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UTIs in Children: Know the Signs
Dr. Schlomer and Dr. Stanasel discuss UTIs in children.
Featured Speaker:
Learn more about Irina Stanasel, M.D
Bruce J. Schlomer, M.D., is a pediatric urologist at Children’s HealthSM and an assistant professor of urology at UT Southwestern Medical Center. Dr. Schlomer earned his medical degree from Washington University School of Medicine in St. Louis, Missouri, and completed his urology residency at UT Southwestern in Dallas. He then completed his fellowship training in pediatric urology at the University of California San Francisco. Dr. Schlomer is active in medical education and directs the resident pediatric urology education program at Children’s Medical Center Dallas. He also teaches the American Urological Association (AUA) Board Review Course and has served on the AUA Core Curriculum writing committee. He conducts a pediatric urology clinic at the Children’s Health Specialty Centers in Dallas, Rockwall and Park Cities. He also practices at a weekly clinic at Texas Scottish Rite Hospital where he cares for children with neurogenic bladder, integrating patient care with a young adult transitional care program at Children’s Medical Center Dallas. Dr. Schlomer is interested in the management of and reconstructive surgery for genitourinary conditions such as undescended testis, congenital penile anomalies such as hypospadias, prenatal hydronephrosis, vesicoureteral reflux, ureteropelvic junction obstruction, urinary tract infections, neurogenic bladder, and pediatric kidney stone disease. He also has extensive training and interest in minimally invasive surgeries including robotic assisted surgeries such as robotic assisted laparoscopic pyeloplasty. Dr. Schlomer lives in East Dallas with his wife and three children. He enjoys chasing after his kids and playing the piano and guitar.
Learn more about Bruce Schlomer, MD
Irina Stanasel, MD | Bruce Schlomer, MD
Irina Stanasel, M.D., is a pediatric urologist at Children’s Health℠ and an assistant professor in the Department of Urology at UT Southwestern Medical School. She provides care for children of all ages who have a variety of urologic disorders. She provides care for children of all ages who have a variety of urologic disorders. “Being a pediatric urologist affords me the opportunity to take care of children with urologic conditions ranging from ones that require a few office visits to others that require surgery and long term regular follow up visits” she says. “I enjoy getting to know patients and helping them and their families by developing individualized treatment plans and caring for the kids at various stages of childhood.” Dr. Stanasel received her medical degree from Baylor College of Medicine in Houston, Texas and completed her residency in urology at Wake Forest University Baptist Medical Center. She completed a pediatric urology fellowship at Texas Children’s Hospital in Houston. Her specialties include fetal urology, bladder bowel dysfunction, complex hypospadias repair, prune belly syndrome and quality improvement in pediatric urology. Dr. Stanasel’s specialties include fetal urology, bladder and bowel dysfunction, complex hypospadias repair, prune belly syndrome and quality improvement in pediatric urology. In addition to her medical degree, Dr. Stanasel holds a chemical engineering degree from the University of Texas, Austin. She also spent two years as a faculty member at the University of New Mexico working with underserved populations. Dr. Stanasel grew up in Romania before moving to Dallas as a teenager. She speaks English, Romanian and some Spanish. In her free time, Dr. Stanasel enjoys yoga, running, hiking, traveling, and spending time with friends and family.Learn more about Irina Stanasel, M.D
Bruce J. Schlomer, M.D., is a pediatric urologist at Children’s HealthSM and an assistant professor of urology at UT Southwestern Medical Center. Dr. Schlomer earned his medical degree from Washington University School of Medicine in St. Louis, Missouri, and completed his urology residency at UT Southwestern in Dallas. He then completed his fellowship training in pediatric urology at the University of California San Francisco. Dr. Schlomer is active in medical education and directs the resident pediatric urology education program at Children’s Medical Center Dallas. He also teaches the American Urological Association (AUA) Board Review Course and has served on the AUA Core Curriculum writing committee. He conducts a pediatric urology clinic at the Children’s Health Specialty Centers in Dallas, Rockwall and Park Cities. He also practices at a weekly clinic at Texas Scottish Rite Hospital where he cares for children with neurogenic bladder, integrating patient care with a young adult transitional care program at Children’s Medical Center Dallas. Dr. Schlomer is interested in the management of and reconstructive surgery for genitourinary conditions such as undescended testis, congenital penile anomalies such as hypospadias, prenatal hydronephrosis, vesicoureteral reflux, ureteropelvic junction obstruction, urinary tract infections, neurogenic bladder, and pediatric kidney stone disease. He also has extensive training and interest in minimally invasive surgeries including robotic assisted surgeries such as robotic assisted laparoscopic pyeloplasty. Dr. Schlomer lives in East Dallas with his wife and three children. He enjoys chasing after his kids and playing the piano and guitar.
