Urinary Bladder Infection in Children:
What You Need to Know

The Most Common Urinary Problem Among Children

Aside from unexpected wetting, bladder infections are the most common urinary problem among children. According to a conservative estimate, 3 percent of girls and 1 percent of boys have had a detected urinary tract infection (UTI) by the age of 11.

Recognizing and treating urinary tract infections is important as untreated bladder infections can lead to serious, life-threatening kidney problems.

Top Causes of Bladder Infection in Children

• Irritation of the urethra - many substances, such as soap, bubble bath, stool, or clothing can cause soreness of the urethra, which makes it easier for bacteria to invade.
• Holding the urine in - this allows more time for the bacteria to get to the bladder and multiply within the bladder.
• Anatomic abnormality - during development in the uterus, the tubes that connect the kidneys to the bladder, or the urethra, don't develop properly or aren't hooked up right. This increases the risk of bladder infections. More on this later.
• Constipation - large amounts of stool sitting in the colon can press up against the bladder and urethra, thus making it more difficult for the bladder to drain completely. This allows bacteria to grow.
• Improper wiping - this can increase stool and bacteria around the urethra.
• Uncircumcised penis - it is only true that an uncircumcised male has a higher chance of bladder infections during the first year of life, this risk goes away after age one; therefore, it is no longer true that circumcising males leads to a significant decrease in the risk of bladder infections.

Five Symptoms of Bladder Infection in Children

• Pain or burning with urination.
• Frequent urination.
• Urgency - your child will have a very strong, painful urge to urinate.
• Fever - mild infections often won't cause fever, but moderate to severe bladder infections that involve the kidneys do cause fever.
• Foul-smelling urine.

PLEASE NOTE: These symptoms do not necessarily mean there is a bladder infection; they just mean there might be a bladder infection.

Symptoms of More Serious Kidney Infection

Most bladder infections DO NOT turn into kidney infections, and a small scar in one kidney infection is harmless. But kidney infections are to be taken very seriously and treated promptly.

Here are signs that a bladder infection has turned into a kidney infection:

• The symptoms of bladder infection - see the above.
• Lower back pain or side pain - this is where the kidneys are located.
• Fever - bladder infections often don't cause fever.
• High fever indicating a possible kidney infection. Unlike "viral infections" in which the fever fluctuates between normal and very high, with kidney infections the fever stays high (usually 102º or higher) and your child looks and acts progressively sicker.
• Vomiting - this is also a common symptom when a kidney infection is present.

Bladder Infections in Paraplegic Children

Neurological conditions like paraplegia, a spinal cord injury, also called spinal cord impairment (SCI), usually result in neurogenic bladder - an unstable or atomic bladder, with no muscle tone.

Children with spinal cord injuries have lost, partial or complete, control over their bladder and sphincter due to the compromised nerve receptors that are responsible for:

• contracting and relaxing the muscles of the bladder and the sphincter, and
• registering feelings of pressure or release.

Due to this condition, most paraplegics are exposed to the regular use of catheters and drugs. (The more traditional cap and bag, with continual drainage, is falling from favor even though it is a safer system).

However, catheters often increase the risk of urinary tract injuries and repeated bladder infections - a common problem in children with spinal cord impairment.

Exposed to repeated or long-term courses of antibiotics, in time, they also develop resistance to drugs what makes maintaining healthy urinary tract for them even more difficult.

However, contrary to a popular belief and common medical practice, children with spinal cord injuries or spinal cord impairment:

• do NOT have to suffer from chronic bladder infections and
• do NOT have to be exposed to vicious antibiotics.

Diagnosing a Bladder Infection

Checking a urine sample is the only way to diagnose a bladder infection, as there is usually no outward sign on the penis or vagina that indicates an infection.

• For older children who have had several bladder infections with common symptoms, usually an antibiotic treatment is elected instead of going through the trouble of checking a urine sample.

  Typically, a urine sample is only done for older children with a known history of bladder infections. In these children, a urine may be checked perhaps every other infection.

• For infants in diapers, a urine collection bag is placed over the penis or vagina and the diaper is closed over it. First, however, the area must be meticulously cleaned with a wipe. This is very important since bacteria that normally live in this area can get into the urine sample and confuse the results. When your infant urinates, take off the bag and place it upright into the sterile urine cup. Don't try to pour it into the cup since this might contaminate the sample.

