Urinary Tract Infection in Baby Girl

I am a nurse in a hospital NICU. We do these tests on any baby who has had a UTI from urine obtained by an in and out catheter. A bagged urine specimen could be contaminated. A cathed specimen, if obtained correctly, shouldn't have contamination. The reason you want to have these tests is to rule out reflux into the kidneys. If urine is backing up from the bladder into the kidneys, it could cause a life-time of problems. Generally, I would say about 1/2 of our kids who have a UTI end up with this reflux problem. They are put on a low dose preventative antibiotic to prevent further infections and damage to the kidneys. You can discuss with your doctor an option to wait until the next bladder infection. But as one poster said, you could have a lot of damage done by then. Usual tests we do are an ultrasound of the kidneys, and then a VCUG.
Good luck. You have to do what you feel is right, and what you can sleep with. I will tell you, when my son was 4, I felt a lump on his abdomen after a small accident. I took him to the ER to get it checked out. The lump was located over his liver. I had a PA tell me it was his diaghram. They took an x-ray, and saw a mass, but my ped, who I just spoke to on the phone wondered if it was stool in his intestine. (She had not seen the x-ray, so was speaking off of the top of her head.) Their CT machine was broke, so they asked me to return in the am. The next morning, I couldn't even feel the lump anymore. But because I wanted peace of mind, and didn't want a problem later, I took him in. Turned out there was a tumor on his liver. 24 hours later, he was in surgery having it removed, and the surgeon prepared us for the worst, Cancer with mets to the lung. Fortunately, we got lucky, and it was a benign thing, rare, and it would have needed to be removed eventually because the liver had started to make room for it. My point is, even if something looks OK, you don't know what's happening under the skin. Peace of mind is wonderful, and knowing you aren't missing something that could have been picked up earlier is great. However, if you find out everything was normal, and will be kicking yourself that you put your child through this unnecessary test, than maybe skipping it is what is best for you. I knew I wanted peace of mind.
Good luck in your decision. Doctors and parents should be partners in their child's care.

Hi, J.. My daughter had her first UTI at the age of 4 months, and I was surprised when my pediatrician (who is very wholistic and noninvasive) referred us for a kidney ultrasound and then the VCUG with the dye. I learned that it is routine with an infant UTI, as the chances are good that your daughter might have vesicoureteral reflux, where the urine backs up into the kidneys. My daughter has it, and while it's a little scary to get a diagnosis, if you're paying attention and working closely with the urologist and your pediatrician, it isn't too difficult to live with. It usually means daily preventative antibiotics, and a catheterized urine sample when your child has a fever, to rule out a UTI. If infections continue, surgery can easily fix the reflux. We are one infection away from our daughter (now 13 months) having surgery, and while that is pretty scary, for pediatric urologists, it is a common problem that they deal with every day. If you're in Columbus, the urology department at Children's Hospital is really great to work with.

A.

Hi! My daughter when she was 3 months old went to the mergency room because she had afever of 102. While she was there for 3 days they did many tests and found thru a catheter dye test that she had 2 ureters-a duplication. She is now 2 and takes the medicine Bactrim daily. We have since had anither dye test taken when she turned 2 in April to see if the reflux has stayed the same, gotten better or worse. With this she is suseptible for UTI's and they monitor her 2 a year because if the refulx gets worse they will go in and either remove the extra ureter or re route it so as she gets older she does not have any issues with incontinence.(I am sure I spelled this wrong!) They also do the ultrasounds because her left kidney is not developing like her right and they feel this is due to the ureter issue. It is still a functioning kidney just half the size. We have had spoken to other Doctor's and asked their opinion and they gave me the same answers. We love Akron Children's and they have taken very good care of both of our kids.

I hope the above was not to confusing.

J.

The exact same thing happened when my daughter was around the same age and I felt the same way as you, no way am I having this test done for one infection. My dr. explained to me though, there is a kidney condition (can't remember the name)that can be present and cause this type of infection. Sometimes kids won't have another infection until late childhood/adolescence, and by then, this condition has caused alot of damage to the kidneys. The chances your daughter has this are pretty slim, most likely, but I was afraid to take the chance. I trust my doctor as she is pretty good about not doing more than needed, looking at natural remedies, etc. however she was pretty insistent about this, so I took her seriously. I won't lie, the test they run is NOT FUN. Not sure it's painful so much as scary and uncomfortable for the little ones. But I did rest easier when the results said she was fine. She has not had another infection since then. Good luck to you, whatever you decide to do.

I would have the test done. My daughter had the exact same thing happen to her when she was 8 months old. They did the VCUG I think that is what it was called, and they found that where the ureter connected to the kidney, there was a funnel shaped tube instead of a normal flowing tube. They put her on preventative antibiotics because the urine will back up into the kidneys and cause other problems. Even though it was difficult, I would definitely have done it all the same.

yes they need to be done.

