Pediatric Urinary Tract Infection (UTI)

Urinary tract infections describe a health problem that results from a bacterial infection along the urinary tract. The urinary tract consists of two kidneys that remove liquid waste from the blood in the form of urine. Two narrow tubes called ureters carry urine from the kidneys to the bladder. The urine is stored in the bladder (a triangle-shaped, hollow organ). When the bladder is emptied, the urine travels through a tube called the urethra and passes outside the body.

Normal urine is sterile and contains fluids, salts and waste products. It is free of bacteria, viruses and fungi. An infection occurs when microorganisms, usually bacteria from the digestive tract, cling to the opening of the urethra, travel up into the bladder and/or kidney, and begin to multiply.

Most infections arise from Escherichia coli (E. coli) bacteria, which normally live in the colon.

Age, sex, race and whether the child is a circumcised boy all affect the risks for UTI:

• In the first year of life, uncircumcised boys are more likely to have bacteria in their urine than girls.
• After 1 year of age, girls are more likely than boys to have UTIs.
• Overall, uncircumcised boys are ten times more likely to have UTIs than circumcised boys.

The following are the most common symptoms of a UTI. However, each child may experience symptoms differently. Symptoms may include:

In babies:

• Fever
• Abdominal pain
• Abdominal fullness
• Foul-smelling urine
• Poor growth
• Weight loss or failure to gain weight
• Irritability
• Vomiting
• Poor feeding 
• Diarrhea

Older children:

• Urgency to urinate
• Incontinence during day and/or night
• Frequent urination
• Painful or difficult urination
• Discomfort above the pubic bone
• Blood in the urine
• Foul-smelling urine
• Nausea and/or vomiting
• Fever
• Chills
• Pain in the back or side below the ribs
• Fatigue 
• Small amount of urine while voiding despite feeling of urgency

The symptoms of a UTI may resemble other conditions or medical problems. Always consult your child's doctor for a diagnosis.

Your child's doctor may diagnose a urinary tract infection based on physical examination and a description of symptoms. Other studies may include a urinalysis (a laboratory examination of urine for various cells and chemicals, such as red blood cells, white blood cells, infection or excessive protein) and culture that will detect the presence of an infection.

Your child may require further diagnostic testing to understand why they had a UTI.

• Abdominal ultrasound. A diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues and organs. Ultrasounds are used to view internal organs as they function and to assess blood flow through various vessels.
• Voiding cystourethrogram (VCUG). A specific X-ray that examines the urinary tract. A catheter (hollow tube) is placed in the urethra (tube that drains urine from the bladder to the outside of the body) and the bladder is filled with a liquid dye. X-ray images will be taken as the bladder fills and empties. The images will show if there is any reverse flow of urine into the ureters and kidneys.

Specific treatment for a urinary tract infection will be determined by your child's doctor based on:

• Your child's age, overall health, and medical history
• Extent of the condition
• Your child's tolerance for specific medications, procedures, or therapies
• Expectations for the course of the condition
• Your opinion or preference

Treatment may include:

• Antibiotics
• A heating pad or medications (to relieve pain)
• Increased fluid intake (especially water)

Your child's doctor may ask you to bring your child back into the office a few days after treatment starts to reevaluate your child.

You can help prevent UTIs in your child if you:

• Have your child drink plenty of fluids
• Tell your child to empty their bladder fully when urinating
• Teach girls to wipe from the front to back after going to the bathroom
• Make sure your child doesn’t get constipated

Call the healthcare provider if your child has:

• Symptoms that don’t get better, or get worse
• New symptoms