Learn more about Bruce Schlomer, MD
Transcription:
Prakash Chandran: You're listening to Children's Health Checkup where we answer a parent's most common questions about raising healthy and happy kids. Today we'll be discussing UTIs in children with our experts, Dr. Irina Stanasel, who's a Pediatric Urologist at Children's Health and Assistant Professor at UT Southwestern and Dr. Bruce Schlomer, a Pediatric Urologist at Children's Health and Associate Professor at UT Southwestern. Today we'll talk about symptoms, diagnosis, and treatment of UTIs in kids. So Dr. Schlomer, we'll start with you. What exactly is a urinary tract infection and what causes them to occur?
Prakash Chandran: You're listening to Children's Health Checkup where we answer a parent's most common questions about raising healthy and happy kids. Today we'll be discussing UTIs in children with our experts, Dr. Irina Stanasel, who's a Pediatric Urologist at Children's Health and Assistant Professor at UT Southwestern and Dr. Bruce Schlomer, a Pediatric Urologist at Children's Health and Associate Professor at UT Southwestern. Today we'll talk about symptoms, diagnosis, and treatment of UTIs in kids. So Dr. Schlomer, we'll start with you. What exactly is a urinary tract infection and what causes them to occur?
Dr. Schlomer: A urinary tract infection just implies inflammation of the urinary tract, which could be any part of the urinary tract. It could be the bladder, it can be the kidneys, the ureters in general. What causes urinary tract infections, is going to be bacterial infections, um, being most common. And the bacteria gets into the bladder lead to inflammation, which leadsto the symptoms of the urinary tract infection, which most people are familiar with. Things like pain in the bladder, pain with urination, frequent urination, stuff like that.
Host: And Dr. Stanasel, I'm moving over to you. I'm curious as to how common UTIs are in children?
Dr. Stanasel: They're actually fairly common. They're a little bit more common in young girls than young boys. Overall. By the time children have reached kind of a school age of about seven years old, girls have usually had about an 8% chance of having had a urinary tract infection. While little boys have had about a 2% chance of having had a urinary tract infection. In the first few months of life, it seems like little boys are more likely to get a urinary tract infection than little girls, but as they age then girls tend to get more infections than boys.
Host: So Dr. Stanasel, I'm sticking with you for a moment. You mentioned that in the first few months of life that it can start occurring in boys. So can parents expect to see urinary tract infections for either a boy or a girl starting at a couple months old and beyond?
Dr. Stanasel: Yes, actually they can get a urinary tract infection basically anytime after birth. And when they occur in the first few months of life, we're actually even more concern than when day occur later in life. So we're a little bit more likely to do more testing than in the older kids when they get a urinary tract infection. But a urinary tract infection, it should always be on the radar for any parent and primary care giver. The young kids, the little babies tend to present a little bit differently. They're more likely to just act ill and have a fever or maybe not be eating well, versus the older kids who are less likely to present with a fever and are more likely to present with the kind of typical symptoms. When we think of urinary tract infection, it hurts and burns to urinate and things like that. So the presentation may be a little bit different, but they can certainly present at any age.
Host: So Dr. Schlomer, Dr. Stanasel spoke to this a little bit, but let's talk about what are the symptoms and how they end up presenting themselves in both babies and older children. And I'm curious as to what specifically parents should be on the lookout for.
Dr. Schlomer: So there's symptoms in babies, newborn infants, it can be a little bit hard to tell when a child is having your neuro checks infection, to be quite honest, especially in less than two months of age, they may not even have any fevers. They could potentially just be sort of lethargic or hard to wake up, not acting right. They tend to start to have fevers more likely as they get older, past the age, two to three months of age. So in little infants older than three months of age, fever is a common symptom. In infants, they generally don't complain of pain with urination or really seem like they're having pain at all. It's usually just a fever. If they get closer to the age of potty training, then they start to have more of the typical symptoms people think of such as pain with urination or pain in the bladder or frequent urination, stuff like that.But even older children sometimes when they have a urinary tract infection, don't have those classic symptoms. So to be honest, it can be hard to tell sometimes if especially an infant has a urinary tract infection or not. If there is a fever getting the child checked by the pediatrician and at least having your back of your mind that a urinary tract infection could be a possibility seems reasonable. But if there's something else obviously causing the fever, like an ear infection or the flu or something like that, then don't necessarily have to test for a urinary tract infection. For older kids, if they're, complaining of pain with urination and are in the process of potty trained or potty trained, then they can easily give a urine specimen and they can be checked for UTI fairly easily. So it does get easier the older children get in general to tell if a urinary tract infection is present or not.
