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urinary tract infections

My eight-month-old daughter will have some tests to determine if the UTI she just had has any further complications. My concern is with sedating my baby for such tests. Is that really necessary? Furthermore, they requested a couple of blood tests prior to the scannings -- are all of these tests necessary?

Urinary tract infections (UTI's) are not very common in children. When a child has a UTI, she may not have any symptoms except fever. Sometimes there will be an unusual smell to the urine or fussiness with peeing. It is important that the urine be tested by a culture that takes a day or two to grow. It should be a sterile specimen, which in a baby means it should be taken through a catheter.

Many parents believe the infection may be the result of poor hygiene, soiling with bowel movement or wiping in the wrong direction in a little girl who is learning to use the toilet. The truth is, many children who have UTI's have a subtle abnormality of their bladder, kidneys or the tubes that connect the kidneys to the bladder, called the ureter. The most common problem in children is that the junction between the ureter and the bladder is weak. Every time the baby urinates, some of the urine goes backward toward the kidney. When the baby is done urinating, this urine runs back into the bladder, so there is always "old urine" in the bladder. That causes infection that can damage the kidney. Many children outgrow this condition. There may be other abnormalities that occurred before the baby was born.

It is important to test for these abnormalities. An ultrasound shows the shape of the kidneys and bladder and will help determine if there is a blockage in the kidney. Another test puts dye into the bladder through a catheter to see if the bladder empties normally or if urine goes backward toward the kidney. Although this sounds uncomfortable, an experienced pediatric radiologist can do the test with minimal discomfort. This test should be done without sedation to obtain the most reliable results. Blood tests will help determine if there has been damage to the kidney. There may be other tests depending on what your doctor finds. Some children will require daily antibiotics to prevent infection from recurring if something does show up on the tests.

All of these tests are very important. One of the most common causes of kidney failure is failure to identify and treat structural problems with the kidney and bladder. The only sign a child may give of these abnormalities is a single urinary tract infection. Your doctor is right to be so concerned and do these tests.