Hhi J. I have never heard of this but I would get a second opinion just to make sure that she wasn't going to be going through xtra's needlessly. It seems that second opinions are needed more today than ever before. Good luck and I hope your little one gets well soon.

Calling for these tests after a UTI in a younger child are very routine. As others have said they are looking for reflux from the bladder into the kidneys. That being said, the same thing happened to my daughter around the age of 2. I have a family history of being very susceptible to UTI's and all the women in my family get them very, very easily. Not a single one of us has any abnormalities to our systems. I have had all the tests they are talking about giving your daughter and they are absolutely nothing I wanted to put my 2 year old through just be to be told what I already knew and that she is just fine. She was working on potty learning at the time of the UTI and I knew she was holding her urine longer than she should (and probably not wiping properly when let her do it herself) which is exactly what causes the UTI's for me so I felt confident in holding off on the tests. If, in the future, she suddenly starts getting recurrent UTI's I will reconsider the testing.

The purpose of telling you my story was basically to say that you should follow your mommy instincts on this and do what you feel is right for your daughter. For me it was holding off on tests for you it might be going ahead with the tests. I do agree with the other mama that suggested asking if they can do a less invasive test first before resorting to the x-ray and CT scans as they do include putting a radioactive dye into her system and inserting a catheter. It is very, very uncomfortable to say the least and it does expose your tiny little girl to the dye and the x-rays.

J.,

I would recommend either a second opinion or telling your doctor that you appreciate their haste but would rather wait and not do anything unless your daughter has another problem. I work in the medical imaging field and we see so many children/babies that get tests just after one infection. As you said, it could have been a bad specimen or just a small infection that her body fought itself. A cat scan gives a person a lot of radiation, and then I'm guessing the 'other tests' could include a voiding cystourethrogram which includes more radiation and discomfort to baby with a urinary catheter. There are so many of us in radiology that see it as unnecessary for just one infection. If she continues to have problems, then of course you're going to get it checked out. You wouldn't be a bad mom if you wanted to wait this time.
I wish you the best with whatever you decide!!

thorough testing last year (when most people thought I was just responding to postpartum hormones) lead to my diagnosis with cancer.
I'd let the doctor do the tests. If they weren't concerned, they wouldn't even suggest it.
Believe me, they want your daughter to be completely healthy. Her pediatrician should be available to call you and explain everything thoroughly if you have questions - it's always OK to get a second opinion, too. I learned that during my treatment - don't feel badly about getting one and feeling better about the recommendation. Usually, insurance will cover the costs.

Please go ahead and get all these tests done. it is very important to find out the prob and nip the bud in the begening because uti can cause a big damage to kidneys.it happened to my 4 months daughter and was already had a abscess in the kidney coz we came to know late, she is fine now but it is veryrisky, so go ahead with all the tests. its better to be safe than sorry.

Hi J.,
I would be concerned about the amount of radiation and the contrast that will be given to your daughter for the kinds of tests the doctor is talking about, if they're not necessary. These aren't completely harmless tests. I think they'll need to give intravenous contrast- there's a possibility for allergic reaction. And of course unnecessary radiation is undesirable; children are particularly sensitive to the carcinogenic effects radiation. I would ask for a second opinion.
I believe that it's an unfortunate truth that sometimes doctors order tests that aren't completely necessary, just because insurance will cover it. This allows them to make more money for themselves and their practice. I'm not saying this is definitely what's going on, but it's something people should be aware of.
However, one of the other moms brought up a good question- how was the urine sample obtained? If it was by cystocentesis (sticking a needle through the skin into the bladder) than any amount of e.coli is a concern as there shouldn't be fecal contamination.
Another mom mentioned that her daughter had an ultrasound done in a similar situation. Ultrasound is preferable to x-ray and CT scans because there isn't any radiation involved.
I'm glad you're exploring your options- good luck no matter what you decide!

Your daughter needs to have the VCUG to check for vericoureteral reflux, a condition where the urine goes back from the bladder through the ureters to the kidneys during urination. Infections and the pressure from the reflux can damage the kidneys. It's more common in girls. Luckily, most kids with it outgrow it. My daughter was 4 when she was diagnosed, and ended up having surgery to correct it just before her 9th birthday. I was concerned about the amount of radiation she was exposed to, as mentioned in another post, as she had the test about 5 times over the years. Our pediatric urologist said that she was exposed to lower doses at the pediatric hospital compared to the tests in the regular hospital. He also said that infections due to wiping (in older kids' cases) are not as common as believed by the general public. I did not get a second opinion. We started off being referred to a regular urologist by our family doctor (no pediatric urologists in our town). I didn't want to do the VCUG and just went with the sonogram, and the doctor actually called and yelled at me about how sometimes parents have to make hard choices to protect their kids, and went over the potential problems down the road if it turned out to be reflux and wasn't treated. I finally went ahead with the test and of course she had it. Later I switched to a pediatric urologist about an hour away in Cleveland cause I didn't like the regular urologist...plus the one we saw in Cleveland chaired the panel that wrote the guidelines for handling reflux in kids. Pediatric hospitals are great for giving the test as well. It was just plain horrible at the regular hospital the first time she had her VCUG. The test is no picnic, but they gave her Versed the first time at the pediatric hospital, after that the child life specialists helped her with coping skills and it went fine. Good luck! If you have any questions let me know.