Host: So Dr. Stanasel, can you talk to us a little bit more about how UTS are diagnosed? You know, I imagine that the older kids will be able to actually communicate with you that it hurts when they go to the bathroom. But you know, I'm curious also for younger kids when they'reexpressing a fever, which could mean 1,000,001 different things, how do you go about diagnosing for both age groups?Dr. Stanasel:If there is a suspicion for urinary tract infection, it's very important for us to have a good urine specimen in order to see what is going on with that urine and if that urine will be positive for signs of infection and inflammation as well as whether or not bacteria will grow out of that specimen in a Petri dish. And the little kids who are not potty trained. The best way to get such a specimen is actually to insert a small catheter through the urethra, into the bladder and allow the urine to drip out of the catheter into the specimen cup. This idea can sometimes be a little bit traumatic for the families to hear that this will be done, but it is very small tube. It's a very quick procedure to obtain this urine specimen and it is incredibly helpful for us to determine whether or not they really have a urinary tract infection without just looking at some contamination from a diaper or the skin or something like that.So we really do ask that the work with us to allow us to get this specimen so we can give them a really good answer for what's going on with their child. When the kid is a little bit older, obviously it's a little bit easier. You can clean off their perineumor clean off their penis around their urethra and make sure that they can just avoid into a specimen cup and that can most of the time be an adequate way to assess whether or not there's a urinary tract infection.So when we get the urine specimen, we look at it under a microscope and look for some inflammatory cells and this can be done pretty quick. You can know an answer for whether or not the child most likely has an infection right away just by looking at the urine and doing a urine analysis in the office or in the emergency room. But in order to truly know whether or not there is infection, we have to send the urine to the lab and allow it to grow on a Petri dish and get a culture of it, which can take up to about 48 to 72 hours.
Host: Yeah, that makes sense. You know, it's test, don't guess in both cases. And I can totally understand the importance of really using that specimen to test whether there's actually bacteria growing. Dr. Schlomer, let's move over toyou and talk a little bit about treatment. Talk to us how UTIs are treated in children.
Dr. Schlomer: In general, urinary tract infections are treated with antibiotics. So let's say you have a child, or let's say an infant with a fever, and they go to thepediatrician and they get a urine specimen. It looks like there's a urinary tract infection than the pediatrician typically will just prescribe an antibiotic, which would be the best guess you know of what antibiotic is going to work for a urinary tract infection. Then when the urine culture comes back in two to three days, then the doctor can kind of determine did they give the right antibiotic, does it need to be changed or not. Antibiotics can come in, pill form, they can come in liquid form and there'sseveral different options. Very, very rarely if there's a highly resistant bacteria that would have to be treated with IV antibiotics, but that's quite rare, so usually they're just treated with oral antibiotics at home. If a patient is quite sick, high fevers, can't tolerate drinking, can't stay hydrated. Sometimes kids have to be admitted to the hospital for IV fluids and also IV antibiotics if they're quite sick from a urinary tract infection. But most of urinary tract infections are managed outpatient with oral antibiotics.
Host: So you know, I'm a parent, parents are listening to this. I'm sure all of us are wondering what can we do to actually prevent our children from getting UTIs in the first place. We know it's fairly common, but Dr. Santasel, is there anything that we can do to minimize the risk of them getting one?
Dr. Stanasel: There are actually quite a few things to implement in order to minimize the risk in the little babies before potty training. Usually if they're getting infections, it may be a sign of something kind of anatomically going on. And that's something that us as doctors and urologists need to look for and treat if that's the case. But around the age of potty training and after, that's where implementing techniques to minimize their risk is really helpful. So one thing would be when the child is going through potty training and the years shortly thereafter, there are a few things to do. One is to encourage the child to void regularly. A lot of little kids at that age want to hold their pee. They don't want to pee. It's either they don't, they're bored, they don't want, they want to play, they don't want to go to the bathroom. They're afraid of the toilets. They don't have enough time at school. There can be a whole lot of reasons for this, but the most important thing is to work with the child and encourage them to void whether or not they feel like it and whether or not they want to take the time. So I would typically say depending on the child and depending on the age, no longer than two to three hours should the child go without voiding.
