Urinary Tract Infections in Children

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This topic is about urinary tract infections in children. For information about these infections in teens and adults, see the topic Urinary Tract Infections in Teens and Adults.

What is a urinary tract infection?

The urinary tract is the part of the body that makes urine and carries it out of the body. It includes the bladder and kidneys and the tubes that connect them. When germs (called bacteria) get into the urinary tract, they can cause an infection.

How serious are the infections in children?

Urinary infections in children usually go away quickly if you treat them right away. But infections that aren't treated right away could cause permanent damage. The kidneys may not work well, which could lead to kidney failure. Infants and young children are at extra risk for kidney damage from infections.

Urinary infections also can lead to a serious infection throughout the body called sepsis. Problems from a urinary infection are more likely to happen in babies born too soon, in newborns, and in infants who have something blocking the flow of urine.

What causes the infections in children?

Germs that live in the large intestine and are in stool can get in the urethra. This is the tube that carries urine from the bladder to the outside of the body. Then germs can get into the bladder and kidneys.

What are the symptoms?

Babies and young children may not have the most common symptoms, such as pain or burning when they urinate. Also, they can't tell you what they feel. In a baby or a young child, look for:

• A fever not caused by the flu or another known illness.
• Urine that has a strange smell.
• The child not being hungry.
• Vomiting.
• The child acting fussy.

Older children are more likely to have common symptoms, such as:

• Pain or burning when they urinate.
• Needing to urinate often.
• Loss of bladder control.
• Red, pink, cloudy, or foul-smelling urine.
• Pain in the back on one side (flank pain) or lower belly pain.

How are the infections diagnosed?

The doctor will give your child a physical exam and ask about his or her symptoms. Your child also will have lab tests to check for germs in the urine, such as a urinalysis and a urine culture. It takes 1 to 2 days to get the results of a urine culture, so many doctors will prescribe medicine to fight the infection without waiting for the results. This is because a child's symptoms and the urinalysis may be enough to show an infection.

After your child gets better, the doctor may have him or her tested to find out if there is a problem with the urinary tract. For example, urine might flow backward from the bladder into the kidneys. Problems like this can make a child more likely to get an infection in the bladder or kidneys.

How are they treated?

Your child will take antibiotics for a urinary tract infection. Give this medicine to your child as your doctor says. Do not stop it just because your child feels better. He or she needs to take all the medicine to get better. Treatment usually lasts 7 to 14 days. But it depends on several things, including where the infection is and how bad it is.

You can help your child get better at home. Have your child drink extra fluids to flush out the germs. Remind your older child to go to the bathroom often and to empty the bladder each time.

Call the doctor if your child isn't feeling better within 2 days after starting the medicine. Your doctor may give your child a different medicine. It is important to treat urinary infections quickly in children to prevent other serious health problems. Sometimes a baby younger than 3 months may need to get medicine through a vein (IV) and stay in the hospital for a while. A child who is too sick to take medicine by mouth or has trouble fighting infections also may need to stay in the hospital.

Frequently Asked Questions

Most urinary tract infections (UTIs) in children are caused by bacteria that enter the urethra and travel up the urinary tract. Bacteria that normally live in the large intestine and are present in stool (feces) are the most common cause of infection. Occasionally bacteria traveling through the blood or lymphatic system to the urinary tract are the cause of kidney or bladder infections.

During potty training, children may not properly wipe their bottoms after a bowel movement. Bacteria may get into the urethra and cause a UTI. Also, constipation or not completely emptying the bladder can cause bacteria to build up in urine.

Problems with the structure or function of the urinary tract commonly contribute to UTIs in infants and young children. Problems that limit the body's ability to eliminate urine completely include:

• A structural problem of the bladder that allows urine to flow backward to the kidneys (vesicoureteral reflux).
• An obstruction, such as a kidney stone, that blocks, slows, or disrupts the normal flow of urine through the urinary tract (obstructions in the urinary tract).
• Other abnormalities of the urinary tract.

