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Patient education: Urinary tract infections in children (Beyond the Basics)

Patient education: Urinary tract infections in children (Beyond the Basics)
Authors:
Nader Shaikh, MD
Alejandro Hoberman, MD
Section Editors:
Tej K Mattoo, MD, DCH, FRCP
Morven S Edwards, MD
Deputy Editor:
Mary M Torchia, MD
Literature review current through: Feb 2022. | This topic last updated: Dec 13, 2021.

URINARY TRACT INFECTION OVERVIEW — The urinary system includes two kidneys (that filter urine), two ureters (that move urine from the kidneys to the bladder), the bladder (that holds urine), and the urethra (that carries urine out of the bladder) (figure 1). Bacteria (germs) do not normally live in these areas. When bacteria enter the bladder or kidneys, an infection can develop. These infections are called urinary tract infections (UTIs).

Kidney infections are the most serious type of UTI because, if not treated quickly, the infection can permanently damage the kidneys. Rarely, damage to the kidney can lead to high blood pressure and kidney failure later in life.

UTIs in adolescents and adults are discussed separately (see "Patient education: Urinary tract infections in adolescents and adults (Beyond the Basics)"). More detailed information about urinary tract infections in children is available by subscription. (See "Urinary tract infections in infants and children older than one month: Clinical features and diagnosis" and "Urinary tract infections in infants older than one month and young children: Acute management, imaging, and prognosis" and "Acute infectious cystitis: Clinical features and diagnosis in children older than two years and adolescents".)

URINARY TRACT INFECTION CAUSES — In healthy children, most urinary tract infections (UTIs) are caused by Escherichia coli (E. coli) bacteria, which are normally found in stool. These bacteria can move from the anus to the urethra and into the bladder (and sometimes up into the kidney), causing infection.

Risk factors — Some children have a higher chance of developing a UTI. The following are some risk factors for UTI:

Young age – Males younger than one year old and females younger than four years of age are at highest risk.

Being uncircumcised – There is a four to 10 times higher risk of UTIs in uncircumcised males. Still, most uncircumcised males do not develop UTIs. (See "Patient education: Circumcision in baby boys (Beyond the Basics)".)

Having a bladder catheter for a prolonged period of time.

Having parts of the urinary tract that did not form correctly before birth.

Having a bladder that does not work properly or constipation (bladder and bowel dysfunction [BBD]).

Having one UTI slightly increases the chance of getting another UTI.

URINARY TRACT INFECTION SYMPTOMS — Symptoms of a urinary tract infection depend on the child's age.

Older children — Children older than two years often have:

Pain or burning when urinating

Frequent need to urinate

New-onset bedwetting or daytime wetting (in children who are toilet trained)

Pain in the lower abdomen or sides of the back (figure 2)

Fever (higher than 100.4°F or 38°C) (see "Patient education: Fever in children (Beyond the Basics)")

Younger children — Symptoms in children younger than two years may include one or more of the following:

Fever, which may be the only symptom

Irritability or fussiness

URINARY TRACT INFECTION DIAGNOSIS — If you are concerned that your child has a urinary tract infection (UTI), make an appointment with the child's doctor or nurse within 24 hours. Waiting to start treatment can increase the risk of damage to the kidneys.

Urine testing — A urine sample is needed to determine if the child has a UTI. In young children who are not toilet trained, initial testing may be performed on a urine sample collected in a bag. However, if those results suggest that the child has a UTI, it is usually necessary to insert a thin sterile tube (a catheter) into the bladder to obtain a urine sample for the urine culture. The use of bags to collect urine for urine culture is discouraged because the results are often misleading.

In older children who can use the toilet, you can collect a urine sample by having the child urinate into a sterile cup.

After obtaining the urine, a urine dipstick test is usually done in the office. If the test suggests a UTI or the child has UTI symptoms, the doctor or nurse will send the urine sample to a laboratory for urine culture to confirm the diagnosis. The culture helps decide which antibiotic is best. It takes up to 48 hours for germs to grow, so the culture results are not available right away.

Based on the child's symptoms and the results of the dipstick test, the doctor or nurse may decide to start antibiotics before urine culture results are available.

Imaging tests — Imaging tests, such as ultrasound, can show if a child's urinary system did not form correctly before birth. If the urinary system is abnormal, a child is more likely to have UTIs. A kidney ultrasound is generally done in younger children (less than three to five years old). Children who have had more than one UTI generally have more detailed imaging tests (a voiding cystourethrogram [VCUG] test) to look for abnormalities that may have been missed by the ultrasound.

