pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

Recurrent Urinary Tract Infection

[A mother is perplexed by her 9 year-old daughters seeming chronic/recurrent urinary tract infections.]

My daughter, who is currently 8 years, 10 months old, has been suffering from recurrent urinary tract infection (UTI) symptoms for almost three years now, on and off. She has had many tests and there are no anatomical defects. She voids often and takes nitrofurantin macro 50 mg QD. We encourage fluids. She pats her peri area dry with toilet paper to reduce friction in the peri area. Many times she will have UTI symtoms of urgency and stomach pain but the UA will be normal and a C & S is not indicated. It is very frustrating for her and us. I do notice that her labia sometimes is red or dark pink and she states it hurts. Thanks you for your help… Jennifer K.
Of course I wouldn’t be able to make treatment advice as I haven’t examined your child.

You didn’t mention what training the physician you’ve been seeing has had. I’m not sure whether you have seen pediatric urologist or a pediatrician; or, if you’re still at the family practitioner stage.

A very common cause of what is “thought to be UTI” is: pin worms- so common that most pediatricians check for those almost whenever a girl has problems with recurrent UTIs. Also vulvo-vaginitis.

You mentioned she “pats” dry. Usually of much more significance is the direction that she wipes. NEVER wipe from back to front (pulling contamination from the anus); ALWAYS wipe from front to back.

And, of course, sometimes nervousness or other emotional issues causes frequency and urgency – wouldn’t be unusual, especially if she is dry through the night. (i.e. has a normal size bladder that can hold a full nights urine.)

And, to round out picking my brain, caffeine drinks (and certain other medications) can produce nervousness with frequency and urgency along with certain types of food allergies – I’ve seen it with milk, and nut allergies… Hope this helps you manage her problem.

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