It sounds to me like the Dr. is trying to make more money for the hospital by running Unnecessary tests. If the fever is gone and your daughter is not showing any signs of illness I certainly wouldn't put the child through any more tests.You must have great insurance so they sound like they want to suck it dry.
You might want to concider a second opinion but that can be costly as well. You can't fix what isn't broken and if your daughter seems fine I sure would not run more tests.I do think I would look for a different Ped. though.
Good Luck

My 13 month old had a UTI a couple months ago. She had the high fever, but no other symptom I could see. They ran blood tests, and cultures..then a urine sample. Gave a nasty antibiotic that I had to have changed and also an Ultrasound. They say it's common procedure when they are this young just to make sure it isn't a physical problem causing the UTI. I was surprised by all this too.

Since she is so young and cannot communicate how she is feeling, I would suggest getting the tests done. Even if everything comes back normal, at least you will have the peace of mind that you made sure. And it doesn't sound like any of the test would cause her pain, so what's there to lose? I do have question though. How do they get a urine sample from babies who are not potty trained? My daughter just turned 2 and had the same symptoms. She had a temperature of 103 and the pediatrician could not find anything wrong with her. She was not given a urine test and am now thinking they should have...

Hi J.
I understand your concern about the testing after "just 1" UTI, but I was a Medical Assistant in a pediatricians office for 7 years and trust me it is definitely important to have the tests run. She could have reflux in her ureters and that can be fixed with long term low dose antibiotics. Gone untreated and it can cause permanent kidney damage. One case in particular I can tell you of is when a mom chose not to perform the tests after "just 1" UTI and by the time she agreed to the tests her daughter ended up requiring surgery and they had to remove a third of one of her kidneys from the damage. That was after her 2nd UTI. So not to scare you, but the tests may show nothing at all or they may prevent permanent damage to her kidneys. Hope this helps a little. A.

I see you have lots of replies and I am rushed now so can't read them. I am a neonatal nurse and a mom of a boy who has *renal reflux*.... That is the disorder you generally think of when a baby or child has a UTI. but.... Girls do get UTIs more commonly than boys, so it is a lil controversial as to what to do now. I agree with you that you need to really think it through with what does she *really need* right now. I am not sure why they would want to do a catscan? That is a very expensive test, normally they will do a simple ultrasound to see if there is any damage, but the VCUG is the the *procedure* that will diagnose Renal Reflux to see if any of the urine is beling reflux back up the ureters.. It is invasive in that they place a urine catheter and put dye in it and the radiologist views as the test is perfomed. Speaking of invasiveness --When they checked her urine and diagnosed the ecoli was it by sterile procedure with a catheter or a *clean cathc* most likely it should of been catheter and therefore would not of been accidentally contaminated with stool. One last tid bit, it is much easier to go through the VCUG with am 11 month old than an older child, she will eventually have to have this if she has another infection, the benefit of getting that done now is that you will know if she has it and can get the preventative help she needs to prevent future infections and damage or just feel at ease with knowing she is great and probably just was more prone to the UTI from having her system down due to the bronchitis. Email me if you have any questions!

While I am not one for doctors to always want to do all types of tests; however, if the first Urine test was showing e-coli, I would allow them to do the catscan. If nothing else it will put everyone at ease.

We know first hand how dangerous e-coli in the Urinary tract can be. I would let them make sure that the E-coli is undercontrol fro your little one.

Hi J.,
I can only tell you of an 18-month old that I know who by that time had been hospitalized 3 times with UTIs. She had kidney reflux where a valve that stops the urine from backing up into the bladder doesn't close completely(I think - I'm not expert and this was a few years ago). Maybe something like this is what your doctor is looking for. This little girl's mother was determined to not have her baby on constant antibiotic (as she recognized the side effects) and was looking for a way to prevent the UTIs rather than continue to treat them. We were able to do that and eventually the baby grew out of the condition. Otherwise, the doctor was recommending surgery.

Best of luck as you make very difficult decisions. Let them do something to us, but leave our children alone. Right?