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Urinary Tract Infections

Summary

Urinary tract infections (UTIs) are common in children and can affect the bladder (cystitis) or kidneys (pyelonephritis). Symptoms vary by age:

  • Infants and young children may have fever, irritability, poor feeding, vomiting, or foul-smelling urine.
  • Older children may experience painful urination (dysuria), frequent urination, urgency, or abdominal pain with a bladder infection. A kidney infection may cause fever, back pain, nausea, or vomiting.

If left untreated, recurrent UTIs can lead to kidney damage (renal scarring), which may affect long-term kidney function.

Diagnosis and When to Seek Help

A UTI is diagnosed by testing a properly collected urine sample, which can confirm infection and identify the bacteria causing it. A urine culture helps determine the most effective antibiotic.

Parents should seek medical attention if their child has:

  • Fever without a clear cause (especially in infants)
  • Pain or burning during urination
  • Frequent or urgent need to urinate
  • Foul-smelling or cloudy urine
  • Back or side pain, fever, and vomiting (signs of a kidney infection)

Children with recurrent UTIs may need additional testing to check for structural or functional urinary tract problems that increase the risk of infection.

Management

  • Antibiotics: UTIs are treated with a short course of antibiotics (typically 3–7 days for bladder infections and 7–14 days for kidney infections). The choice of antibiotic depends on the urine culture results.
  • Pain relief: Drinking plenty of fluids and using paracetamol or ibuprofen can help with discomfort.
  • Further evaluation: Children with recurrent or severe UTIs may need imaging tests (e.g., ultrasound) to check for kidney or bladder abnormalities.

Follow-Up and Monitoring

Most children recover fully within a few days of starting antibiotics. It’s important to:

  • Ensure the child completes the full antibiotic course
  • Follow up with the doctor if symptoms persist or worsen
  • Prevent future UTIs by encouraging regular urination, good hygiene, and staying hydrated

If your child has had multiple UTIs, further medical evaluation can help prevent long-term kidney problems.

History and Exam

Key diagnostic factor

  • Presence of risk factors
  • Fever >39*C (>102.2*F)
  • Irritability (neonates and infants)

Other diagnostic factors

  • Foul-smelling urine (infants, older children, and adolescents)
  • Dysuria (preschool age, older children, and adolescents)
  • Urinary frequency (older children and adolescents)
  • Abdominal/flank pain (infants, older children and adolescents)

Risk factors

  • Age <1 year
  • Female sex
  • Uncircumcised boys in the first year of life
  • Previous UTI

Diagnostic Investigations

1st investigations to order

  • Urine dipstick
  • Urine microscopy
  • Urine culture

Investigations to consider

  • Urine flow cytometry
  • Blood culture
  • Full blood count
  • Inflammatory markers

Emerging tests

  • Head and neck 3- dimensional CT
  • Head and neck MRI

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      Children who experience difficulties in social and emotional functioning may struggle with recognizing their own feelings or those of others, regulating emotional responses, or responding appropriately in social situations. This can lead to challenges such as anxiety, low self-esteem, difficulty making friends, or misunderstandings with peers and adults.

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