Urinary Tract Infection - Children
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Definition
A urinary tract infection (UTI) is an infection of the urinary tract. This article discusses UTIs in children.
The urinary tract includes the:
See also:
Alternative Names
UTI - children; Cystitis - children; Bladder infection - children; Kidney infection - children; Pyelonephritis - children
Causes, incidence, and risk factors
Urinary tract infections (UTIs) can occur when bacteria find their way into the bladder or the kidneys. These bacteria are normally found on the skin around the anus or sometimes around the vagina.
Normally, there are no bacteria in the urinary tract itself. However, certain things can make it easier for bacteria to enter or stay in the urinary tract. These include:
- A problem in the urinary tract, called vesicoureteral reflux, which is usually present at birth. This condition allows urine to flow back up into the ureters and kidneys.
- Brain or nervous system illnesses (such as myelomeningocele, spinal cord injury, hydrocephalus) that make it harder to empty the bladder
- Bubble baths or tight-fitting clothes (girls)
- Changes or birth defects in the structure of the urinary tract
- Not urinating (peeing) often enough during the day
- Wiping from back (near the anus) to front after going to the bathroom. In girls, this can bring bacteria to the opening where the urine comes out.
UTIs are more common in girls, especially around age 3 when they first begin toilet training. In boys who are not circumcised, the risk for UTIs is slightly higher before the first birthday.
References
White B. Diagnosis and treatment of urinary tract infection in children. Am Fam Physician. 2011;83:409-415.
Williams G, Craig JC. Long-term antibiotics for preventing recurrent urinary tract infection in chidlren. Cochrane Database Syst Rev. 2011 Mar 16:(3):CD001534.
Craig JC, Simpson JM, Williams GJ, et al. Antibiotic prophylaxis and recurrent urinary tract infection in children. N Engl J Med. 2009 Oct 29;361(18):1748-59.
Skoog SJ, Peters CA, Arant BS Jr, et al. Pediatric Vesicoureteral Reflux Guidelines Panel Summary Report: Clinical Practice Guidelines for Screening Siblings of Children With Vesicoureteral Reflux and Neonates/Infants With Prenatal Hydronephrosis. J Urol. 2010 Sep;184(3):1145-51.
Shaikh N, Morone NE, Lopez J, Chianese J, Sangvai S, D'Amico F, Hoberman A, Wald ER. Does this child have a urinary tract infection? JAMA. 2007;298:2895-2904.
Review Date: 8/4/2011
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
UTI - children; Cystitis - children; Bladder infection - children; Kidney infection - children; Pyelonephritis - children
Symptoms
Young children with UTIs may only have a fever, poor appetite, vomiting, or no symptoms at all.
Most urinary tract infections in children only involve the bladder. If the infection spreads to the kidneys, it is called pyelonephritis and may be more serious.
Symptoms of a bladder infection in children include:
Symptoms that the infection may have spread to the kidneys include:
- Chills with shaking
- Fever
- Flushed, warm, or reddened skin
- Nausea
- Pain in the side (flank) or back
- Severe pain in the belly area
- Vomiting
Signs and tests
A urine sample is needed to diagnose a UTI in children. The sample is examined under a microscope and sent to a lab for a urine culture.
In children who are not toilet trained, getting a urine sample can be difficult. The test cannot be done using a wet diaper. Possible ways to collect a urine sample in very young children include:
Urine collection bag -- A special plastic bag is placed over the child's penis or vagina to catch the urine. This is not the best method because the sample may become contaminated.
Catheterized specimen urine culture -- A plastic tube (catheter) placed into the tip of the penis in boys, or straight into the urethra in girls, collects urine right from the bladder.
Suprapubic urine collection -- A needle is placed through the skin of the lower abdomen and muscles into the bladder. It is used to collect urine.
If this is your child's first UTI, special imaging tests may be done to find out why the infection happened, or to see if there is any kidney damage. Tests may include:
These studies may be done while the child has an infection. Most often they are done weeks to several months afterward.
Your doctor will consider many things when deciding if and when a special study is needed, including:
How old is the child? (Infants and younger children usually need follow-up tests.)
Has the child had infections in the past?
Is the infection severe?
Does the child have other illnesses?
Does the child have a problem with the spinal cord or defects of the urinary tract?
Has the child responded quickly to antibiotics?
References
White B. Diagnosis and treatment of urinary tract infection in children. Am Fam Physician. 2011;83:409-415.
Williams G, Craig JC. Long-term antibiotics for preventing recurrent urinary tract infection in chidlren. Cochrane Database Syst Rev. 2011 Mar 16:(3):CD001534.
Craig JC, Simpson JM, Williams GJ, et al. Antibiotic prophylaxis and recurrent urinary tract infection in children. N Engl J Med. 2009 Oct 29;361(18):1748-59.
Skoog SJ, Peters CA, Arant BS Jr, et al. Pediatric Vesicoureteral Reflux Guidelines Panel Summary Report: Clinical Practice Guidelines for Screening Siblings of Children With Vesicoureteral Reflux and Neonates/Infants With Prenatal Hydronephrosis. J Urol. 2010 Sep;184(3):1145-51.
