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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 an 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.

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Female urinary tract
Male urinary tract
Voiding cystourethrogram
Vesicoureteral reflux

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Causes

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

Normally, there are no bacteria in the urinary tract. However, some things make it easier for bacteria to enter or stay in the urinary tract. These include:

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

Children with a problem call reflux (vesicoureteral reflux or VUR) are more likely to have infections.

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. If the infection spreads to the kidneys (called pyelonephritis), it may be more serious.

Symptoms of a bladder infection in children include:

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

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:

If this is your child's first UTI, imaging tests may be done to find the cause of the infection or check for kidney damage. Tests may include:

These studies may be done while the child has an infection. Most often, they are done weeks to several months later.

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

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 UTI symptoms continue after treatment, or come back more than twice in 6 months.

Call your provider if the child's symptoms get worse. Also call if your child develops new symptoms, such as:

Prevention

Things you can do to prevent UTIs include:

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

Related Information

Urinary tract infection - adults
Enlarged prostate
Urethral stricture
Bowel incontinence

References

Elder JS. Urinary tract infections. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 538.

Elder JS. Vesicoureteral reflux. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 539.

Keren R, Shaikh N, Pohl H, et al. Risk factors for recurrent urinary tract infection and renal scarring. Pediatrics. 2015;136(1):e13-e21. PMID: 26055855 www.ncbi.nlm.nih.gov/pubmed/26055855.

Sobel JD, Kaye D. Urinary tract infections. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 74.

Williams G, Craig JC. Long-term antibiotics for preventing recurrent urinary tract infection in children. Cochrane Database Syst Rev. 2011;(3):CD001534. PMID: 21412872 www.ncbi.nlm.nih.gov/pubmed/21412872.

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Review Date: 2/13/2018  

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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