Kidney ultrasound — Ultrasound uses sound waves to create a picture of the kidneys. During the test, gel is applied to the skin on the child's back and abdomen, and a small wand-like device is pressed against the body. The test is not painful and usually takes less than 30 minutes.

Voiding cystourethrogram — A VCUG is an x-ray test that shows the outline of the child's bladder and urethra. The test can also show if urine flows from the bladder backwards into the ureters or kidneys; this is called vesicoureteral reflux. Reflux may increase the chance that a child will have kidney infections.

This test takes approximately one to two hours to complete and involves putting a catheter into the child's bladder. Dye is put into the child's bladder through the catheter, and x-rays are taken before and after the child urinates.

URINARY TRACT INFECTION TREATMENT — Antibiotics are used to treat urinary tract infections (UTIs). The best antibiotic depends upon the child's age, the germ that caused the UTI, and the resistance that germs have. Most children who are older than two months are given an antibiotic by mouth, in a liquid or chewable tablet.

If the child is less than two months old, or if the child is vomiting and unable to take medicine by mouth, it may be necessary for the child to be admitted to the hospital for treatment with intravenous (IV) antibiotics.

Antibiotics are usually prescribed for a total of 5 to 10 days. In all cases, it is important for the child to take each dose of the antibiotic on time and to finish all of the medicine.

Response to treatment — Your child should begin to feel better within 24 to 48 hours of starting antibiotics. If they do not get better or worsen, they should be seen again by a doctor or nurse. Most children who have a UTI have no long-term damage to the urinary tract from the infection. It is not necessary to have another urine test after a child has finished antibiotic treatment, as long as the UTI symptoms have resolved.

URINARY TRACT INFECTION PREVENTION — Approximately 8 to 30 percent (1 in 5 to 10) of children who have a urinary tract infection (UTI) develop another UTI. This usually happens within the first six months after the first infection and is more common in females. (See "Urinary tract infections in children: Long-term management and prevention".)

Treatment of constipation and bladder problems will also help prevent future UTIs.

Preventive antibiotics — A low daily dose of an antibiotic may be recommended if your child gets frequent UTIs. This treatment is usually continued for 6 to 12 months.

WHEN TO SEEK HELP — If your child has any of the following, make an appointment with their doctor or nurse:

Fever – Fever (temperature higher than 100.4°F or 38°C) may be the only symptom of urinary tract infection in infants and young children.

Pain or burning with urination or frequent urination.

Back or abdominal pain.

WHERE TO GET MORE INFORMATION — Your child's health care provider is the best source of information for questions and concerns related to your child's medical problem.

This article will be updated as needed on our website (www.uptodate.com/patients). Related topics for patients and caregivers, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below.

Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient education: Urinary tract infections in adults (The Basics)
Patient education: Daytime wetting in children (The Basics)
Patient education: Urinary tract infections in children (The Basics)
Patient education: Vesicoureteral reflux in children (The Basics)

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient education: Urinary tract infections in adolescents and adults (Beyond the Basics)
Patient education: Circumcision in baby boys (Beyond the Basics)
Patient education: Fever in children (Beyond the Basics)

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Acute infectious cystitis: Clinical features and diagnosis in children older than two years and adolescents
Acute infectious cystitis: Management and prognosis in children older than two years and adolescents
Kidney stones in children: Acute management
Urinary tract infections in infants older than one month and young children: Acute management, imaging, and prognosis
Kidney stones in children: Clinical features and diagnosis
Urinary tract infections in infants and children older than one month: Clinical features and diagnosis
Urinary tract infections in children: Epidemiology and risk factors
Etiology and evaluation of dysuria in children and adolescents
Urinary tract infections in children: Long-term management and prevention
Management of vesicoureteral reflux
Clinical presentation, diagnosis, and course of primary vesicoureteral reflux
Kidney stones in children: Prevention of recurrent stones
Urinary tract infections in neonates
Urine collection techniques in infants and children with suspected urinary tract infection

The following organizations also provide reliable health information.

National Library of Medicine

     (https://medlineplus.gov/ency/article/000505.htm)

National Institute of Diabetes and Digestive and Kidney Diseases

     (https://www.niddk.nih.gov/health-information/urologic-diseases/urinary-tract-infections-in-children)

Children’s Hospital of Pittsburgh UTI Center

     (www.chp.edu/CHP/uti+center)

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This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms ©2022 UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.
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References

1 : Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months.

2 : Long-term antibiotics for preventing recurrent urinary tract infection in children.

3 : Reaffirmation of AAP Clinical Practice Guideline: The Diagnosis and Management of the Initial Urinary Tract Infection in Febrile Infants and Young Children 2-24 Months of Age.