Pediatric Urinary Tract Infections

Urinary Tract Infections, or UTIs, are common bacterial infections in children, affecting about 8.4% of girls and 1.7% of boys under the age of 7.¹ UTIs can affect the urethra, bladder, ureters, or kidneys, and how “far up” the urinary system the infection travels is often relative to the severity of the problem.

Many UTIs in children are caused by bacteria that live on or in the body naturally, including the bladder. The infection is caused by the bacteria growing and invading local bladder tissue which causes inflammation and therefore symptoms commonly associated with a UTI. These UTIs are typically classified as lower tract infections – those located in the bladder (cystitis)

An upper tract infection affects the kidney (pyelonephritis) and usually presents with a high fever. A leading cause of pyelonephritis in children is vesicoureteral reflux (VUR) when urine backflows from the bladder into the kidneys. Learn more about the role of VUR in febrile (fever-related) UTIs here.

Getting a proper diagnosis when children are experiencing symptoms of a UTI is critical because there are several causes of UTI-like symptoms. For example, constipation can cause pressure on the back of the bladder and even affect bladder sensation, making it look like the child could have a UTI. Indeed, this can be a self-fulfilling prophecy, as children with constipation may also hold their urine or void incompletely, causing residual urine and bacterial growth. Learn more about the role of Constipation in UTIs and UTI-like symptoms.

Symptoms of a Pediatric UTI

  • Fever
  • Painful urination (dysuria)
  • Frequent urination (urinary frequency)
  • Abdominal or back pain
  • Bloody urine
  • Infants usually experience symptoms like fever or hypothermia (colder than normal temperature), vomiting, irritability, or feeding problems. Any symptoms that seem out of the ordinary or persistent should be a reason to see your pediatrician and discuss checking the urine for infection.
  • Toddlers typically cannot tell you what is wrong, so the most common symptom recognized under the age of 2 is fever.

Diagnosis

Not all children have classic symptoms of urinary tract infections or any symptoms at all, or your child may be unable to tell you what is wrong. Diagnosis of UTIs begins with a medical history and physical exam followed by a urinalysis and urine culture to determine what is causing the infection so the doctor may prescribe the right treatment. The correct way to check a urine culture in a child before they are potty trained is by passing a catheter into the bladder to obtain the sample. This helps avoid a false positive result that can occur in up to 99% if collected with a bagged urine specimen or one collected into a non-sterile toilet hat. You should also speak to your pediatric urologist about your child’s voiding habits and bowel movements.

If your child has recurrent UTIs or has some unusual symptoms or other urinary tract concerns, your doctor may order imaging studies such as ultrasound and voiding cystourethrogram (an x-ray exam of the bladder and urethra).

Treatment

Most UTIs are treated conservatively by addressing the bacteria that caused them and caring for the symptoms of the infection. However, any underlying condition causing the UTI should also be managed to avoid recurrence.

Conservative Management

  • An oral antibiotic that covers a broad spectrum of bacteria is typically prescribed first since the urine culture can take a few days for results. Culture-specific oral antibiotics are prescribed once the bacteria causing the infection is known.
  • IV antibiotics and hospitalization may be needed for severe infections.
  • Your child should increase their fluid intake, as creating and passing urine will help flush the bacteria from the system.
  • Pain and fever management through over-the-counter medications and cooling treatments may help with the discomfort of symptoms.

Surgical Intervention

Surgery is usually only necessary if there is an anatomical abnormality present that is causing UTIs to reoccur. This may be the case with vesicoureteral reflux (VUR) or other anatomic issues such as a blockage, urinary tract cyst, etc.

Follow-Up

Regular check-ups and monitoring for recurrent UTIs and kidney function assessment are important to prevent complications.

Resources:

  1. Barola S, Grossman OK, Abdelhalim A. Urinary Tract Infections in Children. PubMed. Published January 11, 2024. https://www.ncbi.nlm.nih.gov/books/NBK599548/