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Urinary Tract Infections in Children – Part II: Analyze & Treat

In my last post (Urinary Tract Infections in Children – Part I) I discussed the importance of urinary tract infections, how they might present in children of various ages, and testing to verify the presence of these infections. This post will pick up with further diagnostic measures and treatment.

UTI's can be difficult to diagnose with babiesOnce an appropriate sample of urine is obtained, it will then be analyzed in two different ways. A chemical analysis and microscopic exam is done to see whether those elements that might suggest urinary tract infection are present; white cells, protein, blood, etc. The second thing that is done with the urine is to take a culture specimen of the urine and attempt to grow bacteria out of it. This is the true litmus test for urinary infections, as chemical analysis might suggest infection but if there is no bacteria in the urine no true infection is present. The culture can take up to 3 days for a result and therefore in a child who has typical symptoms, the use of an antibiotic may be decided temporarily on the urinalysis alone until the results of the culture are available. A simple bladder infection, which is much more common than a kidney infection can be easily treated with a short course of antibiotics, during which time the symptoms usually resolve completely. Kidney infections, if severe, may take a lot longer and may require intravenous antibiotics.

If a child gets a significant number of infections over a relatively short period of time, or an individual infection appears to be very severe, or a significant infection occurs in an infant or very young child, then it is necessary to explore the problem much deeper in terms of further testing the child. This can be done in one or more ways to be determined by your doctor and the radiology department;

One method is a simple non invasive sonogram wherein a sound waves “picture” is taken of the entire urinary tract. Another method is called a VCUG, voiding cysto-urethrogram in which a small catheter is placed into the bladder through the urethra (the exit from the bladder to the outside), a small amount of dye is placed in the bladder in order to outline the anatomy of the lower urinary tract( bladder and ureters -tubes that go from the kidney to the bladder). A functional picture of the lower tract can be obtained by radiologocally “watching” during and after urinating. Two further tests can be done to more clearly evaluate the anatomy and function of the kidneys. Both involve the injection into the blood stream of a substance that will be taken up by the kidney, delineating structure and function.

A history of repeated urinary tract infections is not an uncommon problem. If something has been found that can be surgically corrected to prevent further infections, this choice may be made. This situation is less common than finding nothing abnormal on the testing in a child who still gets repeated infections. Certainly this situation, as in anyone with repeated infections, will need to be monitored very carefully by your Doctor.

The bottom line in handling urinary infections is to prevent them from ascending up the urinary tract and potentially injuring the kidneys, for this will ultimately lead to a certain amount of loss of function of the kidneys; something better prevented than treated.

Urinary Tract Infections in Young Children – Part I: Diagnosis

Urinary tract infection (bladder, Kidneys) is a very common issue in children and sometimes not the easiest to diagnose. The symptoms depend on the age and sex of the child, and the location of the infection and these symptoms can vary across the board. Urinary tract infections (UTI) are more common in females as a rule but during the first year of life, when it is most difficult to diagnose, the incidence is just about the same in males and females.

Sometimes there is an anatomical problem with abnormalities in the kidney or bladder or both that children can be born with, but most of the time these infections occur de novo. An infection is defined as bacterial growth in the urine in the presence of appropriate symptoms. If there are no symptoms, the presence of bacteria might only mean colonization, eg: there are bacteria in the urine but have not caused a body reaction yet. Under certain circumstances even colonization needs to be treated.

During the first year of life, one might only see a very irritable, cranky baby with or without fever and the source of those symptoms is “hidden” sometimes even to the best and most experienced physician. Therefore, during the first year of life the suspicion for a UTI is very high and the urine might be checked more often than it would in an older child with the same symptoms. As you can imagine, obtaining a “clean” urine specimen is very difficult so a variety of methods have been devised. If one merely “catches” the urine as it is produced externally this stands a significant chance of being contaminated by bacteria living on the skin. The best ways of obtaining a reliable urine specimen is somewhat invasive but at least your doctor can rely on the results of the evaluation. These consist of either a bladder catheterization, where a small tube is passed up into the bladder and a urine specimen is obtained or a supra pubic needle aspiration where a needle on a syringe is passed through the lower abdominal wall and a urine sample is obtained. The urine sample is obtained by a reliable lab or sometimes in the Doctor’s office by means of a urinalysis and a culture of the urine to be sure there are bacteria in it and what kind it may be so as to choose the correct treatment. This culture can take 2- 3 days to complete.

This is a very large and important subject so I will stop here and take on the topic of treatment of UTIs and possible further diagnostic procedures in my next entry.

Childhood Asthma: Part II

In Childhood Asthma: Part I, I presented ways in which Asthma can present and exactly what was the nature of the disease. Today we will deal with the diagnosis and various means of treating asthma.

