Urinary Tract Infections (UTIs) can occur in children of any age.  Symptoms of UTIs in older children look more similar to adult symptoms, such as burning or pain with urination.  In younger children, symptoms appear less obvious, such as just having a fever.

Teddy bear with thermometer

Fever often accompanies a Urinary Tract Infection

UTIs develop because of bacteria growing in the urinary tract – anywhere from the bladder to the kidneys.  Bacteria does not typically appear in the urine normally, and can enter the urinary tract from the skin and rarely through the blood.

UTIs occur more frequently in girls, especially as they get older.  UTIs can occur a bit more commonly in uncircumcised boys under age 1.  

If a child has a structural anomaly in their urinary system, then a higher risk of getting infections exists.  One of these conditions called vesicoureteral reflux results in urine going back up towards the kidneys and can result in more frequent UTIs.

Signs and symptoms

In infants, nonspecific symptoms include:

  • Fever without another source
  • Foul-smelling urine or blood in urine
  • Poor feeding
  • Irritability
  • Vomiting

In older kids, UTI symptoms include the following:

  • Pain or burning when peeing
  • Increased urge to pee, even if there is not much volume
  • Fever
  • Waking at night to pee more often, or bedwetting in a toilet-trained child
  • Fever
  • Low stomach or back/flank pain
  • Blood in urine
  • Vomiting
  • Foul-smelling or cloudy urine

Diagnosis

Your child’s doctor can diagnose a UTI by testing the urine.  To do this, your doctor will need a urine sample.  Older children can pee into the sample cup at the doctor’s office after cleaning well with wipes.  

Younger children, not yet potty trained, may have a sterile bag placed on them so that when they pee, the urine collects in the bag.  This method has limitations; your doctor may choose a completely sterile method of collecting urine.

Therefore, for younger children, to obtain a clean specimen, your doctor may insert a catheter in the bladder to obtain a urine specimen.  While this procedure can be uncomfortable, doctors can determine it necessary to obtain an accurate specimen in a baby who cannot pee in a cup.

The doctor can usually do a preliminary assessment of the urine with a test called a urinalysis which can give some indication.  A definitive diagnose of a UTI requires a urinary test.  It takes 1-2 days to get the results.  A urine culture will reveal the presence of a bacteria causing infection, which bacteria, and what antibiotics work against that bacteria.  

Treatment

Depending on the age of the child and how sick he/she is, the doctor will prescribe antibiotics orally, by injection, or through an IV line, to treat the infection.  Your doctor will also emphasize the importance of fluids and hydration.

In general, children recover quickly after treatment  Parents should seek treatment early once symptoms appear.  If the infection progresses without treatment, then children can get very ill.  Infection can spread into the kidneys or get into the bloodstream.  These children may need hospitalization for treatment.

Other Testing

For very young children with a UTI accompanied by a fever or who has had multiple UTIs, the doctor may request additional testing to determine the possibility of an anatomical problem.  

These additional tests can include an ultrasound of the bladder and kidneys, a voiding cystourethrogram (VCUG), or a DMSA scan.  VCUG and DMSA tests look for vesicoureteral reflux, kidney abnormalities, and/or kidney damage.

Prevention

Parents can prevent UTIs to some extent.  Parents can take steps to avoid getting bacteria that is in stool near the urinary tract opening.  

For girls, wiping from front to back helps to prevent spreading bacteria.  Parents should do this in their infant girls with diaper changes, and then teach their child to continue this as she learns

Teach your child to go to the bathroom regularly and not hold in urine.  Also encourage drinking enough fluids to continue to fill the bladder and help the child empty the bladder more often.

Constipation can lead to urinary tract infections as well.  When constipation occurs, treating it can help prevent a urinary tract infection.

Avoiding bubble baths and perfumed or strong soaps can prevent irritation in genital area.  Wearing cotton underpants, avoiding tight-fitting pants, and minimizing time wet swimsuits can help as well.

Avoid foods and beverages that can irritate the bladder including caffeinated drinks, chocolate, and some spices.

See your child’s doctor if your child has a symptoms of a urinary tract infection.  Seek early treatment to prevent more serious illness or complications.  Also call your doctor if your child has a diagnosed UTI but does not get better after two days of treatment or sooner if symptoms worsen.