Pediatric urinary tract infection (UTI)

What is a pediatric urinary tract infection (UTI)?

The urinary tract is made up of two kidneys, two ureters, the urethra, and the bladder. The kidneys filter liquid waste from the blood and send it through the ureters, which are narrow tubes, to the bladder, where it is stored.

Your child’s bladder is a hollow organ shaped like a triangle. When the bladder empties, the urine travels out of the body through the urethra.

A urinary tract infection is an infection in the urinary tract including bladder, ureters, and kidneys. They are typically diagnosed with a urinalysis and or a urine culture.

Most of the time, urinary tract infections are treated easily by your child’s doctor. However, some children have problems with their kidneys that cause them to get frequent urinary tract infections. If your child experiences multiple urinary tract infections or febrile urinary tract infections, please notify a urologist. These symptoms are more alarming and may need further imaging.

Risk factors

Urinary tract infections (UTIs) are very common in children. Because they have a shorter urinary tract, girls are more likely than boys to have the infections.

Children younger than 3 to 5 years of age are less likely than older children to get urinary tract infections. These infections are also more common in children with a partial or complete blockage in the urinary tract.

What are the signs and symptoms of a pediatric urinary tract infection (UTI)]?

Children experience urinary tract infections in different ways. The symptoms are similar to those of other conditions, so it’s important to seek medical care when your child experiences these symptoms.

The most worrisome symptoms include:

• Fever

• Vomiting

• Flank pain

• Painful urination

• Suprapubic pain

• Burning with urination

• Changes in voiding habits

Symptoms in babies:

• Abdominal pain and/or fullness

• Diarrhea

• Fever

• Irritability

• Strong-smelling urine

• Vomiting

• Weight loss or absence of weight increase

Symptoms in older children:

• Discomfort above the pubic bone

• Pain in the lower back or lower pelvis

• Incontinence

• Hematuria (blood in the urine)

• Cloudy urine

• Strong-smelling urine

• Pain, burning, or difficulty with urination

• Frequent urination, urgency to urinate, or urinating only small amounts

• Fatigue

• Poor appetite

Symptoms that may indicate that the infection has spread to the kidneys include:

• Chills and shaking

• High fever

• Nausea and vomiting

• Severe pain in the belly

• Pain in the side or back

• Flushed, red, or warm skin

How is a pediatric urinary tract infection (UTI) diagnosed?

A doctor may suspect that your child has a urinary tract infection (UTI) after reviewing your child’s symptoms and performing a physical examination. Then your child’s doctor will test your child’s urine before treating the infection.

Urinalysis

Most likely, your child’s doctor will use a urinalysis, or testing of a sample of your child’s urine to check for signs of infection, such as white blood cells. A urine sample will also be sent to a laboratory for a culture—a test to determine if bacteria or other germs are in the urine.

You may have to help or encourage your child collect the urine sample in a sterile container. If a child is very young, your child’s health care provider may collect the sample through a special removable container that seals to your child’s skin or with the use of a catheter, a thin tube inserted into your child’s urethra.

Ultrasound

In rare cases, your child may need an ultrasound examination on his kidneys and bladder. The test is painless and noninvasive. A technologist guides a probe over the kidney from the outside, which creates high-frequency sound waves that bounce back from the kidney, forming an image on a video screen.

Follow up

Once your child’s infection has gone away, doctors may need to perform tests to determine the cause of the infection or frequent infections, which might indicate a problem with the kidneys. These tests may include:

• Computed tomography (CT) 

• Magnetic resonance imaging (MRI)

• Voiding cystourethrogram (VCUG)

These and other tests help doctors find and better manage problems with your child’s kidneys and urinary tract that cause frequent urinary tract infections and kidney infection and disease.

What are the causes of a pediatric urinary tract infection (UTI)?

The micro-organisms that cause urinary infections are usually bacteria. Most live in the colon, sometimes attach to the urethra and enter the urinary tract. These germs then move up into the bladder and, possibly, the kidney, and start to multiply.

Although urinary tract infections are sometimes called bladder infections, they can affect any part of the urinary tract. Urinary tract infections in children typically involve the bladder.

The urinary tract is normally a sterile environment, but bacteria can enter it for a variety of reasons, including

• A urinary tract problem called vesicoureteral reflux that causes urine to flow into the ureters and kidneys

• Illnesses of the brain or nervous system that make it difficult to empty the bladder

• Birth defects or changes over time in the structure of the urinary tract

• Failure to urinate enough during the day

• In girls, wiping from back to front, rather than from front to back, after going to the bathroom. Wiping from back to front can transmit bacteria from the anus to the urethra.

How is a pediatric urinary tract infection (UTI) treated?

If your child has a urinary tract infection, sometimes called a bladder infection, the problem is not serious. However, you should take your child to the doctor to make sure your child gets symptom relief and that the infection doesn’t spread to your child’s kidneys.

Most urinary tract infections are treated with an antibiotic. However it's more important to prevent urinary tract infections. Things like voiding frequently, drinking plenty of water, proper hygiene, and constipation management.

Treatments for urinary tract infections:

• Antibiotics to get rid of the infection

• Medications to reduce pain

• Non-drug methods of pain control, such as the application of a heating pad

• Instructions to drink more fluids

Your child will probably need to return to the doctor’s office for a follow-up visit after treatment with antibiotics. You should make sure your child takes all of the antibiotics as directed and that your child continues drinking plenty of fluids and going to the restroom as soon as she feels the urge, in order to prevent future urinary tract infections.

If your child has frequent or repeated infections, your child’s doctor may recommend treating the cause of the infection or refer you to a specialist who treats childhood kidney or urinary tract disorders. For example, some children have a urinary obstruction, or blockage, that prevents urine from leaving the kidney as it should. Some of these problems require surgery to correct the abnormality.