  An alternative is to place your infant or child in a bath and wait for them to urinate. Have the sterile urine cup ready to catch some of the urine stream. This is more difficult, but the urine results are more accurate and less contaminated than a bag specimen.

• Bladder catheter - as you can imagine, using a bag is difficult and can often get contaminated. Inserting a tiny catheter tube into the bladder through the urethra is a way to collect as sterile sample quickly. It is painful, however, and should only be done when the doctor feels it is really necessary.

Here's how to collect a "clean catch, midstream" urine sample in children:

• Try to collect the first urination in the morning. It's more accurate.
• Wipe off the penis or vagina well with a wipe.
• Have the sterile urine cup ready with the lid unscrewed.
• Tell your child what you're going to do so she isn't startled.
• Have your child start urinating. After two seconds, move the cup into the stream of urine. You only need to collect about a half inch of urine.

PLEASE NOTE: It is important not to allow the first two seconds of the urine to go into the cup. This can cause contamination.

Storing the sample
It is best to take the sample to the lab within 40 minutes of collection or else outside bacteria can start to grow in the sample. If needed, the sample can be placed in the refrigerator overnight, but a fresh sample is preferable.

Types of Urine Tests

Urine tests can be done in the doctor's office or a lab; they just take a few minutes - a dipstick is placed in the urine sample and up to ten different substances can be detected.

During a bladder infection, however, there are three substances that show up positive:

• Nitrite - this is a substance produced by bacteria.
• Leukocyte esterase - this is a substance produce by white blood cells (immune cells) when they attack bacteria.
• Blood - this will sometimes show up during a bladder infection.

Depending on how strongly these substances show up, this test can be interpreted three ways:

• Bladder infection unlikely - if the U/A is normal, an infection is unlikely. However, occasionally this test can be completely normal during an infection.
• Bladder infection possible - if one or two substances show up weak, an infection may be present.
• Bladder infection probable - if two or three substances show up strong, your child probably has a bladder infection.

PLEASE NOTE: Sometimes these substances can show up even when an infection is not present.

II. Microscopic urinalysis (U/A micro)

This test is usually only done by a lab - a drop of urine is examined under a microscope.

Two things can show up in an infection:

• white blood cells - there usually are none or a few of these bacteria-fighting immune cells in the urine. If a lot show up, then there are probably bacteria there as well.
• bacteria - often the bacteria will be seen with a microscope.

PLEASE NOTE: If no white blood cells or bacteria are seen, then there could still be an infection.

III. Urine Culture

This is the most accurate test to determine for sure whether or not an infection is present. It is usually only done in a lab.

The lab puts the sample in an incubator. If any bacteria are in the sample, they will multiply and show up. However, it takes 24 to 48 hours for the bacteria to grow enough to be detected.

Here is how the results are interpreted:

• No growth - if no bacteria grow within 48 hours, then there is no infection.
• Slight growth - if just a few bacteria grow, then they are probably not actually an infection.
• Large growth - if many of one type of bacteria grow, then this is definitely an infection.

Contamination of the Sample
If several different types of bacteria show slight to large growth, then these are probably bacteria that just live on the skin and inadvertently got into the sample and not an actual infection.

Interpreting a contaminated sample then poses a dilemma. If an infection is present, but the sample was also contaminated, the contaminant bacteria will overgrow and hide the one type of bacteria that is causing the infection.

A decision needs to be made whether or not to treat this as an infection depending on how suspicious he is. If the urine analysis (U/A) and microscopic urinalysis (U/A micro) are positive for infection, but the culture is contaminated, it may be assumed that an infection is present.

If the suspicion is low for infection, the urine culture can be repeated to double check, or you can just observe the child to see if symptoms go away.

Culture sensitivity
If one type of bacteria grows in the culture, the lab will expose the bacteria to a variety of antibiotics to see which ones the bacteria is sensitive too. This usually takes one day after the culture is positive. This helps decide which antibiotic is best for the infection.

