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Urinary Tract Infections in Children

Urinary Tract Infections in Children

Topic Overview

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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 are urinary tract infections?

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 they get medical care right away. But if your child keeps getting infections, your doctor may suggest tests to rule out more serious problems.

Urinary infections 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.
  • Vomiting.
  • The child not being hungry.
  • 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 flank, which is felt just below the rib cage and above the waist on one or both sides of the back.
  • 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, such as a urinalysis and a urine culture, to check for germs in the urine. 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. The number of days a child will need to take the medicine depends on the illness, the child's age, and the type of antibiotic.

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.

Cause

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. Sometimes bacteria traveling through the blood or lymph system to the urinary tract are the cause of kidney or bladder infections.

The ways that bacteria buildup can occur include:

  • Not properly wiping the bottom after a bowel movement. Bacteria may get into the urethra and cause a UTI.
  • Constipation.
  • Not completely emptying the bladder. This 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:

Symptoms

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, pinkish, or cloudy urine.
  • Foul-smelling urine.
  • Pain in the flank, which is felt just below the rib cage and above the waist on one or both sides of the back.

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

What Happens

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 injury, 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 get 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 surgery.

What Increases Your Risk

Risk factors (things 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 have UTIs often have vesicoureteral reflux (VUR).

When should you call your doctor?

Urinary tract infections (UTI) in infants and young children need early evaluation and treatment. Call your doctor to make an appointment within 24 hours if your child has:

  • A 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 flank, which is felt just below the rib cage and above the waist on one or both sides of the back.
  • 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 not the right choice if you suspect that your child has a urinary tract infection. Untreated UTIs in children can lead to other kidney problems, high blood pressure, and other complications.

Exams and Tests

Initial tests

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

  • A medical history and physical exam.
  • Urinalysis, which measures different parts of urine to help detect a UTI.
  • Urine culture, which 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. But the results usually are not available for a couple of days. Rather than delay 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 show that a UTI is likely.

A urine sample will be collected.

  • 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. 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 get the sample.

If your child is younger than 2 years, has a UTI, and has a fever, your doctor may order a kidney and bladder ultrasound test.

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

  • Does not improve after 4 days of medicine.
  • 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 injury.

Other tests

Other common tests include:

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

If an ultrasound shows problems, then a VCUG may be done. VCUG can identify vesicoureteral reflux, abnormalities of the urinary tract, and other conditions that may make your child more prone to kidney infections. If the test finds any of these conditions, the doctor can watch and give preventive treatment, if needed, to your child.

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.

Treatment Overview

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-term 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.

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 first 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, is too nauseated or sick to take oral medicines, or has an impaired immune system, the doctor may give your child a shot of antibiotics. Or your child may need a brief hospital stay and a short course of intravenous (IV) antibiotics. After your child's fever and other symptoms improve and your child is feeling better, the doctor may prescribe oral antibiotics.

The number of days a child will need to take these medicines depends on the illness, the child's age, and the type of antibiotic.

Treatment if the condition gets worse or recurs

If your child's urinary tract infection (UTI) does not improve after treatment with antibiotics, your child needs further evaluation and may need more antibiotics. Your child may have a structural problem that is making the infection hard 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.

If tests show a structural problem in the urinary tract (such as vesicoureteral reflux) that increases your child's risk for recurrent UTIs, the doctor may consider preventive antibiotics.

Prevention

Urinary tract infections (UTIs) are hard 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 show abnormalities of the urinary tract that raise the risk for repeat infections, the doctor may recommend long-term antibiotic treatment.

Some evidence suggests that breastfeeding may help prevent UTIs during the first 6 months of life.footnote 1, footnote 2

After learning to use the toilet, some children may not empty their bladders 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 this risk.

Babies younger than 4 months get all the fluids they need from breast milk or formula. But for older children, extra fluids may help. Offer your child drinks (such as water) throughout the day. Drinking enough fluids fills the bladder and can help your child empty the bladder more often.

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.

Home Treatment

Home care isn't a substitute for medical care when it comes to treating a urinary tract infection (UTI). If you think your child may have a UTI, a doctor should see him or her right away.

But along with seeing the doctor, there are things you can do at home that may help your child.

  • Encourage—but do not force—your child to drink extra fluids as soon as you notice the symptoms and for the next 24 hours. This will help make the urine less concentrated and wash out the infection-causing bacteria. 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.

Medications

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.

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

  • Younger than 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

The doctor may consider preventive antibiotics if tests show a structural problem in the urinary tract, such as vesicoureteral reflux, that increases the child's risk for recurrent UTIs.

Preventive treatment may last 3 months or longer. Some doctors are more hesitant about prescribing antibiotics for long-term use because of increasing concern about the growth of antibiotic-resistant bacteria.

Medicine choices

Antibiotics are used to kill the bacteria that cause UTIs.

What to think about

Give your child the antibiotics as directed. Do not stop using them just because your child feels better. Your child needs to take the full course of medicine. 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. Also, not taking the full course of medicine encourages the development of bacteria that are resistant to antibiotics. This makes antibiotics less effective and future bacterial infections harder to treat.

Surgery

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 may benefit from surgery. For more information, see the topic Vesicoureteral Reflux (VUR).

Other Treatment

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

References

Citations

  1. Shortliffe LMD (2012). Infection and inflammation of the pediatric genitourinary tract. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 4, pp. 3085–3122. Philadelphia: Saunders.
  2. Elder JS (2011). Urinary tract infections. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 1829–1834. Philadelphia: Saunders Elsevier.

Other Works Consulted

  • Hannula A, et al. (2012). Long-term follow-up of patients after childhood urinary tract infection. Archives of Pediatric and Adolescent Medicine, 166(12): 1117–1122. Also available online: http://archpedi.jamanetwork.com/article.aspx?articleid=1378179.
  • Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management (2011). Urinary tract infection: Clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics, 128(3): 595–610. DOI: 10.1542/peds.2011-1330. Accessed June 9, 2016.

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