uti in 6 mo old - been refered to paed - any idea why??

[HairyMaclary]

Hi - just wondered if anyone had any ideas why a 6 mo old would be referred to he hospital paediatician after a suspected uniary tract infection. My DS2 has been unwell, not massively but enough for me to take him to the Dr with high temp and rash. Dr advised urine sample which I did and they rang me this morning to say he needs a 7 day course of antibiotics, a referral and a low dose of antibiotics every day until he sees the paed! I was a bit surprised that he had a uti as thought it was unusual for a baby - but even more shocked about the referral - and it's only suspected - I had to give another sample today to check. Is this a bad sign? I don't want to scare myself by googling so thought I would ask here. Any ideas?...

I just found this and thought it fairly reassuring, I hope you do too:

When are further tests advised?

Tests are advised in some cases to check on the kidneys and/or bladder. As a general rule, children under the age of five years who have a first urine infection will usually be referred to a kidney specialist with a view to having some tests. Children over the age of five who have two infections within the space of 12 months will usually be referred to a kidney specialist with a view to having some tests.

The tests that are advised may vary depending on local policies and the child's age. They usually include a kidney scan. There are various other tests that can check on the structure and function of the urinary tract (the kidneys, ureters, bladder and urethra). If a child is referred to a specialist for tests, your doctor may prescribe a daily low dose of antibiotic whilst waiting to be seen. The aim of this is to prevent a further urine infection until the results of any tests are known.

The results of the tests are normal in most cases.

In some cases, a problem is found. The most common condition is called 'vesico-ureteric reflux'. This is a problem at the junction where the ureter enters the bladder. In this condition, urine is passed back (refluxes) up the ureter from the bladder from time to time. This should not happen, as once urine gets to the bladder it should only pass out of the urethra when going to the toilet. This condition makes urine infections more likely. Also, infected urine that refluxes from the bladder back up to the kidneys can cause kidney infection, scarring, and damage. In some cases this leads to severe kidney damage if urine infections recur frequently. Other rare problems that may be found include kidney stones, or congenital abnormalities of parts of the urinary tract.

Diagnosing urinary tract problems in children can make a big difference. Treatment may prevent kidney damage which might have caused high blood pressure or kidney failure later in life.

maybe your doc is worried about prescribing ABs to a baby?

My gp refers at the drop of a hat - both for children's and adults' problems. He always says he doesn't see himself as a specialist and prefers to send you to the experts. It's a bit embarrassing actually as the hospital docs often look at you like a total loser, as if to say "what on earth are you doing here wasting my time you pathetic hypochrondriac?"

Now, if I think there is a danger of a referral, I go to the other GP at the practice, who will not refer you even if you are bleeding out of your eyeballs

It is unusual for boys to get uti's and in small children they may cause kidney damage if untreated, severe or recurrent so it is usual to refer. Sometimes they can be due to bladder reflux which worse case senario is cured by an operation but usually just profalactic antibiotics are given in early childhood. He may be referred for a scan at a later date. All normal proceedure so nothing to worry about.

Oh thanks, I thought it might be something like that - I just didn't want to find the worst case scenario on the internet! I was a bit shocked as I have been enjoying the 'normalness' of him (DS1 has SN) and it's just thrown me - the poor thing must be in such pain.

UTIs are very rare in boys, due to the length of the urethra, and should always be investigated. Could be something simple and easy to sort such as a constriction in the foreskin, but the whole of the urinary tract from the kidneys down need to be checked.

I think it is standard to refer all utis, just in case there is an underlying problem like bladder reflux. Be prepared that he may put your ds on low dose ABs for a couple of years - this has happened to a couple of children I know - this is simply to avoid any further infections which could cause kidney damage, until he is big enough to see if there's any problem or not. Hope he's better soon!

Oh cross posted - thanks everyone - I hope it turns out to be nothing but at least I am now prepared. I hope we get seen before Christmas as I don't like the idea of him being on long term AB's. At least I'm still breastfeeding!

It is indeed unusual for boys to get UTI's but its worth thinking of why and especially insisting on fully cultured urine samples, not just dipsticks. If its a bowel bacterium like E. Coli or any of the others, and most UTI's are, then you need to look to bathtime routines such as

Did you miss the nightly bath for some reason or even several?
Did a nappy change get delayed?

In the bath are you able to retract the foreskin ( if present) and clean carefully?
Are you wiping at the anus only and not contaminating the penis accidentally?
Many modern nappy creams can cause soreness, is he reddish and sore?

The hygiene is ALL important and the answer will lie in routines at home if medical tests show up negative.

hi my dd got a uti at 2 weeks old and cos f that shes been on low antiboitics since then had kidneys scans and an other test to see if its kidney reflux, its routine if they get a uti under 3 years old

angelaki - you are not supposed to try and retract the foreskin

My son has kidney reflux and I have been told it is quite common in boys and they usually 'grow out of it' as the body 'matures'. He has been on ab's since he was born and is due another scan next week to see if it is starting to get better (or cleared). It doesn't bother ds2 at all and he's become quite used to taking his medicine.

why would not having a daily bath cause a uti in a boy? sounds dubious to me. and a bit guilt inducing to lay the blame at 'routines at home' if med tests are neg. do you have any links to support those opinions angelaki? freely admit to knowing practically nothing about utis in newborns but always willing to learn
agree with theblonde re retracting the foreskin - not recommended practice nowadays.
it's good that you've got a referral, it's only like seeing a gp who specialises in children iyswim? i wish we could all take our kids to paeds rather than gps

Morocco I'm a GP and I feel I give my patients and their parents a good medical opinion and they are happy,and often refuse a paediatric opinion if I offer it!

angelaki hygiene has nothing to do with UTIs.And no, you do not retract the foreskin.

HairyMcLary your baby has been referred because UTIs under the age of about 5 and certainly in infants may be a sign of a condition called ureteric reflux. This means that the valves at the junction between bladder and ureters(the pipes that lead from the kidneys to the bladders) are leaky and urine can reflux back up to the kidneys . This can cause infection which can lead to scarring of the kidneys, which leads to them not working fully in later life.
Most babies grow out of it-that is to say that it rights itself as the baby grows. So the antibiotics are to prevent this whilst the body rights itself. In severe cases surgery is needed-this is not common though.

The vast majority of babies with UTIs have nothing wrong.

HTH!

Agree it is more likely they want to rule out a chronic problem such as kidney reflux. dd had a uti at 3 months and went through ultrasound and dye tests for that reason . A chronic problem may need to be treated with a longer course of ab's to prevent infections whereas an acute uti would be a short course and then the urine should be ok.

sorry, neverenoughmistletoe, did it sound anti gp? although i can very often be anti some particular gps I have in mind at times when posting I don't mean to be anti all gps at all and didn't in that particular post either, was aiming for a reassuring note of 'a pead referral doesn't mean anything terrible is wrong' kind of thing.
mind you, many countries have paeds as standard for children rather than gps and I have always preferred those systems,but have also had crap advice from some of them at times as well. my gp is great but I'd always rather take my kids to a specialist in children if there was a choice. i'd have thought that was a reasonable opinion?