Four Ways to Prevent Urinary Tract Infections in Children

Urinary tract infections are a common and painful ailment for children, but a few simple strategies can go a long way toward keeping the problUTI_Prevention_Tips_CHOCem at bay, says Dr. Antoine Khoury, medical director of urology at CHOC Children’s.

Dr. Khoury offers four measures parents and children can take to promote good urinary tract health in kids.

Drink lots of water

Parents should encourage children to stay hydrated.

“Water is really important,” explains Dr. Khoury. “Drinking water increases the volume of urine. This helps the child flush bacteria from their bladder out.”

A dehydrated body conserves water, which can prompt constipation and reduce the frequency of urination, and the flushing of bacteria, Dr. Khoury says.

“Constipation also stops the bladder from emptying completely,” he says. “This results in retention of some bacteria in there that will start multiplying as soon as the child stops peeing.”

Dr. Khoury also says that children should examine their urine to ensure proper hydration.

“If it’s yellow, it’s concentrated so they haven’t had enough water to drink,” he says. “It should be the same color as the water in the toilet bowl, which is clear.”

Urinate frequently

Ensure children urinate every two to three hours or at least seven times a day, which reduces the length of time that urine sits in the bladder and bacteria can grow, Dr. Khoury says

“Kids should go to the bathroom when they wake up; before going to school or at morning recess; at lunchtime; at afternoon recess or when they get home from school; before dinner; between dinner and bedtime; and before they go to bed,” he says.

Children also should be encouraged to use the toilet at school and not “hold it” until they get home, as some kids might do because they don’t want to give up playtime at recess.

To help encourage children to urinate regularly, parents can buy their kids a watch with multiple alarms or set a schedule, Dr. Khoury recommends.

“I tell kids, ‘I want you to be your bladder’s boss. You tell your bladder it’s time to go,’” he says.

Eat a healthy diet

Preventing and correcting constipation is an important factor in ensuring proper urinary tract health, children should eat plenty of fruits, veggies and foods rich in fiber, Dr. Khoury says.

Fiber-rich foods include cereals, whole wheat bread and Fiber One bars.

“I prefer water, but if parents have to give the kids juice, use cranberry juice or prune juice,” Dr. Khoury says.

Practice good hygiene

Cleanliness, good toilet habits and proper hygiene in the genital area helps prevent the introduction of bacteria into the urinary tract, Dr. Khoury says.

When using the toilet, girls should be taught to wipe from front to back to prevent the spread of bacteria, he recommends.

Uncircumcised boys should be taught to regularly clean their penis and foreskin in the bath or shower, Dr. Khoury advises.

More articles about urinary tract infections in kids:

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Kids and Bedwetting

girl laying on bed
CAUSES AND SOLUTIONS
Bedwetting (nocturnal enuresis) can frustrate parents and children who often feel embarrassed and anxious about this problem and suffer from low self-esteem. Bedwetting occurs more frequently in boys than in girls and Dr. Khoury says the problem typically stops once the child is motivated and ready to work on staying dry at night. “It’s not the kid’s being lazy or irresponsible” says Dr. Khoury. “It’s not a reflection of the child’s intelligence, and in fact, a majority of children with bedwetting say math is their favorite subject at school.”

CAUSES
“The problem with bedwetting is not that the kidneys produce too much urine. The issue is: is the brain waking up to the full bladder and the need  to go to the bathroom when the bladder is full?” explains Dr. Khoury. “In a child with a bedwetting issue, the communication between brain and  bladder is incomplete and inefficient. You need the brain and bladder talking to each other so you can be responsive and awaken to that stimulus.”

BEST SOLUTION
Ideally, reducing the intake of liquid before bed will help reduce bedwetting. But training the brain to respond to the need to urinate is the goal. A wetness alarm with sensors can be placed on the child’s underwear and when wetness is detected, a buzzer goes off and wakes the child. “After three to four weeks, the brain realizes it isn’t keeping track of the bladder at night,” says Dr. Khoury. “If your brain is now  expecting a buzzer every time the bladder begins to wet, the brain begins to wake up before it wets. So you get up and go to the bathroom. The brain begins to communicate with the bladder and tells the bladder to wait, and you can sleep all night.” Medication that reduces the amount of urine produced by the kidneys at night, a safe and common treatment, can also be used, Dr. Khoury says.

WHAT IF MY CHILD ISN’T MOTIVATED TO WORK ON STAYING DRY AT NIGHT?
“If the child isn’t ready, wait and when the child is ready, that will be the time to start talking to them about the alarm. It has to be used properly,” says Dr. Khoury.

FAST FACTS

  • Number of U.S. children overage 6 affected by persistent nighttime bedwetting: 5 Million
  • Percentage of 5-year-olds that wet the bed: 15%
  • Chance that a child will be a bedwetter if both parents were: 50%

View the full feature on Kids and Bedwetting

Dr. Khoury
Dr. Antoine “Tony” E Khoury

PHYSICIAN FOCUS: Antoine “Tony” E Khoury, MD

Dr. Khoury completed his residency in urology at the University of Toronto in Canada. He completed a clinical fellowship and a research fellowship  in pediatric urology at the Hospital for Sick Children in Toronto, followed by a research fellowship at the University of Calgary in Alberta, Canada, in the area of biomaterial-related infections. He is recognized for his expertise in complex urological reconstruction of major birth defects.