Asthma may present in early infancy but is very difficult to diagnose for the reasons mentioned in part one. Also the signs and symptoms of asthma in the very young child can be caused by many other issues. So it is when the symptoms are very severe or they continue beyond two to four years of age that one begins to suspect asthma.

Let’s assume for the purpose of this article that all asthma_pt2the other causes have been ruled out and that it appears that your child indeed has asthma. The first thing to realize is that the symptoms may vary from very severe to extremely mild requiring daily close control or only occasional use of medications and treatments to keep your child comfortable and active. The goal in treatment is twofold: first to allow your child to remain active, socially oriented, and happy. The second is to prevent the permanent secondary changes in the lungs from longstanding uncontrolled asthma.

Early in the course of treatment, a child who presented to the emergency room or physician’s office with symptoms of acute asthma usually needed to be admitted to the hospital for a few days in order to get the symptoms controlled. As time went on, newer systems such as nebulizer treatments that could be performed at home were implemented and admissions to hospitals dramatically diminished. Today it is not uncommon at all to see a nebulizer machine in the home of a child with asthma. The other issues that were improved upon were the level of education of a family in which there is a child with asthma, and the greatly improved medications available to treat asthmatic symptoms with fewer side effects and greater efficiency.

As more becomes known about asthma, through research and observation, the efficiency of treatments increases dramatically. Since we know from the previous article that the underlying problems causing symptoms of asthma are related to constriction of the small airways, mucus production and inflammation, there was a body of research that tried to find out which of these causes were more important, and which specific medications could be used for each symptom. At one point or another each of them were implicated but recently the inflammatory process seems to be very important. Also inhaled medications seemed to give the best results without some of the bothersome side effects, both long term and short term.

With the development of better mobile delivery systems for these medications and the increase in knowledge that families now have about the disease, the disease can now be managed very efficiently at home. Fewer and fewer hospitalizations have been the result with a greatly decreased cost of delivering medical care to these children.

Your Doctor is very familiar with the armamentarium of medications available to use for children with various degrees of the disease. The two main issues with the treatment of asthma is the immediate treatment of the acute problem, breathing difficulty, and then the long term control of the recurrence of those symptoms. There are many medications, or combinations of medications, available to gain and maintain control over the symptoms of asthma and your child should be able to live a perfectly normal life style.

You as parents will shortly become, with the help of your Doctor, the “expert” when it comes to asthma in your child.

Childhood Asthma: Part I

Asthma is the most common chronic disease in children and is responsible for more school absences than any other childhood disease in this country. It is a disease with a long history and is surrounded by much misconception and fear. Asthma is constantly being studied in the medical community which leads to new methods of diagnosis and treatment.

What is Asthma?

Asthma is a disease characterized by repeated, mostly reversible episodes of wheezing. The symptoms of asthma are the end result of a series of reactions occurring in the body set off by a variety of causes. These causes vary from true allergy to specific substances in the air, to emotions, to exercise, to plain old colds. The tendency to develop asthma may very well be an inborn trait present from birth but the final common pathway of observable events remains child with inhalerthe same: the development of small airway narrowing (bronchioles) with a decreased ability to move air in and out of the lungs, slowing down the normal process of exchanging oxygen from the air for carbon dioxide from the body through the lungs. The reasons for this narrowing are related to inflammation in those airways with the production of mucus, and muscle spasm surrounding the airways: all have the effect of narrowing these airways. Oxygen is needed by every cell in the body in order to carry on the process of metabolizing various products that we use every minute of every day.

When the inability to properly exchange these gases is recognized by the body, a series of changes immediately takes place to make the system work better. Because each breath brings in less oxygen, the rate of breathing increases so as to equalize the gas exchange rate. We see that as breathing faster in the child with an asthmatic attack. Since the air that does get in and out must go though narrower airways, a person having an asthma attack must use accessory muscles (such as abdominal and even neck muscles) to help breath, and we see that as working harder to breath, and may even hear it as a whistling sound as the air is forced through narrow spaces (wheezing). Cough is produced as a reflex to the various changes in the airways. As the lack of gas exchange progresses there are further changes that can lead to failure of the lungs to do any of the work.

Needless to say, it is important to recognize the symptoms of asthma and treat vigorously.

How to recognize asthma

Many children will have wheezing during the first two years of life and this is usually part of a viral respiratory infection. This child will usually not have wheezing at any other times. A small percent of these children will develop true asthma over time but at this time it is difficult to tell who they will be. Many children outgrow this type of wheezing and therefore many physicians will withhold labeling a child with “asthma” until at least 2-3 years of age. There is also several other types of “asthma”. Some children with allergies develop wheezing secondary to exercise – or exercise induced asthma (especially in cold weather). Others might just have a persistent cough without wheezing for no apparent reason and might eventually be diagnosed with “cough variant asthma”.

