Fever is one of the most common reasons parents and caregivers end up at the doctor’s office with their children. In fact, nearly one-third of visits to pediatricians are for fever, whether detected by a thermometer or suspected by a mere kiss on the forehead.
When pediatricians evaluate children with fevers, they begin by looking for a cause. You will answer questions about runny noses, coughs and ear pain. And when there appears to be no obvious explanation, the fever is labeled “a fever without a source.” If no cause can be found, your child’s fever will likely be attributed to a viral or bacterial infection. When bacterial, the most common site of infection is the urinary tract.
Urinary tract infections may be limited to the bladder, but when they reach the kidney, fever becomes more common. Fever may be the only sign of infection in the youngest patients, while older children may have pain with urination, frequent or urgent runs to the bathroom, or even accidents. Back pain or vomiting may be signs of a more severe urinary tract infection.
Because most children will have a fever before the age of 3, and many of those children will have urinary tract infections, does this have any impact on their future health as adults? The answer is a painless, silent, long-term threat.
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When infections are not appropriately treated with antibiotics, scars may develop on the kidneys. These scars represent a loss of nephrons, the individual filters that make up a kidney. These filters work continuously to clean the body of waste and maintain the ideal internal balance. Once damaged and lost, they cannot be replaced.
We are each born with the number of nephrons on which we will depend for the rest of our lives. So, while no child can feel a scar on the kidney, as an adult he or she may be at increased risk for high blood pressure or low kidney function. Fortunately, scars develop in only 7 percent of children who suffer urinary tract infections.
Some children are at higher risk for urinary tract infection, with some key risk factors being age and sex. For example, Caucasian girls under the age of 2 and uncircumcised boys under the age of 3 months are at increased risk. Urinary tract infections are also seen more commonly in children who struggle with constipation, and in those with reflux of urine from the bladder back up to the kidneys.
There are several ways that parents and caretakers can help lower the risk of urinary tract infection in their children:
▪ Drinking water ensures that your child will have to go to the bathroom, so any bacteria will be flushed from the bladder and the urinary tract. Going to the bathroom often lowers the chance of bacteria multiplying in the bladder.
▪ Proper hygiene — wiping from front to back — will lower the chances of spreading bacteria from stool.
▪ Avoiding bathtub bathing in young girls reduces the pooling of water and bacteria near the urethra.
▪ Treating constipation allows the bladder to empty completely.
If your child does develop a urinary tract infection, the latest research shows that prompt evaluation and treatment lower the risk of developing a scar on the kidney. If you suspect your child has a urinary tract infection, medical care should be sought quickly. Your pediatrician will confirm the infection with a laboratory culture of your child’s urine.
Once the infection is confirmed, don’t wait to start treatment. A delay of 48 hours or more in starting antibiotic treatment can increase the risk of scarring.
Also, to avoid unnecessary exposure to antibiotics, make sure a diagnosis is confirmed through a lab test before starting a prescription. This will lower your child’s risk of becoming antibiotic resistant in the future.
Urinary tract infections in children are common and, for some, preventable. More importantly, urinary tract infections are treatable with prompt medical care. If an underlying abnormality of the urinary tract is identified, specialty care is available, as with the Division of Pediatric Nephrology at UHealth, the University of Miami Health System.
Chryso Pefkaros Katsoufis, M.D., specializes in pediatric nephrology at UHealth – the University of Miami Health System. For more information, visit UHealthSystem.com/patients/pediatrics or pediatrics.med.miami.edu/nephrology.