Dr. Khoury’s philosophy of care: “I take a very analytical approach to the patient’s medical issues and listen to the family. With that in mind, I tailor their diagnostic studies and surgical intervention to the patient’s needs without putting them at risk for under-investigation or over-investigation.”

EDUCATION:
Ain Shams University Medical School in Cairo, Egypt

BOARD CERTIFICATIONS:
Urology

More about Dr. Khoury

This article was featured in the Orange County Register on January 21, 2014 and was written by Amy Bentley.

What if My Child Isn’t Motivated to Work on Staying Dry at Night?

iStock_000011371901Small“The problem with bedwetting is not that the kidneys produce too much urine. The issue is: is the brain waking up in response to the full bladder and the urge to go to the bathroom when the bladder is full?” explains CHOC Pediatric Urologist Dr. Tony Khoury. “In a child with a bedwetting issue, the communication between brain and bladder is incomplete and inefficient. You need the brain and bladder talking to each other so that the child can awaken in response to that stimulus.”

Training the brain to respond to the need to urinate is the goal, so one treatment option is the use of an alarm. An alarm with sensors is placed on the child’s underwear and when wetness is detected by the sensors, a buzzer goes off and wakes the child.

“If the child isn’t ready, wait and when the child is ready, that will be the time to start talking to them about the alarm. It has to be used properly,” says Dr. Khoury.

Dr. Khoury suggests that parents not push their child to stop wetting the bed or use the alarm unless the child is ready and motivated to stop. To help motivate your child to work on staying dry and to work with the alarm, parents can try taking off the potty training pants and put the child in regular underwear. Parents also can have their child help do his laundry and change the sheets to get him more motivated, Dr. Khoury says.

In cases where the child isn’t ready or motivated and still wets the bed despite using the alarm, it’s not the alarm that is failing to work.

“The alarm requires them to wake up. The alarm is doing its job and buzzing when the urine is coming out but the child is not responding,” Dr. Khoury says. If this is the case, Dr. Khoury says, “Have a parent or older sibling sleep with the child the first few nights of using the alarm and the parent or sibling can make sure he is waking up. If the child fights this, then there isn’t enough motivation so wait a few months and try again. The problem is, families give up. Wait until the child is ready. The child has to want it. If he is ready to be dry, he will work very hard with the alarm.”

The success rate of wetness alarms is excellent – provided the child wakes up to the alarm. In fact, 75 percent of children in three weeks manage to respond to the alarm and wake up as they are wetting or right before they wet, and then they sleep through the night.

“They begin to wake up on their own to go to the bathroom,” says Dr. Khoury. “I tell parents to keep putting the alarm on for six months past the child’s last wet night.”

Parents can tell their child is motivated to stay dry if he starts to notice that he is wet in the morning and doesn’t like it, if he says he doesn’t want to wear potty training pants anymore, and if he avoids sleepovers he wants to attend.

View our Health Feature on Bedwetting.

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One For the Books

 

“Your baby has no kidneys.”  That’s what Nicola and Clifford Vazquez were told when a prenatal ultrasound showed an abnormal mass where their baby’s kidneys should be. Just halfway through the pregnancy, they were also told that their baby would die shortly after birth. they were devastated.  The Vazquezes decided to get a second opinion, which ultimately led them to CHOC children’s pediatric urologist Antoine Khoury, M.D.  He saw things differently.

When Madison Vazquez was born last November, Dr. Khoury and his team were ready and waiting. Dr. Khoury used tiny, minimally invasive instruments to drain accumulated fluid that appeared to explain the abnormal  images on the ultrasound. But he sensed there was more to the picture. He decided to look further.

ar-2012-one-for-the-books2What Dr. Khoury found was a structural abnormality that was undetectable by ultrasound. It explained everything.  No one in the operating room had ever seen anything like it. But Dr. Khoury and his team used a combination of reconstructive techniques to correct the newly discovered abnormality. Their ingenuity  in the operating room saved Madison from having a more extensive surgical procedure that very same day.

“The first condition was so glaringly abnormal that it masked the primary condition,” Dr. Khoury said.  “We’ve checked the literature and haven’t found reports of anyone else using the combination of techniques that we brainstormed that day. We are submitting it for publication in hopes it may save other children from having more extensive procedures.”

Looking back over their ordeal, Nicola and Clifford have already found a silver lining. “If we had not gotten the misdiagnosis before Madison was born, we would not have met Dr. Khoury when we did, and he saved her life,” Nicola said.

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  • Circumcision and Urinary Tract Infections
    Some evidence shows that circumcised boys have a lower chance of developing urinary tract infections (UTIs) in their first years of life, but the added protection  may be miniscule, say ...
  • Urinary Tract Infections
    “UTIs are very common in children. Kids can get them at any age as they grow,” says Dr. Khoury, medical director of pediatric urology at CHOC. “What’s important for parents ...
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