Common Steps in the Treatment of Children

Urinary analysis (U/A) is performed in the office:

• If normal, and child's symptoms are mild, then you can probably just observe the child for the next few days. You can send a culture just to be sure.
• If positive for infection, and the child's symptoms are moderate to severe, probably a culture will be sent to confirm, and start an antibiotic now to avoid allowing the infection to get worse.
• If the urinary analysis (U/A) is positive, but the child's symptoms are mild, you may not start treatment while the culture is being done (since a positive U/A doesn't necessarily mean there is an infection).

A doctor may also wait a few hours for the lab to run a microscopic urinalysis ((U/A micro) to help in the decision whether or not to start treatment while the culture is running.

PLEASE NOTE: Mild bladder infection can be left untreated for a few days without risking harm to your child while the culture is being done.

If a urine culture is sent, you should call your doctor's office after one and two days to check the results. If positive, don't wait and call the next day again to check the sensitivity of the antibiotics.

Standard Medical Treatment

• Antibiotics - a 5 to 7 day course of an antibiotic, or longer for recurrent cases. If a kidney infection is suspected, a shot of a strong antibiotic can be given in the muscle to hit the infection harder, then continue with an oral antibiotic.
• Cranberry juice - considered by medical establishment useful in addition to antibiotics in helping the bladder to more easily flush out the bacteria (three cups a day during the course of antibiotics are recommended).
• Drinking lots of water - to flush out the bacteria.
• Urinating frequently - it keeps the bacteria from multiplying inside the bladder.
• Urinating in the warm bath - have your child sit in a warm bath and urinate if she is too afraid to urinate because of the burning.

Urine Culture Checkups

If your child has recurrent bladder infections, you should check a urine culture every one or two months to monitor for infections.

If your child goes for six months without an infection, you can space out these urine checks per your doctor's advice.

Preventing Bladder Infections in Children

• Avoid irritants - soap, bubble bath, and shampoo suds can irritate the urethra and wash away it's protective mucus layer. Avoid bubble baths and don't allow your child to sit in soapy bath water.
• Avoid tight underpants - this can irritate the urethra.
• Teach proper wiping - show your child how to wipe from front to back after having a bowel movement. For infants in diapers, be careful not to wipe around the vaginal area with a stool-contaminated wipe.
• Avoid constipation
• Increase daily fluid intake
• Don't hold in the urine
• Drink one glass of cranberry juice each day - this is very important!
• Double voiding - have your child try to urinate twice each time to make sure the bladder is completely empty
• Periodic urine cultures - you should check a urine culture every one or two months, then less often if your child is doing well.

Recurrent Bladder Infections in Children

There are three possible abnormalities:

• Tight or posterior urethral valves - the valve or sphincter that normally keeps the bladder from emptying can sometimes be too tight or in the wrong position. This prevents the bladder from emptying completely, and can make the urine back up and cause backpressure on the kidneys. This can cause the kidneys to dilate, which can lead to serious kidney damage, called hydronephrosis.

  Newborns born with this problem can either already have kidney damage from in utero backpressure, or can develop kidney damage rapidly during the first few months of life. This condition that occurs mostly in males is rare, but does need to be diagnosed quickly. One clue to this problem is a weak urine stream. The urine will dribble out instead of shooting out to hit you in the face.

• Vessico-ureteral reflux (VUR) - the problem here occurs where the urine tubes from the kidneys empty into the bladder. These tubes are called the ureters. A one-way valve normally prevents the urine in the bladder from going back up into the ureters and kidneys.

  Some children are born with immature ureter valves that allow the urine to go backwards and cause backpressure on the kidneys, or hydronephrosis. The backpressure on the kidneys isn't as rapid and severe as the above problem, but over time it can damage the kidneys. Children will often outgrow this problem as the valves mature over several years. Some, however, do not.

• Abnormal kidneys or ureters - very rarely the kidneys, or the tubes that drain them into the bladder, can develop abnormally in a variety of ways. This prevents the urine from draining properly into the bladder and can lead to infections.

Diagnosing an Anatomic Abnormality

• Ultrasound - this is the same harmless test most pregnant women get to look at the fetus. It is painless and non-invasive. An ultrasound can tell us if there is a structural problem with the kidneys or ureters, or if any hydronephrosis (back-pressure) is present. It cannot tell us if there is VUR or a urethral valve problem.

