Children at risk of kidney damage after tests miss 70% of UTIs
Doctors are failing to spot signs of painful UTIs in children, putting them at risk of kidney and bladder damage, experts warn.
The uncomfortable condition, often described as a urinary tract infection, affects around one in ten girls before the age of 16, as well as one in 30 boys and if caught early it can be treated effectively with the help of antibiotics.
However, studies show that up to half of children who visit their family doctor with the problem are not promptly diagnosed.
Doctors fail to spot signs of painful UTIs in children, putting them at risk of kidney and bladder damage, experts warn
Doctors say this is because tests used by GPs to detect the disease miss more than two-thirds of infections. A more accurate test exists but is used less, possibly because GPs are discouraged by local spending bosses as it is more expensive and takes longer.
The most common test is equally inaccurate for adults, but campaigners say the problem causes greater problems in children, who are harder to diagnose based on symptoms alone. And they are also more likely to suffer from serious life-altering illnesses as a result of untreated UTIs.
“It’s really difficult to diagnose a younger child with a UTI, as they are often unable to find the words to explain their symptoms,” says Dr Cat Anderson, GP and specialist in microbial infections.
“While an adult may say their bladder is hurting or itchy when peeing, a child may just say they have a stomach ache. You have to test for the disease, but the most commonly used test often doesn’t work, so many girls and boys go undiagnosed with painful infections every year.
UTIs occur when bacteria enter the urinary tract – a catch-all term for the bladder, kidneys and the tubes connected to them. Sufferers typically experience a burning sensation when urinating, along with difficulty urinating and a high temperature
UTIs occur when bacteria enter the urinary tract – a catch-all term for the bladder, kidneys and the tubes connected to them. Affected individuals typically experience a burning sensation when urinating, along with difficulty urinating and a high temperature.
NHS GPs should monitor fever, vomiting and loss of appetite in young children. But these symptoms are also commonly seen in other childhood illnesses, such as stomach bug. It is crucial for GPs to spot UTIs in children because, if left untreated, the infection can cause serious harm.
Studies show that children are more likely than adults to have kidney scarring after a UTI – a condition that often leads to kidney failure later in life. Research also shows that children under the age of three are at risk of developing sepsis – a life-threatening immune system reaction to an infection.
For this reason, in May, NHS guidelines were released which urged family doctors to rely on tests – instead of looking for common symptoms – when diagnosing UTIs in children. But experts say that advice is wrong because it suggests using the inaccurate dipstick test. This involves dipping a test strip into a sample or urine. The strip has squares that change color in the presence of certain substances – including sugar and white blood cells – that indicate infections or other problems.
But Professor Jennifer Rohn, UTI expert from University College London, says: ‘The strip test is abysmal. He catches an infection about 50% of the time. You might as well flip a coin to decide.
Doctors say it’s even more difficult to get an accurate result with young children, with accuracy as low as 30%.
The gold standard test is a urine culture, where the sample is sent to a lab and examined under a microscope. Studies show that this technique identifies approximately 95% of the bacteria responsible for urinary tract infections. But experts say that all too often cultures are not carried out for reasons of time and money.
“The number of parents contacting us and saying their child continues to fail urine tests despite all the obvious symptoms of a UTI is clear,” says Alison Pearce, Director of Infections Charity CUTIC urinary. “The NHS urgently needs to reassess how it diagnoses this condition.”
One child left with an undiagnosed UTI was Lea Mackintosh from London, who began experiencing debilitating symptoms aged 11. Lea, now 19 and a student, suffered from bladder pain, stings while peeing and had a constant need to go to the bathroom. But her mother Beth, 58, says at the time she was unable to describe her symptoms. “She wasn’t old enough to put her pain into words, she just said her stomach hurt and something was wrong.”
Beth, a charity worker, took Lea to the GP, who carried out a dipstick test, which came back negative. When Beth pushed Lea to see a hospital consultant, she was told her daughter was most likely suffering from stress. “The consultant refused to do more tests and said it must have been the stress of her SAT exams. But the only thing stressing her was the pain.
Lea continued to suffer from recurring bouts of pain over the next two years – what doctors now believe were repeated urinary tract infections.
“When she was 13, Lea was afraid to go to the bathroom because she didn’t want to hurt,” Beth explains. “She would try to hold him off as long as possible. When she finally had to leave, there were always tears after.
In 2016, Lea was taken to a private urologist, who performed a urine culture and diagnosed her with a UTI. “He spotted it instantly,” Beth says. “And then Lea was immediately given a heavy dose of antibiotics – the first time she was ever offered medication.”
After ten months of repeated courses of antibiotics, Lea’s symptoms began to improve.
Beth: ‘My daughter was repeatedly told that her pain was all in her head, when it clearly wasn’t. I don’t want other children to go through the same ordeal.
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