And sometimes even as short of a time period is 90 minutes. But trying for about every two hours to avoid whether or not they feel like it is a really good idea. Of course, staying hydrated. And another thing that I feel like a lot of people don't realize is the connection between bowel health and urinary tract health. It is very important to ensure that the children are not getting constipated, especially as they're going through potty training. They tend to want to do the same thing with their bowel habits as with their urinary habits, which is again to hold it and not spend the time that they need to on the toilet to have a good bowel movement. So encouraging them to stay on a toilet for an appropriate amount of time and making sure that their diet has an adequate amount of fiber and liquid as well as support for medications if necessary, to make sure that they're having regular soft bowel movements is very important. So just those things alone, making sure that they're peeing and pooping well will go a very long way in minimizing their risk of urinary tract infections.
Dr. Schlomer: So I agree with Dr. Stanasel. Essentially two timeframes are two main timeframes that we see urinary tract infections. We see urinary tract infections in children with significant congenital anomalies, you know, in infancy. And then we also see lots of urinary tract infections happen around the time of potty training. And this is just like she said, when kids learn to hold it and they just don't go pee enough. So we have lots and lots of referrals where kids come for current urinary tract infections who've just developed bad habits where they hold it too long, don't empty their bladder all the way, hold it until the last minute and then they get constipated too, and it just kind of perpetuates the problem. For boys there is always a question of should a boy get circumcised or not and there is a slightly decreased risk of urinary tract infection in infant boys who are circumcised but also you can decrease the risk of urinary tract infection in boys who are uncircumcised by using a steroid cream to release the tight phimosis. The risk of urinary tract infection in boys who are uncircumcised is around 1% so it's still quite rare, but if a boy who was uncircumcised gets a urinary tract infection, oftentimes a good treatment is to either consider a circumcision or consider using a steroid cream to release the phimosis so they don't get any more UTIs.
Host: And Dr. Schlomer just sticking with you as we wrap up here. Is there an age where parents are effectively in the clear around worrying whether their kid is going to get a UTI or not?
Dr. Schlomer: So I would say for a boy who is circumcised with normal prenatal ultrasounds, he is very, very unlikely to get a urinary tract infection. That's actually quite rare. Anytime I see a patient referred who is a boy who was circumcised with a urinary tract infection, I'm worried that we're going to find a significant congenital anomaly. For a boy who's uncircumcised, as soon as the foreskin kind of releases and pulls back easily, generally the risk of urinary tract infection is lower. We see urinary tract infections in kids after potty training and it's usually around the age from two to six or seven. And there are some patients who continue to have urinary tract infections from poor voiding habits even later than that. So I don't know if there's really an age that you're in the clear, but there are kind of ages where things are more common I guess.
Host: That's Dr. Bruce Schlomer and Dr. Irina Stanasel. Thank you for listening to Children's Health Checkup, head to childrens.com for more information. If you found this podcast helpful, please rate and review or share the episode and please follow Children's Health on your social channels. Thanks, and we'll talk next time.
Host: And Dr. Stanasel, I'm moving over to you. I'm curious as to how common UTIs are in children?
Dr. Stanasel: They're actually fairly common. They're a little bit more common in young girls than young boys. Overall. By the time children have reached kind of a school age of about seven years old, girls have usually had about an 8% chance of having had a urinary tract infection. While little boys have had about a 2% chance of having had a urinary tract infection. In the first few months of life, it seems like little boys are more likely to get a urinary tract infection than little girls, but as they age then girls tend to get more infections than boys.
Host: So Dr. Stanasel, I'm sticking with you for a moment. You mentioned that in the first few months of life that it can start occurring in boys. So can parents expect to see urinary tract infections for either a boy or a girl starting at a couple months old and beyond?
Dr. Stanasel: Yes, actually they can get a urinary tract infection basically anytime after birth. And when they occur in the first few months of life, we're actually even more concern than when day occur later in life. So we're a little bit more likely to do more testing than in the older kids when they get a urinary tract infection. But a urinary tract infection, it should always be on the radar for any parent and primary care giver. The young kids, the little babies tend to present a little bit differently. They're more likely to just act ill and have a fever or maybe not be eating well, versus the older kids who are less likely to present with a fever and are more likely to present with the kind of typical symptoms. When we think of urinary tract infection, it hurts and burns to urinate and things like that. So the presentation may be a little bit different, but they can certainly present at any age.