• Voiding Cysto-urethrogram (VCUG) - this test involves restraining an infant or child, inserting a catheter through the urethra into the bladder, injecting a dye into the catheter, pulling out the catheter, and allowing the infant to urinate the dye back out. Several x-rays are taken during the procedure. This test is invasive and can be painful and scary for a child yet, it's the only way to detect problems with the urethra and ureters. This test gives very little information about the kidneys

• Intravenous pyelogram (IVP) - dye is injected through an IV into the blood stream. The dye travels through the kidneys and into the urine, thus outlining the structure of the kidneys on x-ray. Several x-rays are taken. This test does not show VUR or urethra problems.

• Nuclear medicine scan - similar to an intravenous pyelogram (IVP), but this test shows the kidneys in such a way that checks the kidney function and checks for scars in the kidneys.

PLEASE NOTE: Except for the ultrasound, none of these tests sounds very fun, especially when it's YOUR child. Deciding when testing should be done is difficult. You need to weigh the likelihood that an abnormality is there and how serious such abnormalities can be versus the trouble and trauma of putting your child through such testing.

Prophylactic Antibiotics

Prophylactic antibiotics are appropriate - if a child

• has known anatomic abnormality that makes him prone to infections.
• does not have abnormality but continues to have infections despite the non-medical preventions.

Typically children will take an antibiotic for six to twelve months, then come off of it and monitor the urine.

D-Mannose: The Natural Alternative to Antibiotics

Even more remarkably, D-mannose accomplishes this feat without killing a single bacterium! (Exactly how does this it will be explained later).

Suffice it to say that, because it gets rid of bladder infection-causing bacteria without committing "bactericide," people who use it suffer none of the unwanted side effects of antibiotics:

• no gastrointestinal (GI) problems,
• no yeast infections, and
• no resistant bacteria.

In fact, D-mannose has no adverse side effects of any kind.

It Tastes Good!
As a bonus, D-mannose actually tastes good. Where a "spoonful of sugar" helped the medicine go down in Mary Poppin's day, with D-mannose, a spoonful of sugar IS the medicine.

It Is Effective and Safe!
Because it is so effective and so benign, women (even pregnant women) who are susceptible to recurrent bladder infections, can safely take D-mannose as a preventive measure to head off future attacks.

It Is Suitable for Children
D-mannose is also ideally suited for children with bladder infections. Because it tastes so good (it is a sugar, after all!), children actually enjoy taking it.

It Is Just As Effective As Antibiotics
Although D-mannose is virtually unknown to practitioners of conventional medicine, many research reports have demonstrated its mode of action and effectiveness against E. coli, the microorganism that causes most bladder infections.

Moreover, nearly 15 years of clinical experience have shown that it is just about as effective at curing bladder infections as antibiotic drugs.

It Has No Known Drawbacks
At first glance, D-mannose may sound too good to be true: a "medicine" that's highly effective, perfectly safe, pleasant to use, inexpensive, and available without a doctor's prescription. Yet, it is true!

Unlike virtually any conventional medication, and many natural or "alternative" treatments as well, D-mannose has no known drawbacks.

E. Coli Bacterial Infections

The urinary tract reacts to a bacterial infection in much the same way that the upper respiratory system reacts to a cold virus. The tissues become inflamed, irritated, and swollen. Just as it's hard to breathe through swollen and inflamed nasal passages, swollen and inflamed urinary ducts can partially obstruct normal flow, making it painful and difficult to pass urine.

Built-In Safeguards
Ordinarily, the urinary system is hostile territory for bacteria, viruses, or any other microorganisms.

Bugs that do make their way into a healthy urinary tract are likely to find an inhospitable acidic environment (pH <5.5).

Bugs are also subject to attack by the body's immune defenses. (Adult men have the added protection of a specific bacterial growth inhibitor squirted directly into the urinary system by their prostate gland.)

Even if microorganisms manage to overcome these considerable obstacles, they would typically be flushed out with the normal flow of urine. So effective are these natural antibacterial defenses that in a study in which bacteria were instilled directly into the bladders of guinea pigs, simple urination expelled 99.9 percent of the bugs.