Shaikh N, Morone NE, Lopez J, Chianese J, Sangvai S, D'Amico F, Hoberman A, Wald ER. Does this child have a urinary tract infection? JAMA. 2007;298:2895-2904.
Review Date: 8/4/2011
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
UTI - children; Cystitis - children; Bladder infection - children; Kidney infection - children; Pyelonephritis - children
Treatment
In children, UTIs should be treated quickly with antibiotics to protect the kidneys. Any child under 6 months old or who has other complications should see a specialist right away.
Younger infants will usually stay in the hospital and be given antibiotics through a vein. Older infants and children are treated with antibiotics by mouth. If this is not possible, they are admitted to the hospital where they are given antibiotics through a vein.
It is important that your child drink plenty of fluids while they have a urinary tract infection.
Some children may be treated with antibiotics for long periods of time (as long as 6 months - 2 years). This treatment is more likely when the child has had repeat infections or a condition called vesicoureteral reflux, which causes urine to flow back up into the ureters and kidneys.
The health care provider may also recommend low-dose antibiotics after the first symptoms have gone away. This type of treatment is less common now than it once was.
Antibiotics commonly used in children include:
Amoxicillin or amoxicillin/clavulanic acid (Augmentin)
Cephalosporins
Doxycycline (should not be used in children under age 8)
Nitrofurantoin
Trimethoprim-sulfamethoxazole
Follow-up urine cultures may be needed to make sure that bacteria are no longer in the bladder.
Expectations (prognosis)
Most children are cured with proper treatment. The treatment may continue over a long period of time.
Long-term problems from repeated UTIs in children can be serious. However, these infections can usually be prevented.
Complications
Calling your health care provider
Call for an appointment with your health care provider if your child's UTI symptoms continue after treatment or come back more than twice in 6 months.
Call your health care provider if the child's symptoms get worse, or new symptoms develop, especially:
Bad-smelling, bloody, or discolored urine
Fever of 100.4°Fahrenheit (38°Celsius) rectally in infants, or over 101°Fahrenheit (38.3°Celsius) in children
Low-back pain or abdominal pain (especially below the belly button)
Persistent fever
Unusually frequent urination or frequent urination during the night
Vomiting
References
White B. Diagnosis and treatment of urinary tract infection in children. Am Fam Physician. 2011;83:409-415.
Williams G, Craig JC. Long-term antibiotics for preventing recurrent urinary tract infection in chidlren. Cochrane Database Syst Rev. 2011 Mar 16:(3):CD001534.
Craig JC, Simpson JM, Williams GJ, et al. Antibiotic prophylaxis and recurrent urinary tract infection in children. N Engl J Med. 2009 Oct 29;361(18):1748-59.
Skoog SJ, Peters CA, Arant BS Jr, et al. Pediatric Vesicoureteral Reflux Guidelines Panel Summary Report: Clinical Practice Guidelines for Screening Siblings of Children With Vesicoureteral Reflux and Neonates/Infants With Prenatal Hydronephrosis. J Urol. 2010 Sep;184(3):1145-51.
Shaikh N, Morone NE, Lopez J, Chianese J, Sangvai S, D'Amico F, Hoberman A, Wald ER. Does this child have a urinary tract infection? JAMA. 2007;298:2895-2904.
Review Date: 8/4/2011
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
UTI - children; Cystitis - children; Bladder infection - children; Kidney infection - children; Pyelonephritis - children
Prevention
Avoid giving your child bubble baths
Have your child wear loose-fitting underpants and clothing
Increase your child's intake of fluids
Keep your child's genital area clean to prevent bacteria from entering through the urethra
Teach your child to go the bathroom several times every day
Teach your child to wipe the genital area from front to back to reduce the chance of spreading bacteria from the anus to the urethra
Long-term use of preventive (prophylactic) antibiotics may be recommended for some children who get repeated UTIs.
References
White B. Diagnosis and treatment of urinary tract infection in children. Am Fam Physician. 2011;83:409-415.
Williams G, Craig JC. Long-term antibiotics for preventing recurrent urinary tract infection in chidlren. Cochrane Database Syst Rev. 2011 Mar 16:(3):CD001534.
Craig JC, Simpson JM, Williams GJ, et al. Antibiotic prophylaxis and recurrent urinary tract infection in children. N Engl J Med. 2009 Oct 29;361(18):1748-59.
Skoog SJ, Peters CA, Arant BS Jr, et al. Pediatric Vesicoureteral Reflux Guidelines Panel Summary Report: Clinical Practice Guidelines for Screening Siblings of Children With Vesicoureteral Reflux and Neonates/Infants With Prenatal Hydronephrosis. J Urol. 2010 Sep;184(3):1145-51.
Shaikh N, Morone NE, Lopez J, Chianese J, Sangvai S, D'Amico F, Hoberman A, Wald ER. Does this child have a urinary tract infection? JAMA. 2007;298:2895-2904.
Review Date: 8/4/2011
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Review Date: 8/4/2011
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.