The American Academy of Pediatrics has new guidelines on the evaluation and treatment of children ages two to 24 months with bladder infections. Previously, all infants and toddlers with their first bladder infection were tested with a somewhat invasive radiologic procedure (VCUG) looking for an anatomic predisposition to bladder/kidney infections (vesicoureteral reflux or “VUR”) and future kidney damage. It was also routine to treat young children who had this predisposition with a nightly low dose of an antibiotic until they outgrew this condition.
After an exhaustive review of the scientific literature, the AAP now says that a VCUG is only necessary if a child has more than one bladder infection or has an abnormality detected on a kidney ultrasound. And, doing a nightly dose of an antibiotic does NOT help in lowering the risk of future kidney damage in kids with mild to moderate VUR. The key to reducing kidney damage is diagnosing and treating a bladder infection promptly.
Bottom line: If you have a young child with vesicoureteral reflux (VUR), talk to your doctor about the latest guidelines. And young children with a fever without any obvious source of infection should be checked out by their healthcare provider.