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.

Once 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.

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 the 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

How Can a Cookie Teach My Child to be Calm?

All children benefit from learning relaxation skills.

One of the most commonly used and effective relaxation skills is deep breathing. Deep breathing (also known as diaphragmatic breathing) involves slow, deep breaths through the diaphragm to initiate the body’s relaxation response. Relaxation skills are important to master because they can help children better manage anger, stress, fear, and anxiety.

Children may be resistant to learning and implementing relaxation skills. Teaching children to relax using a playful technique is an effective way to break through the resistive barrier.

An engaging intervention to teach diaphragmatic breathing is the Cookie Breathing Game (Lowenstein, 2016).

The child is directed to follow these steps:

• Put your hand on your tummy, where your belly button is.
• Slowly breathe in through your nose for three seconds and feel your tummy move out.
• Slowly breathe out through your mouth for four seconds, and feel your tummy move in.
• Make sure your shoulders and chest are relaxed and still.
• Only your tummy should be moving in and out.
• To help you learn this special way of breathing, imagine a yummy batch of cookies that just came out of the oven.
• As you breathe in, smell those yummy cookies!
• But they’re hot, so you have to blow on them to cool them down.
• As you breathe out, blow on the cookies to cool them down.

A game is then played to help the child practice. The child rolls the dice and does Cookie Breathing slowly and properly two times when an even number is rolled. The child gets a point if an odd number is rolled. The child gets a cookie once four points are earned.

Repeated practice is required when building relaxation skills; thus, home-based practice exercises are strongly encouraged. Parents should learn the Cookie Breathing technique as well so they can coach the child to practice the strategy at home. Practicing at bedtime is recommended as this helps the child relax in preparation for sleep.

Reference: Lowenstein, L. (2016). Creative CBT interventions for children with anxiety. Toronto, ON: Champion Press.

 

Why You Need to Stop Giving Energy and Sports Drinks to Kids

First let’s differentiate between these two popular drinks. Sport drinks have water, sodium, potassium and sugar (among other things), while energy drinks include caffeine or other stimulants. For the most part, after moderate exercise, only water needs to be replaced and free access to water is key to training athletes. While large amounts of water can be lost in highly trained athletes, younger children will probably not lose an exceptional amount of anything, and water is the only thing necessary. Even in adult trained athletes, the amount of sodium and potassium lost through sweating is probably negligible; again water is the vital component needing replacement.

Also included in these drinks is a significant amount of calorie- containing sugars; highly trained athletes who have depleted their sugar resources might benefit from this addition as an immediate energy boost, but in younger children and non-training athletes, this only adds to the sugar intake and can contribute to childhood obesity and dental cavities. These same stimulants can be found in coffee and colas, also to be avoided in younger children.

The use of stimulants in children probably has more unwanted side effects than the possibility of any positive effects. Jitteriness, poor sleep, elevated blood pressure, and increased risk of dehydration through the diuretic effects of caffeine and other stimulants, can be just a few of these negative effects. Depending on the quantities consumed, it can even lead to cardiac irregularities with other potentially serious consequences resulting from that

Unfortunately, these products are promoted in every form of advertising by highly popular athletes in high profile positions and many parents have gotten the idea to have these drinks readily available for their children. Children may actually prefer this substitute fluid in place of other drinks during meals and other snack times. Milk and some juices are still important to the growing, developing child and should not be forgotten. By far the most important ingredient remains water and parents should promote it as the primary source of fluid intake.

Energy or health bars create the same dilemmas for parents and children and may also contain sugar, stimulants, fats, and vitamins and minerals that may not be appropriate for children or may be over the daily recommended intake for children since most are developed for adults.

Always read the labels carefully