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Urinary tract infection - children

UTI - children; Cystitis - children; Bladder infection - children; Kidney infection - children; Pyelonephritis - children

A urinary tract infection is a bacterial infection of the urinary tract. This article discusses urinary tract infections in children.

The infection can affect different parts of the urinary tract, including the bladder (cystitis), kidneys (pyelonephritis), and urethra, the tube that empties urine from the bladder to the outside.

Causes

Urinary tract infections (UTIs) can occur when bacteria get into the bladder or to the kidneys. These bacteria are common on the skin around the anus. They can also be present near the vagina.

Some factors make it easier for bacteria to enter or stay in the urinary tract, such as:

  • Vesicoureteral reflux in which urine flow backs up into the ureters and kidneys.
  • Brain or nervous system illnesses (such as myelomeningocele or spinal cord injury).
  • Bubble baths or tight-fitting clothes (girls).
  • Changes or birth defects in the structure of the urinary tract.
  • Not urinating often enough during the day.
  • Wiping from back (near the anus) to front after going to the bathroom. In girls, this can bring bacteria to the opening where the urine comes out.

UTIs are more common in girls. This may occur as children begin toilet training around 3 years of age. Boys who are not circumcised have a slightly higher risk of UTIs before age 1.

Symptoms

Young children with UTIs may have a fever, poor appetite, vomiting, or no symptoms at all.

Most UTIs in children only involve the bladder. It may spread to the kidneys.

Symptoms of a bladder infection in children include:

Signs that the infection may have spread to the kidneys include:

  • Chills with shaking
  • Fever
  • Flushed, warm, or reddened skin
  • Nausea and vomiting
  • Pain in the side (flank) or back
  • Severe pain in the belly area

Exams and Tests

A urine sample is needed to diagnose a UTI in a child. The sample is examined under a microscope and sent to a lab for a urine culture.

It may be hard to get a urine sample in a child who is not toilet trained. The test cannot be done using a wet diaper.

Ways to collect a urine sample in a very young child include:

  • Urine collection bag --  A special plastic bag is placed over the child's penis or vagina to catch the urine. This is not the best method because the sample may become contaminated.
  • Catheterized specimen urine culture -- A plastic tube (catheter) placed into the tip of the penis in boys, or straight into the urethra in girls, collects urine right from the bladder.
  • Suprapubic urine collection -- A needle is placed through the skin of the lower abdomen and muscles into the bladder. It is used to collect urine.

Imaging may be done to check for any anatomical abnormalities or to check kidney function, including:

Your health care provider will consider many things when deciding if and when a special study is needed, including:

  • The child's age and history of other UTIs (infants and younger children usually need follow-up tests)
  • The severity of the infection and how well it responds to treatment
  • Other medical problems or physical defects the child may have

Treatment

In children, UTIs should be treated quickly with antibiotics to protect the kidneys. Any child under 6 months old or who has other complications should see a specialist right away.

Younger infants will most often need to stay in the hospital and be given antibiotics through a vein. Older infants and children are treated with antibiotics by mouth. If this is not possible, they may need to get treated in the hospital.

Your child should drink plenty of fluids when being treated for a UTI.

Some children may be treated with antibiotics for periods as long as 6 months to 2 years. This treatment is more likely when the child has had repeat infections or vesicoureteral reflux.

After antibiotics are finished, your child's provider may ask you to bring your child back to do another urine test. This may be needed to make sure that bacteria are no longer in the bladder.

Outlook (Prognosis)

Most children are cured with proper treatment. Most of the time, repeat infections can be prevented.

Repeated infections that involve the kidneys can lead to long-term damage to the kidneys.

When to Contact a Medical Professional

Call your provider if your child's symptoms continue after treatment, or come back more than twice in 6 months or your child have:

  • Back pain or flank pain
  • Bad-smelling, bloody, or discolored urine
  • Fever of 102.2°F (39°C) in infants for longer than 24 hours
  • Low back pain or abdominal pain below the belly button
  • Fever that does not go away
  • Very frequent urination, or need to urinate many times during the night
  • Vomiting

Prevention

Things you can do to prevent UTIs include:

  • Avoid giving your child bubble baths.
  • Have your child wear loose-fitting underpants and clothing.
  • Increase your child's intake of fluids.
  • Keep your child's genital area clean to prevent bacteria from entering through the urethra.
  • Teach your child to go the bathroom several times every day.
  • Teach your child to wipe the genital area from front to back to reduce the spread of bacteria.

