India, Sept. 28 -- In today's guest column, reputed Paediatric Nephrologist, Dr Arvind Bagga addresses Urinary Tract Infections in children. Urinary tract infections (or UTI) are a common bacterial infection in children. It is estimated that UTI affect 1% to 5% of children, occurring most frequently in infants and adolescent girls. The chief organism causing these infections is Escherichia coli, although other bacteria and occasionally viruses may be responsible. UTI in older children is usually limited to the urinary bladder. However, the infection is serious in young children in whom the kidneys are commonly affected. Untreated, these infections can damage the kidneys. Further, up to one-third of children with UTI might have abnormalities of the urinary tract that require specialised management. The symptoms of UTI depend on the patient's age and severity of the infection. Unexplained high fever is often the only symptom in infants and young children, although irritability, poor feeding and vomiting may be observed. Symptoms of UTI are easier to recognise in older children, who present with fever, frequent or painful urination (dysuria), urgency or incontinence, and pain in the abdomen or lower back. Almost 30% children with UTI have more than one episode (recurrent UTI). Factors that increase the risk of UTI are constipation and/or voiding postponement, often as part of bladder-bowel-dysfunction, unsatisfactory toilet hygiene and structural abnormalities of the urinary tract. There is no evidence that use of Western or public toilets increases the risk of these infections. Although the use of diapers does not cause UTI, prolonged exposure to a soiled diaper and poor hygiene should be avoided. UTI are diagnosed on a urine sample that has been obtained by 'clean-catch' specimen. Sick patients might require bladder catheterisation. Freshly voided urine is examined for the presence of white cells and bacteria, either on microscopy or by special dipsticks. However, the detection of few white cells in urine is not abnormal, and the diagnosis of UTI requires the finding of high counts of bacteria on urine culture. Urine culture not only identifies the organism, but also provides information on the antibiotics that are likely to be effective for treatment. Therapy of UTI relies on appropriate use of antibiotics, that are administered for seven to 10 days. A repeat urine culture is not required following completion of therapy. Given the risks of an underlying urinary tract abnormality, it is recommended that an ultrasound of the kidneys and urinary tract be done during or immediately following the first UTI in all children. Children with recurrent UTI or with abnormalities on ultrasonography need further investigations, including radiocontrast studies to evaluate the lower urinary tract. Early recognition and management of UTI are necessary to avoid complications of the acute infection and prevent kidney damage. Parents should also be aware about the risk of recurrences, and the need for evaluation for urinary tract abnormalities by appropriate radiological investigations. Dr Anupam Sibal is a leading Paediatric Gastroenterologist and Hepatologist with over three decades of experience and five books to his credit, including, Is Your Child Ready to face the World?...