Urinary tract infections (UTIs) in children may not cause obvious urinary symptoms. Symptoms of a UTI in an infant or young child may include:

• Fever. This may be the only symptom in infants.
• Irritability.
• Lack of appetite.
• Failure to gain weight or develop normally.
• Foul-smelling urine.
• Crying during urination.
• Vomiting or diarrhea.

In an older child with a UTI, symptoms are usually easier to recognize and may include:

• Pain or burning when urinating.
• Urge to urinate frequently but usually passing only small amounts of urine.
• Loss of bladder control, new bed-wetting, or other changes in urination habits.
• Pain in the lower abdomen.
• Reddish or pinkish urine.
• Cloudy or foul-smelling urine.
• Pain in the back just below the rib cage, on one side (flank pain).

A doctor's evaluation can determine whether a UTI or another condition is causing your child's symptoms.

In a urinary tract infection (UTI), bacteria usually enter the urinary tract through the urethra. They may then travel up the urinary tract and infect the bladder (cystitis) and the kidneys (pyelonephritis). Most UTIs in children clear up quickly with proper antibiotic treatment.

The biggest concern over UTIs in children is that they can cause permanent kidney damage and scarring. Repeated scarring can lead to high blood pressure and reduced kidney function, including kidney failure. Infants and young children seem to be at higher risk for this complication.

The risk of irreversible kidney damage makes early medical evaluation and treatment of UTIs in infants and young children very important. Unfortunately, detecting UTIs in infants and young children can be difficult. Unlike symptoms in older children and adults, symptoms in the very young can be vague and inconsistent.

Serious short-term complications of UTIs are unusual but do occur. They include an abscess in the urinary tract, acute kidney failure, and widespread infection (sepsis), which can be life-threatening. These complications are more likely in premature infants and newborns and in infants with urinary tract obstructions.

Recurrent UTIs

Infants and young children often develop another UTI during the months after their first UTI. If an infection comes back (recurs), it usually happens within the same year as the first UTI.

Recurrent UTIs in a child can mean that there is a problem with the structure or function of the urinary tract. Because repeated infections increase the risk of permanent kidney damage, your child's doctor will evaluate and monitor any structural or functional problems. In some cases, your child may need surgical correction.

Factors that increase a child's risk of urinary tract infection (UTI) include:

• Abnormalities of the urinary tract, including kidney stones and other urinary obstructions. Structural or functional problems that limit the kidneys' or the bladder's ability to eliminate urine properly can increase the risk of UTIs. These problems may be present at birth or may develop soon after.
• Infrequent urination, incomplete emptying of the bladder, or constipation. These patterns are common during toilet training and make it easier for bacteria to build up in the urine.
• An uncircumcised penis. The foreskin can trap bacteria, which can then enter the urinary tract and cause infection.
• Catheterization, which is used in a hospital when a child is unable to urinate on his or her own. Bacteria can enter the catheter and start an infection.
• Previous UTIs. The risk for future infections increases with each additional infection.
• History of UTI or the backward flow of urine from the bladder into the kidneys (vesicoureteral reflux) in a parent or sibling.

Infants and young children who develop UTIs often have vesicoureteral reflux (VUR). In most cases it does not raise a child's risk of UTIs, but it could raise the risk of kidney damage caused by infection.

Urinary tract infections (UTI) in infants and young children need early evaluation and treatment. Call your doctor if your child has:

• Unexplained fever.
• Vomiting.
• Urine that looks pink, red, brown, or cloudy or is foul-smelling.
• Burning pain with urination.
• Frequent need to urinate without being able to pass much urine.
• Pain in the back just below the rib cage, on one side of the body (flank pain).
• Vaginal discharge with urinary symptoms.
• Symptoms similar to those of a previous UTI.

Call the doctor if your child isn't feeling better within 48 hours after starting an antibiotic.