What to do

If your child has already been diagnosed with asthma you will already know most of the information in this article. If your child has had a few previous episodes of “wheezing” or seems to be “wheezing” for the first time and your child’s breathing is not normal (remember the symptoms mentioned above), you will need to call your Doctor for further information and treatment.

What else can be done?

There are many ways to treat the symptoms of asthma and get these under control. There are also many ways to control and prevent the episodes of asthma and therefore the aim of treatment is to relieve and prevent the symptoms, allowing your child to be normally active and to enjoy all the activities of childhood without breathing problems. These treatments are very effective, and the well educated family unit blends with the medical home to produce excellent outcomes and many fewer episodes leading to sickness and missing school.

Note: Childhood Asthma: Part II will deal more specifically with the diagnosis and treatment of asthma

Why You Should Not Give Milk to a Child on an Antibiotic

For any drug or medication to be effective it must reach the gastrointestinal tract where it will be absorbed through the stomach or intestinal lining and enters the blood stream. It then circulates in the bloodstream to get to the site where it can affect the infection or other issue for which it is being used, in the right concentration to be maximally effective. If this process is interrupted or altered in any way the effectiveness of the medication may also be altered and therefore the infection might not be treated adequately.

First of all, the medication (antibiotic) must be in the effective chemical form to enter the gastrointestinal tract and be absorbed, and so most medicines are combined with a chemical to aid in ingestion and absorption. Children obviously have problems with pill form medications and therefore liquid preparations have been developed for just about any medications. If that medication causes nausea and/or vomiting the chain is broken and adequate delivery of the antibiotic cannot be established. One must also be aware of the local climate in the stomach and intestines; any variety in the acidity or other factors can alter the absorption of the medication. If there is disease process affecting the lining of the stomach or intestines such as malabsorption, short bowel syndrome after certain surgeries, acid reflux disease, hyperacidity, and other issues, this may also affect absorption of medications. Any food or fluid taken with a medication may alter the effectiveness of the medicine and therefore it is very important to follow directions on the prescription bottle placed there by the pharmacist, the expert in such matters.


This brings me to the topic at hand today:

Because of the calcium content of certain foods, and because calcium can bind to certain medicines making them more or less effective, there are certain antibiotics that should absolutely not be taken with milk, cheese or other milk products.

Tetracycline (doxycycline and other forms) can be deactivated or inactivated by concurrent ingestion of these milk products. To some extent some other antibiotics may also be affected by milk, etc. so it is again very important to follow the pharmacist’s directions; ask any questions you may have regarding these directions because occasionally taking some antibiotics along with food can enhance the absorption.

Just to be absolutely clear – before you leave the pharmacy, ask your pharmacist the following two questions: “should this be taken with food? Does my child need to avoid milk products while taking this?”

How to Treat Your Child’s Infectious Disease

Chickenpox

Incubation period: One to three weeks
Infectious period: The most infectious time is one to two days before the rash appears, but it continues to be infectious until all the blisters have crusted over.

Symptoms

Chickenpox is a mild infectious disease that most children catch at some time. It starts with feeling unwell, a rash and, usually, a fever.

Spots develop, which are red and become fluid-filled blisters within a day or two. They eventually dry into scabs, which drop off. The spots first appear on the chest, back, head or neck, then spread. They don’t leave scars unless they’re badly infected or picked.

What to do

You don’t need to go to your GP(*physician) or accident and emergency (A&E) department(*emergency room) unless you’re unsure whether it’s chickenpox, or your child is very unwell or distressed.

  • Give your child plenty to drink.
  • Use the recommended dose of paracetamol to relieve any fever or discomfort. Ibuprofen isn’t recommended for children who have chickenpox as, in rare cases, it can cause skin complications.
  • Taking baths, wearing loose, comfortable clothes and using calamine lotion can all ease the itchiness.
  • Try to discourage or distract your child from scratching, as this will increase the risk of scarring. Keeping their nails short will help.
  • Let your child’s school or nursery know they are ill, in case other children are at risk.
  • Keep your child away from anyone who is pregnant or trying to get pregnant. If your child had contact with a pregnant woman just before they became unwell, let the woman know about the chickenpox and suggest that she sees her GP or midwife. For women who have never had chickenpox, catching the illness in pregnancy can cause miscarriage, or the baby may be born with chickenpox.

For more information, see our page on chickenpox.

See our visual guide to rashes in babies and children.

Measles

Incubation period: 7 to 12 days
Infectious period: From around 4 days before the rash appears until 4 days after it’s gone.

Symptoms

  • Measles begins like a bad cold and cough with sore, watery eyes.
  • Your child will become gradually more unwell, with a fever.
  • A rash appears after the third or fourth day. The spots are red and slightly raised. They may be blotchy, but not itchy. The rash begins behind the ears and spreads to the face and neck, then the rest of the body.
  • The illness usually lasts about a week.

