Foul smelling urine in young kids may be sign of urinary infection: study

TORONTO – Is smellier-than-usual urine a sign of a urinary tract infection in a young child? A new study suggests perhaps sometimes.

The results aren’t a slam-dunk, though. In fact, based on these findings, pediatricians would not urge parents to take a child for care if his or her – mostly her – urine is particularly stinky. (Girls are more likely than boys to have urinary tract infections.)

But the authors say the findings suggest doctors examining children with unexplained fevers should investigate the possibility of urinary tract infections, if the parents report strong smelling urine.

“It should make the clinician more suspicious of this type of infection in a young child with FWS (fever without source),” the authors, from Sainte-Justine University Hospital Centre in Montreal, wrote in the journal Pediatrics.

They also suggested it might be useful for a pediatrician who suspects a urinary tract infection in a young child to ask about malodorous urine.

But a pediatric urologist at the Hospital for Sick Children in Toronto cautioned against reading too much into the findings, saying the association between foul smelling urine and urinary tract infections isn’t terribly strong in this study.

“It’s not really a robust conclusion that will really change practice. What it may do – and this is what I’m worried about being published in … a newspaper – is it may make people seek help for no reason,” Dr. Walid Farhat said.

For the study the researchers enrolled children who were brought to Sainte-Justine’s emergency department and who were tested for a urinary tract infection. A total of 331 children between the ages of one month and three years old were entered into the study, which ran from July 31, 2009 to April 30, 2011.

Parents were asked a series of questions, some of which were standard for an investigation into a urinary tract infection. They were asked, for instance, if it seemed like their child was having trouble urinating or whether urinating seemed painful for the child.

Among the eight questions were two asking if the parents had noticed their child’s urine smelled stronger than normal or offensive.

Only 51 urinary tract infections were diagnosed from among the 331 children.

Of the children with urinary infections, 57 per cent were reported by their parents to have had foul smelling urine. But the parents of 40 per cent of the children with infections did not report noticing unusually smelly urine.

The paper doesn’t explain why three per cent of children with infections are not accounted for. Lead author Dr. Marie Gauthier was not available for interview late last week or during the weekend.

Farhat said for a diagnostic test to be useful, it needs a high level of sensitivity – meaning the percentage of positives that are actually true positives. And 57 per cent isn’t high enough, he suggested.

Many things can make urine seem more strong smelling than normal, he said, including diet, how well hydrated the child is, and the time of day at which the smell test is conducted. As well, smell is subjective; what is unusual to one nose might not be to another.

In fact, the study notes that parents of 32 per cent of the children who didn’t have a urinary tract infection reported their children had foul smelling urine.