Watchful Waiting

Watchful waiting is a wait-and-see approach. If you get better on your own, you won't need treatment. If you get worse, you and your doctor will decide what to do next. Watchful waiting is not appropriate if you suspect your child has a urinary tract infection. Untreated UTIs in children can lead to permanent kidney damage, high blood pressure, and other serious complications.

Who To See

The following health professionals can treat UTIs in children:

• Nurse practitioner
• Physician assistant
• General practitioner
• Family medicine physician
• Pediatrician
• Urologist

To prepare for your appointment, see the topic Making the Most of Your Appointment

Initial tests

If your child has symptoms of a urinary tract infection (UTI), the doctor's initial evaluation will probably include:

• A medical history and physical exam.
• Urinalysis, which measures different parts of urine to help identify a UTI.
• Urine culture, which detects and identifies the bacteria that are causing a UTI.

If the doctor suspects that your child has a UTI, a urinalysis will help point to a diagnosis. A urine culture can confirm the diagnosis and identify what is causing the infection. However, the results usually are not available for a couple of days. Rather than delaying treatment to wait for the results of the urine culture, the doctor probably will start your child on antibiotics if your child's symptoms, history, and urinalysis make the presence of a UTI likely.

One of several methods may be used to collect the urine sample.

• Older children may urinate into a container.
• In babies and young children, the doctor may:
  • Insert a catheter through the urethra and into the bladder to collect urine.
  • Collect urine by attaching a bag around the child's genitals until the child urinates. However, the risk of having other substances get into (contaminate) the urine sample is extremely high with this method.
  • Insert a needle through the abdomen directly into the bladder (suprapubic aspiration) to obtain the sample.

The doctor may do other tests if your child has a UTI and:

• Does not improve after 4 days of antibiotic treatment.
• Has a known abnormality of the urinary tract or a history of certain kidney or bladder problems that could make the infection harder to treat.
• May be infected with unusual bacteria that won't respond to the usual treatment.
• Shows signs of kidney failure.

These other tests may include kidney (renal) ultrasound to identify the cause of blocked urine flow in a kidney and voiding cystourethrogram to detect obstructions and vesicoureteral reflux.

Tests after a child's first UTI

Some doctors recommend an evaluation of the urinary tract after the first UTI in an infant or young child. The American Academy of Pediatrics recommends evaluation after a first UTI for children ages 2 months to 2 years in particular. But a study reports that these tests may not provide information that helps with treatment plans.¹ The most common tests after an infant's or young child's first UTI are:

• Kidney (renal) ultrasound. The doctor may review a fetal ultrasound that was done during the mother's third trimester of pregnancy, if available.
• Voiding cystourethrogram, which is an X-ray test that takes pictures of your child's bladder and urethra during urination.

The purpose of doing these tests after treatment for your child's UTI is to reduce the risk of future kidney damage and related problems, such as high blood pressure and kidney failure. These tests can identify vesicoureteral reflux, abnormalities of the urinary tract, and other conditions that may make your child more prone to kidney infections. If the tests identify any of these conditions, the doctor can monitor and give preventive treatment, if needed, to your child. The doctor will do these tests at the earliest convenient time after your child's UTI improves.

The doctor may do a kidney scan (renal scintigram) to evaluate persistent kidney infection or to evaluate kidney scarring or damage caused by previous infection.

During the year after your child's first UTI, the doctor may do periodic urine cultures to screen for UTI infections. But doctors do not agree on the effectiveness of follow-up urine cultures.²

Antibiotic medicine and home care are effective in treating most urinary tract infections (UTIs) in infants and children. The main goal of treatment is to prevent kidney damage and its short- and long-term complications by eliminating the infection quickly and completely. Early evaluation and treatment are very important. Do not delay calling a doctor if you think your baby or young child may have a UTI.

Home treatment includes:

• Having your child drink extra fluids to flush bacteria out of the bladder.
• Reminding your child to urinate often and to empty the bladder each time.

Initial treatment

Infants and young children with urinary tract infections (UTIs) need early treatment to prevent kidney damage. Your doctor is likely to base the initial treatment decision on your child's symptoms and urinalysis results rather than waiting for the results of a urine culture.