Measles is much more serious than chickenpox, german measles, or mumps. It’s best prevented by the MMR vaccination. Serious complications include pneumonia and death.

What to do

  • Make sure your child gets plenty of rest and plenty to drink. Warm drinks will ease the cough.
  • Give them paracetamol or ibuprofen to relieve the fever and discomfort.
  • Put Vaseline around their lips to protect their skin.
  • If their eyelids are crusty, gently wash them with warm water.
  • If your child is having trouble breathing, has a seizure, is coughing a lot or seems drowsy, seek urgent medical advice.

For more information, read see our page on measles.

Mumps

Incubation period: 14 to 25 days
Infectious period: From a few days before starting to feel unwell until a few days afterwards.

Symptoms

  • A general feeling of being unwell.
  • A high temperature.
  • Pain and swelling on the side of the face (in front of the ear) and under the chin. Swelling usually begins on one side, followed by the other side, though not always.
  • Discomfort when chewing.

Your child’s face will be back to normal size in about a week. It’s rare for mumps to affect boys’ testes (balls) – this happens more often in adult men with mumps. If you think your child’s testes are swollen or painful, see your GP.

What to do

  • Give your child paracetamol or ibuprofen to ease pain in the swollen glands. Check the pack for the correct dosage.
  • Give your child plenty to drink, but not fruit juices, as they make the saliva flow, which can worsen your child’s pain.
  • There’s no need to see your GP, unless your child has other symptoms, such as a severe headache, vomiting, rash or, in boys, swollen testes.
  • Mumps can be prevented by the MMR vaccine.

See our page on mumps for more information.

Slapped cheek disease (also known as fifth disease or parvovirus B19)

Incubation period: 1 to 20 days
Infectious period: A few days before the rash appears. Children are no longer contagious when the rash appears.

Symptoms

  • It begins with a fever and nasal discharge.
  • A bright red rash, like the mark left by a slap, appears on the cheeks.
  • Over the next two to four days, a lacy rash spreads to the trunk and limbs.
  • Children with blood disorders such as spherocytosis or sickle cell disease may become more anaemic. They should seek medical care.

What to do

  • Make sure your child rests and drinks plenty of fluids.
  • Give them paracetamol or ibuprofen to relieve any discomfort and fever.
  • Pregnant women or women planning to become pregnant should see their GP or midwife as soon as possible if they come into contact with the infection or develop a rash.

Go to our page on slapped cheek syndrome for more information.

German measles (rubella)

Incubation period: 15 to 20 days
Infectious period: From one week before symptoms develop until up to four days after the rash appeared.

Symptoms

  • It starts like a mild cold.
  • A rash appears in a day or two, first on the face, then on the body. The spots are flat and are pale pink on light skin.
  • Glands in the back of the neck may be swollen.
  • Your child won’t usually feel unwell.

It can be difficult to diagnose rubella with certainty.

What to do

  • Give your child plenty to drink.
  • Give them paracetamol or ibuprofen to relieve any discomfort or fever.
  • Keep them away from anybody who’s in the early stages of pregnancy (up to four months) or trying to get pregnant. If your child has had contact with any pregnant women before you knew about the illness, you must let the women know, as they’ll need to see their GP.
  • Rubella can be prevented by the MMR vaccine.

For more information, go visit our page on rubella.

Whooping cough

Incubation period: 6 to 21 days
Infectious period: From the first signs of the illness until about three weeks after coughing starts. If an antibiotic is given, the infectious period will continue for up to five days after starting treatment.

Antibiotics need to be given early in the course of the illness to improve symptoms.

Symptoms

  • The symptoms are similar to a cold and cough, with the cough gradually getting worse.
  • After about two weeks, coughing fits start. These are exhausting and make it difficult to breathe.
  • Younger children (babies under six months) are much more seriously affected and can have breath-holding or blue attacks, even before they develop a cough.
  • Your child may choke and vomit.
  • Sometimes, but not always, there will be a whooping noise as the child draws in breath after coughing.
  • The coughing fits may continue for several weeks, and can go on for up to three months.

What to do

  • Whooping cough is best prevented through immunisation.
  • If your child has a cough that gets worse rather than better, and starts to have longer fits of coughing more often, see your GP.
  • It’s important for the sake of other children to know whether or not your child has whooping cough. Talk to your GP about how to look after your child. Avoid contact with babies, who are most at risk from serious complications.
  • Whooping cough can be prevented by childhood vaccinations.

For more information, go to our page on whooping cough.

Editor’s Note: *clarification provided for our US readers.

NHS Choices logo


From www.nhs.uk





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