (tube), and thread­ing it up the ure­thra to get some urine from the blad­der.

Be­fore do­ing so, the doc­tor per­form­ing the pro­ce­dure will clean the gen­i­tals thor­oughly to re­duce the risk of bac­te­ria get­ting into the blad­der dur­ing the catheter­i­sa­tion process, Dr Leo ex­plains.

The pro­ce­dure can be un­com­fort­able for your lit­tle one and she may cry dur­ing the process. But it helps your baby’s doc­tor to cor­rectly di­ag­nose UTI, de­ter­mine

the bac­te­ria caus­ing the in­fec­tion and pre­scribe the right an­tibi­otics for it, Dr Oh says.

There is an­other method, which in­volves col­lect­ing urine in a bag pasted over the child’s gen­i­tals, she points out. But there is a chance that bac­te­ria from around the gen­i­tals can con­tam­i­nate the sam­ple.

6 It can turn deadly.

If your lit­tle one has a UTI, she will need to be treated promptly with an­tibi­otics and have her kid­neys checked us­ing an ul­tra­sound scan. If she gets it be­fore her rst birth­day, she may be hos­pi­talised and given an­tibi­otics via drip, says Dr Oh.

Don’t de­lay treat­ment – you run the risk of the in­fec­tion pro­gress­ing to the blood­stream or to other or­gans,

Dr Leo warns.

If the in­fec­tion spreads to the up­per urinary tract, such as the kid­neys, it could lead to kid­ney scar­ring and fail­ure,

Dr Oh adds. And if the bac­te­ria en­ter your baby’s blood­stream, there could be life-threat­en­ing com­pli­ca­tions.

Don’t wait till it hap­pens.

Pre­vent UTI with th­ese ex­pert tips:

Main­tain good hy­giene. If you have a girl, al­ways clean her gen­i­tal area from front to back. If you have a boy, clean his gen­i­tals by re­tract­ing the fore­skin gen­tly.

En­cour­age good toi­let habits. Train your tod­dler to go promptly when­ever she feels the urge to pee or poo. Hold­ing it in can in­crease UTI risk.

Choose cot­ton un­der­pants and avoid tight-tting bot­toms.

Avoid bub­ble baths and other sub­stances like de­odor­ants and per­fumed soaps that can ir­ri­tate the gen­i­tals.

En­cour­age your child to drink plenty of plain wa­ter to “ush out” the blad­der. Avoid giv­ing food and bev­er­ages, like choco­lates and caf­feinated drinks, that can ir­ri­tate the blad­der.

About one in 20 ba­bies can have fever with­out other com­mon symp­toms of urinary tract in­fec­tion. This lack of signs is why this in­fec­tion of­ten goes un­de­tected in in­fants.

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