Despite all these built-in safeguards; each year millions of people, overwhelmingly women, still develop bladder infections.

Urethritis
Most bladder infections begin when bacteria originating in the bowels travel to and grow in the urethra. Infections limited to the urethra are known as "urethritis."

Cystitis
When bacteria travel upstream to the bladder, the infection is called "cystitis."

Nephritis
Infections that reach the kidneys are known as "nephritis" or "pyelonephritis."

The E. coli that cause most bladder infections are among the most common friendly bacteria in the gastrointestinal (GI) tract, where they aid digestion, produce a few vitamins, and in general, behave themselves without bothering us.

However, when E. coli and other bugs exit the lower GI tract, they may gain entry to the urinary tract via the urethra, where they may attach to the internal lining of the bladder, multiply, and spread.

Other Infectious Bacteria
Although up to 90 percent of bladder infections are caused by E. coli, the remaining 10 percent are caused by bacteria known as

• Chlamydia
• Mycoplasma
• Neisseria gonorrhea
• and others.

Unlike E. coli, these bugs tend to be transmitted via sexual contact and rarely cause the more serious bladder and kidney infections.

Still, all of these non-E. coli infections combined amount to no more than 10 percent of all bladder infections.

Bladder Infection Treatment With D-Mannose

While there's nothing essentially wrong with killing disease-causing bacteria, this approach does have some very serious drawbacks, as we have noted earlier. Happily, "bacteria-cide" is not the only possible avenue of attack.

More Natural Way
Another, more natural way to eliminate E. coli infections from the urinary tract is to beat them at their own game. If they're going to cause trouble, bacteria usually have to find a way to adhere (stick) to the body tissue they're infecting. In bladder infection, E. coli attach to cells lining the bladder and urinary tract using filmy, hair-like projections called fimbria on their cell walls.

At the tip of each fimbrium is a glycoprotein (a combination carbohydrate and protein) called a lectin that is programmed to bind to the first molecule of the sugar mannose that it encounters.

It turns out that molecules of mannose (produced inside urinary tract lining cells) naturally dot the surfaces of these cells. Here they act as "receptors," inviting the fimbria of E. coli to attach, and allowing them to bind to the tissue in a tight, Velcro-like grip.

If not for this attachment to the cell's mannose, any E. coli that had successfully ventured up the urethral river would be unable to stick to the slippery surface and would be washed right back out on the next tide of urination.

How Does D-Mannose Work?

The E. coli couldn't turn around without bumping into D-mannose "just floating around" in the urine. Unable to resist the tasty bait they suddenly find themselves swimming in, they would latch onto the nearest mannose molecules, and happily sail off into the porcelain sunset.

Those few E. coli left clinging to mannose molecules on cells then become easy prey for white blood cells and other agents of the immune system.

E. Coli Coated With D-Mannose
In addition to its natural occurrence in the cells lining the epithelial tract, the sugar D-mannose is also found in relatively large quantities in fruit such as peaches, apples, oranges, and certain berries, like cranberries and blueberries.

Extracted in the form of D-mannose, a white crystal sugar similar to glucose, it can be easily dissolved in a liquid and swallowed. (Mannose can also be synthesized from other simple sugars.)

When someone with bladder infection consumes a dose of D-mannose, the sugar is absorbed in the upper GI tract, but at a much slower rate than most other sugars. (For example, glucose is absorbed more than eight times faster.)

Moreover, unlike other sugars, D-mannose is not readily converted to glycogen (and stored) in the liver, but instead passes directly into the bloodstream largely unchanged.

As the D-mannose-laden blood passes through the kidneys, a considerable proportion of the sugar is extracted and added to the urine.

The D-mannose-sweetened urine flows from the kidneys through the ureters to the bladder and on to the urethra, literally sugar-coating any free-floating E. coli it might encounter, so they can't stick to cells any more.

It also unsticks most of the E. coli already "Velcro-ed" to the inner surface of the bladder and urinary tract, ultimately flushing them all down the drain.

It Is Scientifically Proven
First, the "molecular mechanism" of the action of D-mannose on E. coli is scientifically proven. There's no argument at all about this among researchers who have studied it.