To prevent recurrent UTIs, the provider may recommend low-dose antibiotics after the first symptoms have gone away.

References

American Academy of Pediatrics. Subcommittee on urinary tract infection. 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. Pediatrics. 2016;138(6):e20163026. PMID: 27940735 pubmed.ncbi.nlm.nih.gov/27940735/.

Jerardi KE and Jackson EC. Urinary tract infections. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 553.

Sobel JD, Brown P. Urinary tract infections. In: Bennett JE, Dolin R, Blaser MJ eds. Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 72.

Wald ER. Urinary tract infections in infants and children. In: Kellerman RD, Rakel DP, eds. Conn's Current Therapy 2020. Philadelphia, PA: Elsevier; 2020:1252-1253.

  • Female urinary tract

    Female urinary tract - illustration

    The female and male urinary tracts are relatively the same except for the length of the urethra.

    Female urinary tract

    illustration

  • Male urinary tract

    Male urinary tract - illustration

    The male and female urinary tracts are relatively the same except for the length of the urethra.

    Male urinary tract

    illustration

  • Voiding cystourethrogram

    Voiding cystourethrogram - illustration

    One method of examining bladder function is by injecting dye that is visible on X-rays through a tube (catheter) to fill the bladder. X-rays are taken while the bladder is full and while the patient is urinating (voiding) to determine if fluid is forced out of the bladder through the urethra (normal) or up through the ureters into the kidney (vesicoureteral reflux). This study is usually done with the patient lying on an X-ray table.

    Voiding cystourethrogram

    illustration

  • Vesicoureteral reflux

    Vesicoureteral reflux - illustration

    When the ureters enter the bladder, they travel through the wall of the bladder for a distance in such a way that they create a tunnel so that a flap-like valve is created inside the bladder. This valve prevents urine from backing-up into the ureters and kidneys. In some children, the valves may be abnormal or the ureters in the bladder may not travel long enough in the bladder wall, which can cause vesicoureteral reflux. Vesicoureteral reflux is a condition that allows urine to go back up into the ureters and kidneys causing repeated urinary tract infections. The reflux of urine exposes the ureters and kidney to infection from bacteria and high-pressure, which is generated by the bladder during urination. If left untreated, urinary infections can cause kidney damage and renal scarring with the loss of potential growth of the kidney and high blood pressure later in life. Vesicoureteral reflux is treated with antibiotics, and in severe cases surgically.

    Vesicoureteral reflux

    illustration

    • Female urinary tract

      Female urinary tract - illustration

      The female and male urinary tracts are relatively the same except for the length of the urethra.

      Female urinary tract

      illustration

    • Male urinary tract

      Male urinary tract - illustration

      The male and female urinary tracts are relatively the same except for the length of the urethra.

      Male urinary tract

      illustration

    • Voiding cystourethrogram

      Voiding cystourethrogram - illustration

      One method of examining bladder function is by injecting dye that is visible on X-rays through a tube (catheter) to fill the bladder. X-rays are taken while the bladder is full and while the patient is urinating (voiding) to determine if fluid is forced out of the bladder through the urethra (normal) or up through the ureters into the kidney (vesicoureteral reflux). This study is usually done with the patient lying on an X-ray table.

      Voiding cystourethrogram

      illustration

    • Vesicoureteral reflux

      Vesicoureteral reflux - illustration

      When the ureters enter the bladder, they travel through the wall of the bladder for a distance in such a way that they create a tunnel so that a flap-like valve is created inside the bladder. This valve prevents urine from backing-up into the ureters and kidneys. In some children, the valves may be abnormal or the ureters in the bladder may not travel long enough in the bladder wall, which can cause vesicoureteral reflux. Vesicoureteral reflux is a condition that allows urine to go back up into the ureters and kidneys causing repeated urinary tract infections. The reflux of urine exposes the ureters and kidney to infection from bacteria and high-pressure, which is generated by the bladder during urination. If left untreated, urinary infections can cause kidney damage and renal scarring with the loss of potential growth of the kidney and high blood pressure later in life. Vesicoureteral reflux is treated with antibiotics, and in severe cases surgically.

      Vesicoureteral reflux

      illustration

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    Review Date: 1/1/2020

    Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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