Urinary tract infection? Follow your nose!

The Pediatric Insider

© 2012 Roy Benaroch, MD

Longtime followers know I love a simple study with results that can be used by parents and doctors  to make life easier, happier, and healthier. Today’s example confirms that doctors need to listen when parents notice something odd about their children.

Normal pee, of course, does have an odor. The odor might get more intense as it sits in a diaper, and will also be stronger if the urine is concentrated because of fever or decreased fluid consumption when children are ill. But parents do tend to know what their kids ought to smell like. If you’re getting the impression that your child’s urine is a bit, shall we say, extra whiffy, that might just be a clue to look for a urinary tract infection.

In a study published in May, 2012, researchers fromCanada looked at about 400 children who presented to their hospital from 2009-2011. These children, aged 1 to 36 months, all had urine cultures performed to determine whether a urinary tract infection was present. In addition, their parents were asked about the presence of a strong or objectionable urine odor and other symptoms. There was indeed a close association between parent-reported odor and a UTI. Children of parents who reported a strong odor were 80% more likely to have a UTI than children with ordinary-smelling urine. The “odor” test wasn’t 100% accurate—many smelly urines were not in fact infected—but the presence of odor was a good predictor. In fact, it was a better predictor of infection than parent-reported presence of painful urination (that’s kind of hard to detect accurately in babies.)

In young children, the most common symptom of urinary tract infection is fever, often without any other more-specific hints that the infection is in the urine. If you’ve noticed a different or strong odor from your child’s urine, especially if there has been a fever, you ought to discuss this with your pediatrician so that appropriate testing for urinary tract infection can be considered. When your nose tells you something is up, listen!

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