American Medical Association Family Medical Guide - American Medical Association [202]
Diagnosis
A diagnosis of a urinary tract infection is based on a child’s symptoms, a physical examination, and the results of urine tests. If your child is a boy or is younger than 2, has recurring urinary tract infections, or appears to be very ill, the doctor will recommend additional tests, such as an ultrasound (see page 111) or a CT scan (see page 112) of the kidneys, ureters, and bladder; a radionuclide scan (see page 114) of the kidneys; and a voiding cystogram (see page 805). The ultrasound or CT scan shows the shape of the kidneys, ureters, and bladder. The radionuclide scan shows how the kidneys function and detects any infection in the kidneys. The voiding cystogram enables the doctor to examine the bladder during urination to determine the size of the bladder and to check for vesicoureteral reflux.
Treatment
To treat a urinary tract infection, a doctor will prescribe antibiotics in tablets or in liquid form. If the kidneys are affected, the doctor may prescribe antibiotics given intravenously (through a vein).
Any underlying abnormality of the urinary tract can be corrected with surgery. The doctor will recommend giving your child plenty of clear fluids, preferably water, and encouraging your child to empty his or her bladder completely and frequently (at least every 4 to 6 hours). The symptoms usually subside a few days after the child begins taking the antibiotics, but your child still needs to finish all of the prescribed medication or the infection will recur.
Vesicoureteral Reflux
Vesicoureteral reflux is a urinary tract disorder in which the mechanism that prevents the backflow of urine malfunctions, causing urine to flow backward from the bladder through the ureters and up into the kidneys. This backflow of urine can cause increased pressure on the kidneys or recurring kidney infections, both of which can lead to permanent damage and scarring of the kidneys.
Bed-Wetting
By age 4 or 5, most children stay dry through the night. Other children may continue to wet the bed at night, and, in rare cases, may also wet themselves during the day. The medical term for this condition is enuresis. If a child begins wetting the bed again after a long period of staying dry through the night, the condition is called secondary enuresis. Enuresis, which can last for several years, occurs slightly more often in boys than in girls and tends to run in families.
In most cases, the cause of bed-wetting is not known. However, in some cases, the cause of enuresis (especially of secondary enuresis) may be psychological, such as stress associated with the arrival of a new baby. In a few cases, an underlying illness—such as a urinary tract infection or undiagnosed diabetes (see page 889)—may be causing the condition. Treating the underlying illness that is causing the bed-wetting usually eliminates the problem.
Dealing With Bed-Wetting
If your child has been wetting the bed, have him or her urinate right before going to bed at night. Then, just before you go to bed, wake your child and have him or her get up and urinate again. If your child is of school age, try setting an alarm clock to go off during the night so he or she can get up and urinate. For an older child, put out dry pajamas and sheets so he or she can change them without waking you for help. If, after a few weeks, this approach has not been effective, have the doctor examine your child to rule out an underlying disorder. The doctor may take a sample of your child’s urine for laboratory analysis and, although rare, he or she may order tests to evaluate your child’s bladder and kidneys.
Your child must want to deal with his or her bed-wetting problem for treatment to be effective. Use the same principles that apply to toilet training: provide support and encouragement, praise your child for dry nights, and never scold or punish your child for wet nights. A negative, punishing approach