Question about young child with (possibly) second UTI in short space of time - sorry long!

[mintymellons]

Hello

I'm posting in here as well as 'children's health' in the hope that someone can advise me.

DD2 is 35 months old. She started with urination pain in early December. I have urine dipstick tests at home for my own use (another story!), so when she complained of painful weeing, I tested her urine and it tested positive for leukocytes, non hemolyzed blood and a trace of protein. We took her to the out of hours GP as it was a weekend, and she was prescribed a course of ABs. After a single dose, she was much better. She completed the course. In the meantime though, the original urine sample had been sent of to the lab for culture and sensitivity test and that came back negative for bacteria. I tested her urine again to check if whatever she'd had had cleared, but it was still showing positive for the same things.

So, back to the (regular) GP who sent of a second sample to the lab. Thsi time it came back showing mixed bacterial growth amnd we were told this meant that the sample was contaminated. As DD's symptoms were gone, the GP said she wouldn't treat her and leave it to see what happened.

Well, a few days later she was crying when weeing again so another trip to the GP. This time she dipped her urine but it showed very little wrong with it. On this basis, the GP said she thought that perhaps the painful urination was caused by irritation to the vulva - DD does get sore 'down there' sometimes. We left it at that and she was pretty much fine for the next few weeks.

Anyway, last Monday we were away from home for a few days. DD2 got up and went for her morning wee and immediately cried and refused to continue. I checked her vulva and it was very red/sore looking. I put some cream on as advised and by the following day she was urinating as normal, without pain. She continued to be ok for two days, and then last Thursday was complaining of pain again first thing.

I decided to return to the GP to see if they could recommend any better cream - I wasn't really thinking of a UTI at this point. I took a urine sample along anyway and when dipped this showed leukocytes. The GP asked if she'd had a temp and I told him no, just the burning when she wees, on and off for the previous few days. He said it didn't sound like a UTI and gave me more cream for her vulva (which wasn't sore at this point). He did also send the urine sample to the lab to be on the safe side. Fast forward to today and I get a call from GP office to go and collect a prescription for ABs for DD2 - the lab culture showed bacteria and therefore positive for infection.

I spoke to the GP on the phone and he said he is going to look at the guidlines for children with recurrent UTIs and get back to me if it needs to be taken further.

This has left me really confused. Firstly I don't know if she did have a UTI the first time back in December. If not, what did she have? How does that tie in with the sore red vulva which obviously causes pain when she wees? Basically, WTF is going on with her?!

She is perfectly well apart from the painful wees. She isn't weeing more frequently, is dry at night etc...

I'm still not convinced that this current bout is actually a UTI. Is it possible for bacterial growth to come from elsewhere?

Sorry this is so long and drawn out, but it's doing my head in! Has anyone else had this with a child?

Thanks for reading!

It's quite difficult when they're little I think to decide whether the soreness when weeing is due to the urine or just because they're sore outside iyswim? Possible she has some sort of bacterial bug in her vagina rather than up in her ladder/tubes and the sample is being populated as it comes out?

Just some thoughts;

Have they determined which bacteria?

Are you doing her wiping or is she doing it herself? - back to front wipe, clean piece of paper each time.

Get her to have a wee standing in the shower - it's a good way to make sure the bladder is completely empty and give her a stool to put her feet on when on the loo - again helping to make sure she empties her bladder.

You could try a couple of drops of tea tree oil in her bath - good for fungal and bacterial infections.

Is she drinking plenty? Drinking cranberry?

Are the AB's causing thrush - again more irritation?

GP may go with prophylactic anti-bs and perhaps some tests, kidney scan and scan of her passing urine. usually they have to have 3 or more confirmed infections for them to do that I think.

Poor her and you - we've had a lifetime of UTIs with dd - that's what it feels like anyway.

Thank you so much for your reply, Dame and sorry that you've had lots of problems.

My theory (such as it is) is that the soreness around her vulva could be causing bacteria from there to get into her urinary tract or, like you said, that bacteria from her vulva is contaminating the urine sample. As far as I know, the bacteria is e coli - she's been given Trimethoprim which I understand is the bog standard AB for treating this bacteria.

I wipe her after she's used the loo so I'm def doing front to back. I suppose it's possible that she's not fully emptying her bladder - I'll try the stool thing. Ditto the tea tree in the bath.

She drinks an average amount but probably should drink more under the circs. I've tried to tell her this and keep foisting drinks on her, but it's hard! I haven't tried her with cranberry as there seems to be so much conflicting advice about it.

She didn't have thrush from the first ot of ABs, although this time she's been given a higher dose, so might well suffer after :(

It's all just so frustrating, not really knowing if she has a UTI or something else and obviously not nice seeing her in pain on the loo.

Just another thought - is there any chance she has threadworms? Could she be scratching/sore and transferring bacteria from bum to vagina? And is she constipated, that can mean they have trouble clearing the bladder.

dd had Trim prophylactic as a toddler, for a couple of years iirc. She had all the scans and they were clear (though her tubes are a bit short) but she always had trouble emptying fully even now. She's 19 now and has recently had all the tests redone after another difficult period of constant infections. She won't drink cranberry but we seem to have had some success with cranberry capsules so are going with what works Trim didn't work during this last period even though it was e-coli so she had a combo of others. I do sympathise.

Does she have bubble bath etc in the bath?

Dame, I'm fairly sure it's not threadworms as she had those last summer (twice!) and we got rid of them and they haven't been back. She didn't have any urinary symptoms when she had them.