Treatment for most children with UTIs is oral antibiotics and home care. If your child is younger than 3 months of age, is too nauseated or sick to take oral medicines, or has an impaired immune system, brief hospitalization and a short (1- to 3-day) course of intravenous (IV) antibiotics may be necessary. After your child's fever and other symptoms improve and he or she is feeling better, the doctor may prescribe oral medicines for another 7 to 10 days. The overall length of treatment varies, depending on the severity and location (bladder or kidneys) of infection, your child's age and medical history, and other factors.

Infants and young children being treated for their first UTI need follow-up evaluation after the infection is gone. Tests may include an ultrasound of the kidneys and a voiding cystourethrogram to identify vesicoureteral reflux and other structural or functional problems with the urinary tract that could increase the child's risk for repeat infections and kidney damage. The doctor may do periodic urine cultures during the first year after a child's first UTI to screen for repeat infection.

Treatment if the condition gets worse or recurs

If your child's urinary tract infection (UTI) does not improve after treatment with antibiotics, he or she needs further evaluation and may need additional antibiotic treatment. Your child may have a structural problem that is making the infection difficult to treat, or the cause of the infection may be different from the types of bacteria that usually cause UTIs.

If the infection spreads and affects kidney function or causes widespread infection (sepsis), your child may be hospitalized. These complications are rare, but they can be very serious. Children with impaired immune systems, untreated urinary tract obstructions, and other conditions that affect the kidneys or bladder are at higher risk for complications.

Recurrent UTIs increase the risk of long-term kidney damage and high blood pressure. The doctor may prescribe preventive antibiotic therapy after treatment for a first UTI if your child has a structural problem, such as vesicoureteral reflux, that increases the risk of additional infections, or if your child has more than two UTIs in a 6-month period.

Urinary tract infections (UTIs) are difficult to prevent in children who seem to get them easily. The doctor may prescribe antibiotics to prevent repeat infection while waiting for test results after your child's first UTI. If test results reveal abnormalities of the urinary tract that raise the risk for repeated infections, the doctor may recommend long-term antibiotic treatment.

Some evidence suggests that breast-feeding may help prevent UTIs during the first 6 months of life.^{3, 4}

After learning to use the toilet, some children may not empty their bladder often enough. Without regular bladder emptying, which flushes out the germs in urine, children may be more likely to get a UTI. Encourage a schedule of bladder emptying to help lower their risk.

Constipation can also put a child at risk of a UTI. Regular toileting habits and a nonconstipating diet are the best ways to prevent constipation. For more information see the topics Constipation, Age 11 and Younger and Constipation, Age 12 and Older.

Early diagnosis and early treatment are the most important steps in preventing UTI-caused kidney damage. Periodic urine cultures during the first year after a child's first UTI and for children at risk for recurrent UTIs can help detect infections before they do serious damage.

Starting home treatment at the first signs of a urinary tract infection (UTI) in your child may prevent the problem from getting worse and help clear up your child's infection.

• Encourage—but do not force—your child to drink extra fluids as soon as you notice the symptoms and for the next 24 hours. These fluids will help dilute the urine, flush bacteria out of the bladder, and decrease irritation. Do not give your child caffeinated or carbonated beverages, which can irritate the bladder.
• Encourage your child to urinate often and to empty his or her bladder each time.

Note: Remember that home treatment is not a substitute for professional care and evaluation. If you think your child may have a UTI, a doctor should see him or her right away.

Oral antibiotic medicine usually is effective in treating urinary tract infections (UTIs). In many cases, if the symptoms and urinalysis suggest a UTI, the doctor will start medicine without waiting for the results of a urine culture.

Antibiotic treatment for a UTI in a child typically lasts 7 to 14 days. A shorter course of antibiotics is sometimes appropriate in older children.

The doctor may give intravenous (IV) antibiotics if your baby is:

• Younger than 2 to 3 months.
• Too ill or nauseated to take oral medicine.
• Very sick with a severe kidney infection.

