WHAT IS A UTI? Cheer explains that a UTI occurs when bacteria enter the urinary system, causing infection in the bladder, urethra, uterus or kidneys. While girls are generally more likely to develop UTIs because of their short urethra, boys can also be affected. In girls, bacteria can enter the urethra through: incorrect wiping after using the toilet soiled nappies or underwear remaining in wet clothing for too long. Cheer says UTIs are much more likely to occur when a child does not empty their bladder fully, because bacteria remain in the urinary tract for longer. Many parents and educators are surprised to learn how closely constipation and bladder health are linked, leading it to being a significant but often overlooked risk factor. A constipated child may experience recurrent UTIs because stool in the bowel presses on the bladder, preventing complete emptying and allowing bacteria to multiply. Other contributing factors include infrequent nappy changing, ‘wee withholding’, inadequate fluid intake, poor toileting habits and underlying bladder conditions. Sunni Liston, paediatric bowel and bladder nurse specialist at ERIC, says that while toilet training itself does not cause UTIs, some challenges associated with toilet training can increase the risk. These include: Children rushing to the toilet and not relaxing to empty their bladder. Holding on to wee because they are distracted or reluctant to use the toilet. Learning incorrect wiping techniques. Developing constipation during toilet training. WHAT ARE THE SYMPTOMS? Symptoms vary considerably depending on a child's age. Older children may complain that it hurts when they wee or say they need to go to the toilet frequently. Younger children, however, cannot explain these sensations. Instead, they may simply appear unsettled or generally unwell. Educators should be alert to children showing one or several of these symptoms: Smelly, cloudy or unusually dark urine. Complaints of tummy ache. Painful or stinging urination. Visible blood in the urine. High temperature. Frequent small wees. Urgent rushes to the toilet. New daytime wetting accidents. Bedwetting. Signs that may suggest a more serious infection of the kidneys and/or ureters include: Fever. Tummy pain. Back pain. Appearing generally unwell. You should inform a parent or carer if a child is showing any of the listed symptoms and encourage them to seek medical advice (see box). ‘Some children may not appear generally unwell, so a UTI can be easily missed,’ says Liston. ‘However, as many of the same symptoms can be caused by constipation or drinking the wrong things, it is best to work through the “Four steps to a healthy bladder” [see Further information] to work out what is going on.’ HOW CAN THEY BE AVOIDED? Encouraging regular hydration is one of the simplest and most effective strategies you can take. Some children become so engrossed in play that they forget to drink, leading to concentrated urine that may irritate the bladder. Cheer recommends encouraging children to drink a minimum of six to eight cups of fluid throughout the day. Similarly, children should be encouraged to use the toilet regularly rather than delaying because they are busy playing. Educators can help by: making drinking water easily accessible throughout the day offering regular drink breaks supporting children to use the toilet without rushing them encouraging children to fully empty their bladder maintaining clean, welcoming toilet facilities teaching correct wiping techniques – especially girls wiping front to back changing nappies and wet or soiled underwear promptly, using appropriate hygiene procedures. For children who are toilet training, patience is especially important. Pressuring children to remain dry for long periods may encourage ‘wee withholding’, which can increase the risk of bladder problems. You should also report constipation concerns to parents promptly and advise that they address the possible problem swiftly. WHAT ARE THE RISKS? ‘Without treatment, a UTI is unlikely to resolve on its own and can lead to several complications,’ warns Liston. Immediate risks Pain and discomfort. Fever and illness. Frequent or urgent urination. Daytime wetting and bedwetting. Disrupted bladder function leading to toilet-training difficulties. More serious risks Infection spreading to the kidneys (upper UTI). Recurrent infections. Need for specialist assessment and investigations. Kidney damage or scarring in some children with recurrent or severe infections. ‘Children with recurrent UTIs may require scans, including a DMSA scan, to check kidney function and look for scarring,’ adds Liston. ‘Babies under three months with suspected UTIs require immediate specialist referral because of the increased risk of serious illness.’ TREATMENT A GP may do a urine test to confirm a UTI. UTIs can be treated with a short course of antibiotics along with liquid paracetamol to reduce any pain. The NHS also recommends rest