Cabbageleaves, she has a small squirt of bubble bath, although I've cut that out now.

What types of fluids does she drink?

Hidden, she drinks milk or weak cordial. I give her water with her meals but it's not her favourite.

Okay, sometimes acidic drinks can irritate the bladder which leave it vulnerable to infection.

I'm an old hat at this so marking my place and perhap s abit too tired to post etc.

Dd9 has had repeat UTIs since aged about 3. She has scarring on one of her kidneys. I don't say this to scare you but to ensure that you always pester the gp if you think she has a UTI and not to ignore it yourself.

Please be aware of a condition of a vaginitis. This is where pre pubescent children get sensitive on their vulva. When they wee, it stings much the same as a UIT. I was advised by the paed to give her vinegar baths. Some nights she used to wake up in a state with itching that would only be relieved by a bath. I would also check threadworms. I have medicated for this on a number of occasions just as a precaution.

Will check back tomorrow as pretty tired

Nomads, thanks for posting.

We were very much thinking that she does have vaginitis and the Gp prescribed cream, but obviously the culture showed a uti. She does get sore and red but not itchy.

Another one here whose dd now 8 had recurrent utis from age 4. She also has scarring on one of her kidneys. I would also stress that you make sure every thing is checked and doublechecked each time your dd complains of soreness. I found with my dd that a sore vulva was usually linked with a uti.

My dd is quite a lot better now as in her case the utis were mainly caused by reflux in her bladder and she now longer has this but it's been quite a few years with repeated scans, antibiotics and visits to the urologist.

The urologist did stress to us the importance of making dd's school aware of her condition so that she could drink whenever she needed to and go to the loo. We were also told that probiotic drinks were good for the bladder aswell as cranberry juice.

HTH

Thank you Orange, that does help. I'm worried that her kidneys may have been scarred as it seems like she may have had this current one a good few days but we mistook it for a sore vulva.

Sorry to hear your DD has suffered. Glad things have improved though.

Minty - you could make sure you have a couple of urine pots at home. You might be able to get an arrangement with the surgery just to send off the urine without seeing the gp. A fair few times dd showed conflicting signs or symptoms that were gone the next day. Also, when they're so little they don't have the language. I wish I'd been more insistent. Get a urine sample every time she shows the vaguest symptom.

I totally agree with being insistent nomad. However I did find it depended on which doctor I spoke to at my surgery. One particular doctor stood out for me in that she followed up everything really quickly and would leave urine pots and paperwork behind the receptionist's desk for me to collect. If I'd spoken to her everytime I don't think my dd would have scarring

mintymellons your dd is only 3 and it is so difficult to work out the symptoms. I missed things that I probably should have spotted earlier but often my dd appeared quite well and it was only later something was picked up. It is difficult for them to tell you what's happening too.

DD had this - she had to go for a kidney scan just to check they were functioning normally, this is routine in UTI cases in Under 3s so don't panic.

We also found that switching to non-coloured/chlorinated nappies helped too, so we buy Natys which are available at larger Boot stores.

Thanks again everyone.

We're nearly finished the ABs now and she has been fine since starting them. Just hoping it doesn't return when she stops. I'll be watching her like a hawk for signs! No word from GP about a follow up, so he's either forgotten to check or doesn't deem it necessary at this stage.

Orange, you're so right about how difficult it s dealing with a variety of GPs and having to be pushy. It must be frustrating for you feeling that you weren't taken seriously enough initially.

World, I'm actually quite keen for her to go for a scan just to be on the safe side. Thank you for your tip about nappies. DD only wears one at night, but I will look at changing them.

Oh yes, defo depends on who you speak to. I remember gp telling me to collect pots on the way out. When I asked the receptionist if I could have some pot s, she complained that I wasn't entitled to them and she only had one left. I sighed and said well I'll just have to waste the gps time then when I think dd next has a urine infection.

Hi, another one with a dd who suffered from a very early age! She is twelve now and still has the odd problem.

With mine it was two things, bubble bath or wipes or anything like that near her; and secondly, constipation. When that was bad, it affected her urine output, all the pressure.

A consultant confirmed this and she ended up on movicol long term, still has the odd one now. Had a scan too to rule out scarring.

Oh and they never drink enough do they!

Worth a thought!

Hi again

Just wanted to update.

DD finished her ABs just under a week ago and is no longer having urinary pain, however for the last couple of days and she has had a very sore, red vulva/anus again. The best way to describe it is like a bright red ring which starts at the top of her vulva where the 'split' begins and spreads all the way down and round her anus. It's very clearly defined. She has had this on and off before as I mentioned in my OP. I'm using barrier cream tonight, but for the past week I've been applying a thin layer of Timodene cream which the GP prescribed.

I'm just dreading her saying it hurts when she goes to the loo again! I'm also baffled as to what causes this rash (starnge how it comes and goes) and whether or not it's linked to UTIs or even if she has had something other then a UTI. I just don't know.

Sounds a bit thrushy - with the defined edge.

Is she properly dry - not leaking at all, no damp pants?

Poor thing.

Hi sorry to hear your dd is still suffering. My dd suffered with the redness you describe and when I talked about it with the paediatrician she prescribed 'Zidoval' (TM), active ingredient Metronidazole 7.5mg Vaginal Gel. This gel did seem to work well.

I was told at the time not to use Canesten cream as the redness was not caused by thrush.

Hope your dd gets better soon.