The doctor will stop the IV medicine and begin oral medicine treatment after your child is stabilized and feeling better.

Preventive antibiotics

To prevent kidney damage that can result from recurrent infection, the doctor may prescribe long-term treatment with antibiotics for children who are at risk for repeated infections. The doctor may consider preventive antibiotics:

• While waiting for the results of tests done after treatment for a child's first UTI.
• If tests done after treatment for a child's first UTI reveal a structural problem with the urinary tract, such as vesicoureteral reflux, that increases the child's risk for recurrent UTIs.
• For children who have frequent UTIs, with or without an abnormality of the urinary tract.

Preventive treatment may last from several months to several years. Experts disagree about the best approach. Some doctors believe that long-term use of low-dose antibiotics can safely prevent UTIs in children.⁵ However, their long-term effects need more study. Some doctors are becoming more hesitant about prescribing antibiotics for long-term use because of increasing concern about the growth of antibiotic-resistant bacteria.

Medication Choices

Medicines that treat UTIs in children include antibiotics to kill the bacteria that cause UTIs.

What To Think About

Give your child all of the antibiotics that the doctor prescribes. Your child may begin to feel better soon after starting the medicine. But if you stop giving your child the medicine too soon, the infection may return or get worse. More importantly, not taking the full course of antibiotics encourages the development of bacteria that are resistant to antibiotics. This makes antibiotics less effective and future bacterial infections more difficult to treat.

Surgery is not used to treat urinary tract infections (UTIs) in children. If there is a problem with the structure of the urinary tract that is causing frequent, severe infections and increasing the child's risk of long-term complications, the doctor may consider surgery to correct the problem. For instance, children with severe vesicoureteral reflux (VUR) may benefit from surgery.

There is no other treatment for urinary tract infections (UTIs) in children at this time.

Online Resource

Organizations

• Abdominal Pain, Age 11 and Younger
• Bed-Wetting
• Constipation, Age 11 and Younger
• Kidney Stones
• Toilet Training
• Urinary Problems and Injuries, Age 11 and Younger
• Urinary Problems and Injuries, Age 12 and Older
• Urinary Tract Infections in Teens and Adults
• Vesicoureteral Reflux (VUR)

Citations

1. Hoberman A, et al. (2003). Imaging studies after a first febrile urinary tract infection in young children. New England Journal of Medicine, 348(3): 195–202.

2. Currie M, et al. (2003). Follow-up urine cultures and fever in children with urinary tract infection. Archives of Pediatrics and Adolescent Medicine, 157(12): 1237–1240.

3. Shortliffe LMD (2002). Urinary tract infections in infants and children. In PC Walsh et al., eds., Campbell's Urology, 8th ed., vol. 3, pp. 1846–1875. Philadelphia: W.B. Saunders.

4. Elder JS (2004). Urinary tract infections. In RE Behrman et al., eds., Nelson Textbook of Pediatrics, 17th ed., pp. 1785–1790. Philadelphia: Saunders.

5. Karpman E, Kurzrock EA (2004). Adverse reactions of nitrofurantoin, trimethoprim and sulfamethoxazole in children. Journal of Urology, 172(2): 448–453.

Other Works Consulted

• Alon US (2006). Urinary tract infection and perinephric/intranephric abscess. In FD Burg et al., eds., Current Pediatric Therapy, 18th ed., pp. 594–596. Philadelphia: Saunders Elsevier.

• Bloomfield P, et al. (2006). Antibiotics for acute pyelonephritis in children. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.

• Lum GM (2007). Urinary tract infections section of Kidney and urinary tract. In WW Hay et al., eds., Current Pediatric Diagnosis and Treatment, 18th ed., pp. 684–707.

• Murray MT, Bongiorno PB (2006). Cystitis. In JE Pizzorno, MT Murray, eds., Textbook of Natural Medicine, 3rd ed., vol. 2, pp. 1597–1604. St. Louis: Churchill Livingstone Elsevier.