Urinary Tract Infection (UTI) in Children

What is a urinary tract infection (UTI) in children?

A urinary tract infection is inflammation of part of the system that takes urine out of the body. It’s caused by bacteria. The urinary tract includes the 2 kidneys. They remove liquid waste from the blood in the form of urine. Narrow tubes (ureters) carry urine from the kidneys to the bladder. Urine is stored in the bladder. When the bladder is emptied, the urine travels through a tube called the urethra and passes out of the body. Bacteria can infect any part of this system.

What causes a UTI in a child?

Normal urine contains water, salts, and waste products. It is free of germs such as bacteria, viruses, and fungi. An infection happens when germs enter the urethra, travel up to the bladder, ureters, and kidneys, and begin to grow. Most infections are caused by bacteria from the digestive tract. The most common is E. coli (Escherichia coli) bacteria. These normally live in the colon.

Which children are at risk for a UTI?

A UTI is not common in children younger than age 5. A UTI is much more common in girls. This is because they have a shorter urethra. A UTI is unlikely in boys of any age. But it can occur in boys if part of the urinary tract is blocked. Uncircumcised boys are more at risk for a UTI than circumcised boys. A child with a part or full blockage in the urinary tract is more likely to develop a UTI.

Bubble baths may irritate the urethra and allow bacteria to grow there. Incorrect wiping (child should wipe front to back) increases the risk. This is even more risky after a bowel movement. Delaying going to the bathroom and constipation are also linked to UTIs.

What are the symptoms of a UTI in a child?

Symptoms can be a bit different for each child.

Symptoms in babies can include:

• Fever

• Bad-smelling urine

• Irritability

• Crying

• Fussiness

• Vomiting

• Poor feeding

• Diarrhea

Symptoms in children can include:

• Sudden need to urinate

• Need to urinate often

• Loss of control of urine (incontinence)

• Pain while urinating

• Trouble urinating

• Pain above the pubic bone

• Blood in the urine

• Bad-smelling urine

• Nausea and vomiting

• Fever

• Chills

• Pain in the back or side below the ribs

• Tiredness

The symptoms of a UTI can seem like other health conditions. Have your child see his or her healthcare provider for a diagnosis.

How is a UTI diagnosed in a child?

The healthcare provider will ask about your child’s symptoms and health history. The provider will give your child a physical exam. Your child may also have tests, such as:

• Urine testing ( urinalysis). Your child’s urine is sent to a lab to check for red blood cells, white blood cells, bacteria, protein, and signs of infection. The urine will also be sent for a culture and sensitivity. This is done to figure out what type of bacteria is causing the infection and what medicine is best to treat the infection.

• Kidney ultrasound. This is a painless imaging test. It uses sound waves and a computer to make images of blood vessels, tissues, and organs. It can show internal organs as they function and can assess blood flow through vessels. A boy with a UTI or a girl younger than age 5 or 6 may need this test.

• Voiding cystourethrogram (VCUG). This is a type of X-ray of the urinary tract. A thin, flexible tube (catheter) is put in the tube that drains urine from the bladder to the outside of the body (the urethra). The bladder is filled with a liquid dye. X-ray images are taken as the bladder fills and empties. The images will show if there is any reverse flow of urine into the ureters and kidneys.

• Nuclear medicine scan. A DMSA scan can help find out if there is scarring or a more severe infection. A small amount of radioactive tracer is injected through an IV. Then pictures of the kidneys will be taken. This will show how well the kidneys are working.

How is a UTI treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. Treatment may include:

• Antibiotic medicine

• A heating pad or medicines to ease pain

• Drinking plenty of water

Your child's healthcare provider may want to see your child back again a few days after treatment starts to see how treatment is working.

Talk with your child’s healthcare providers about the risks, benefits, and possible side effects of all treatments.

How can I help prevent a UTI in my child?

You can help prevent UTIs in your child if you:

• Have your child drink plenty of fluids

• Tell your child to empty his or her bladder fully when urinating

• Teach girls to wipe from the front to back after going to the bathroom

• Make your child doesn’t get constipated

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:

• Symptoms that don’t get better, or get worse

• New symptoms

Key points about a UTI in children

• A urinary tract infection (UTI) is inflammation of part of the system that takes urine out of the body.

• Most infections are caused by bacteria from the digestive tract. The most common is E. coli bacteria. These normally live in the colon.

• A UTI is not common in children younger than age 5. A UTI is much more common in girls because they have a shorter urethra.

• A UTI is unlikely in boys of any age, unless part of the urinary tract is blocked. Uncircumcised boys are more at risk for a UTI than circumcised boys.

• Symptoms vary by age. They can include fever, need to urinate often, pain, and crying.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.