Host: So Dr. Schlomer, Dr. Stanasel spoke to this a little bit, but let's talk about what are the symptoms and how they end up presenting themselves in both babies and older children. And I'm curious as to what specifically parents should be on the lookout for.
Dr. Schlomer: So there's symptoms in babies, newborn infants, it can be a little bit hard to tell when a child is having your neuro checks infection, to be quite honest, especially in less than two months of age, they may not even have any fevers. They could potentially just be sort of lethargic or hard to wake up, not acting right. They tend to start to have fevers more likely as they get older, past the age, two to three months of age. So in little infants older than three months of age, fever is a common symptom. In infants, they generally don't complain of pain with urination or really seem like they're having pain at all. It's usually just a fever. If they get closer to the age of potty training, then they start to have more of the typical symptoms people think of such as pain with urination or pain in the bladder or frequent urination, stuff like that.But even older children sometimes when they have a urinary tract infection, don't have those classic symptoms. So to be honest, it can be hard to tell sometimes if especially an infant has a urinary tract infection or not. If there is a fever getting the child checked by the pediatrician and at least having your back of your mind that a urinary tract infection could be a possibility seems reasonable. But if there's something else obviously causing the fever, like an ear infection or the flu or something like that, then don't necessarily have to test for a urinary tract infection. For older kids, if they're, complaining of pain with urination and are in the process of potty trained or potty trained, then they can easily give a urine specimen and they can be checked for UTI fairly easily. So it does get easier the older children get in general to tell if a urinary tract infection is present or not.
Host: So Dr. Stanasel, can you talk to us a little bit more about how UTS are diagnosed? You know, I imagine that the older kids will be able to actually communicate with you that it hurts when they go to the bathroom. But you know, I'm curious also for younger kids when they'reexpressing a fever, which could mean 1,000,001 different things, how do you go about diagnosing for both age groups?Dr. Stanasel:If there is a suspicion for urinary tract infection, it's very important for us to have a good urine specimen in order to see what is going on with that urine and if that urine will be positive for signs of infection and inflammation as well as whether or not bacteria will grow out of that specimen in a Petri dish. And the little kids who are not potty trained. The best way to get such a specimen is actually to insert a small catheter through the urethra, into the bladder and allow the urine to drip out of the catheter into the specimen cup. This idea can sometimes be a little bit traumatic for the families to hear that this will be done, but it is very small tube. It's a very quick procedure to obtain this urine specimen and it is incredibly helpful for us to determine whether or not they really have a urinary tract infection without just looking at some contamination from a diaper or the skin or something like that.So we really do ask that the work with us to allow us to get this specimen so we can give them a really good answer for what's going on with their child. When the kid is a little bit older, obviously it's a little bit easier. You can clean off their perineumor clean off their penis around their urethra and make sure that they can just avoid into a specimen cup and that can most of the time be an adequate way to assess whether or not there's a urinary tract infection.So when we get the urine specimen, we look at it under a microscope and look for some inflammatory cells and this can be done pretty quick. You can know an answer for whether or not the child most likely has an infection right away just by looking at the urine and doing a urine analysis in the office or in the emergency room. But in order to truly know whether or not there is infection, we have to send the urine to the lab and allow it to grow on a Petri dish and get a culture of it, which can take up to about 48 to 72 hours.
Host: Yeah, that makes sense. You know, it's test, don't guess in both cases. And I can totally understand the importance of really using that specimen to test whether there's actually bacteria growing. Dr. Schlomer, let's move over toyou and talk a little bit about treatment. Talk to us how UTIs are treated in children.
Dr. Schlomer: In general, urinary tract infections are treated with antibiotics. So let's say you have a child, or let's say an infant with a fever, and they go to thepediatrician and they get a urine specimen. It looks like there's a urinary tract infection than the pediatrician typically will just prescribe an antibiotic, which would be the best guess you know of what antibiotic is going to work for a urinary tract infection. Then when the urine culture comes back in two to three days, then the doctor can kind of determine did they give the right antibiotic, does it need to be changed or not. Antibiotics can come in, pill form, they can come in liquid form and there'sseveral different options. Very, very rarely if there's a highly resistant bacteria that would have to be treated with IV antibiotics, but that's quite rare, so usually they're just treated with oral antibiotics at home. If a patient is quite sick, high fevers, can't tolerate drinking, can't stay hydrated. Sometimes kids have to be admitted to the hospital for IV fluids and also IV antibiotics if they're quite sick from a urinary tract infection. But most of urinary tract infections are managed outpatient with oral antibiotics.