Second, literally tens of thousands of women working with natural medicine doctors have successfully applied this science to their own bladder infections.

Therapeutic Value of D-Mannose
Considerable circumstantial evidence, combined with common sense and over 15 years of clinical experience, makes a compelling case for the therapeutic value of D-mannose.

Laboratory Studies
In one laboratory study, for example, rats' urinary tracts were inoculated with E. coli. Within one day, those rats also given D-mannose were found to have significantly lower levels of bacteria in their urine.

In another study, administering a mannose-like substance (niethyl a-D-mannopyranoside) to E. coli-infected mice led to a 90 percent reduction in bacterial attachment to the urinary tract.

Research in humans shows that ingesting D-mannose significantly elevates blood mannose levels, a prerequisite if urinary levels are to rise.

Epidemiological Evidence
Perhaps the best available evidence, though, comes from the experience of people who have used it. Natural medicine-oriented physicians have been recommending D-mannose to people with bladder infection since the mid-1980s with great success.

A 5-Year-Old Girl
For example, in one case, a 5-year-old girl had almost continuous bladder infections for her entire life that had failed to respond to every antibiotic therapy her physicians tried (72 doctors in all!).

At the end of their rope, her doctors were now considering a kidney transplant, since her kidneys were starting to fail due to years of chronic infection.

Since urine culture showed her bladder infection was due to E. coli, she was started on D-mannose (1 tsp in a glass of water every 2-3 hours). Within 48 hours, her infection had vanished, and her kidneys were saved!

Recurrent Bladder Infections
Physicians experienced with D-mannose report that children prone to very frequent recurrent bladder infections can benefit from taking D-mannose preventively.

Single Bladder Infections
By far the most frequent success with D-mannose has been achieved by the children who have suffered single (non-recurrent) episodes of bladder infection.

In over 90 percent of such cases, 1 teaspoon of D-mannose every 2 to 3 hours usually clears the infection in 1 to 3 days.

Try D-Mannose PLUS First

PLEASE NOTE: Even though symptoms are improved within 24 hours, D-mannose Plus should be continued for 2 to 3 days after the last symptom is gone, just to "make sure."

A Word of Caution
If a bladder infection treated with D-mannose Plus does not show significant improvement within 24 hours (about 10 percent of cases), it is likely that the causative organism is not E. coli.

D-Mannose Powder PLUS

Serving Size: 1 Level Teaspoon (4.7 grams)
Servings Per Container: 30

Amount Per Serving:

• d-Mannose: 1,500 mg
• Cranberry (vaccinium macrocarpon): 800 mg
• Vitamin C (as ascorbic acid): 60 mg

Other Ingredients: Natural mixed berry flavor, xylitol, citric acid and sucralose.

Contains no added starch, salt, wheat, gluten, corn, coloring, dairy products or preservatives.

Keep container tightly closed in a cool, dry and dark place. Keep out of reach of children.

Recommended Intake

For relief from a urinary tract infection, repeat four to five (4-5) times per day.

For prevention of a urinary tract infection, drink once a day.

Description: D-Mannose is a naturally occuring simple sugar, closely related to glucose. Clinical studies have demonstrated its ability to prevent E. Coli bacteria from adhering to the inner walls of the bladder, potentially reducing the incidence and severity of urinary tract infections. D-Mannose Powder Plus combines d-Mannose with Cranberry extract to enhance its effectiveness.

PLEASE NOTE: These statements have not been evaluated by the Food and Drug Administration (FDA). This product is not intended to diagnose, treat, cure or prevent any disease.

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© 2003-2008 Remedy-Bladder-Infection.com: Urinary Bladder Infection. The Natural UTI Cure Treatment Prevention. Alternative, herbal and nutritional treatment for cystitis, urethritis, and prostatitis. Prevent and remedy urinary tract infection (UTI) in children without antibiotics. The information provided herein on bladder infection in children is a general overview on this topic and may not apply to everyone, therefore, it should not be used for diagnosis or treatment of any medical condition. While reasonable effort has been made to ensure the accuracy of the information on bladder infection in kids, Full of Health Inc. assumes no responsibility for errors or omissions, or for damages resulting from use of the bladder-prostate infection information herein.
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