Host: So you know, I'm a parent, parents are listening to this. I'm sure all of us are wondering what can we do to actually prevent our children from getting UTIs in the first place. We know it's fairly common, but Dr. Santasel, is there anything that we can do to minimize the risk of them getting one?
Dr. Stanasel: There are actually quite a few things to implement in order to minimize the risk in the little babies before potty training. Usually if they're getting infections, it may be a sign of something kind of anatomically going on. And that's something that us as doctors and urologists need to look for and treat if that's the case. But around the age of potty training and after, that's where implementing techniques to minimize their risk is really helpful. So one thing would be when the child is going through potty training and the years shortly thereafter, there are a few things to do. One is to encourage the child to void regularly. A lot of little kids at that age want to hold their pee. They don't want to pee. It's either they don't, they're bored, they don't want, they want to play, they don't want to go to the bathroom. They're afraid of the toilets. They don't have enough time at school. There can be a whole lot of reasons for this, but the most important thing is to work with the child and encourage them to void whether or not they feel like it and whether or not they want to take the time. So I would typically say depending on the child and depending on the age, no longer than two to three hours should the child go without voiding.
And sometimes even as short of a time period is 90 minutes. But trying for about every two hours to avoid whether or not they feel like it is a really good idea. Of course, staying hydrated. And another thing that I feel like a lot of people don't realize is the connection between bowel health and urinary tract health. It is very important to ensure that the children are not getting constipated, especially as they're going through potty training. They tend to want to do the same thing with their bowel habits as with their urinary habits, which is again to hold it and not spend the time that they need to on the toilet to have a good bowel movement. So encouraging them to stay on a toilet for an appropriate amount of time and making sure that their diet has an adequate amount of fiber and liquid as well as support for medications if necessary, to make sure that they're having regular soft bowel movements is very important. So just those things alone, making sure that they're peeing and pooping well will go a very long way in minimizing their risk of urinary tract infections.
Dr. Schlomer: So I agree with Dr. Stanasel. Essentially two timeframes are two main timeframes that we see urinary tract infections. We see urinary tract infections in children with significant congenital anomalies, you know, in infancy. And then we also see lots of urinary tract infections happen around the time of potty training. And this is just like she said, when kids learn to hold it and they just don't go pee enough. So we have lots and lots of referrals where kids come for current urinary tract infections who've just developed bad habits where they hold it too long, don't empty their bladder all the way, hold it until the last minute and then they get constipated too, and it just kind of perpetuates the problem. For boys there is always a question of should a boy get circumcised or not and there is a slightly decreased risk of urinary tract infection in infant boys who are circumcised but also you can decrease the risk of urinary tract infection in boys who are uncircumcised by using a steroid cream to release the tight phimosis. The risk of urinary tract infection in boys who are uncircumcised is around 1% so it's still quite rare, but if a boy who was uncircumcised gets a urinary tract infection, oftentimes a good treatment is to either consider a circumcision or consider using a steroid cream to release the phimosis so they don't get any more UTIs.
Host: And Dr. Schlomer just sticking with you as we wrap up here. Is there an age where parents are effectively in the clear around worrying whether their kid is going to get a UTI or not?
Dr. Schlomer: So I would say for a boy who is circumcised with normal prenatal ultrasounds, he is very, very unlikely to get a urinary tract infection. That's actually quite rare. Anytime I see a patient referred who is a boy who was circumcised with a urinary tract infection, I'm worried that we're going to find a significant congenital anomaly. For a boy who's uncircumcised, as soon as the foreskin kind of releases and pulls back easily, generally the risk of urinary tract infection is lower. We see urinary tract infections in kids after potty training and it's usually around the age from two to six or seven. And there are some patients who continue to have urinary tract infections from poor voiding habits even later than that. So I don't know if there's really an age that you're in the clear, but there are kind of ages where things are more common I guess.
Host: That's Dr. Bruce Schlomer and Dr. Irina Stanasel. Thank you for listening to Children's Health Checkup, head to childrens.com for more information. If you found this podcast helpful, please rate and review or share the episode and please follow Children's Health on your social channels. Thanks, and we'll talk next time.