Urinary Tract Infections in Young Children

What is a urinary tract infection?

A urinary tract infection (UTI) affects the kidneys, bladder, and urethra. Infection occurs when bacteria builds in the urinary tract when waste isn’t removed or the bladder isn’t emptied. When the bladder is involved in the infection, it is called cystitis. If the kidneys are involved, it is a more serious condition called pyelonephritis.

In general, UTIs are more common in girls. They can occur more often when children are potty training. Boys who have not been circumcised by the age of 1 are at risk of UTIs as well. Kids who have vesicoureteral reflux (VUR) may get UTIs more often. VUR is a condition in which urine can flow back into the urinary tract. VUR typically is present at birth.

Path to improved health

The sooner you detect a UTI, the quicker treatment can begin. It is important to know the symptoms. Common UTI symptoms include:

• Burning feeling or pain when you urinate
• Feeling like you need to urinate more often than usual
• Feeling the urge to urinate but not being able to
• Stomach pain
• Low back pain

Your child may not be able to communicate these symptoms. You should look for the following warning signs:

• Cloudy, dark, smelly, or bloody urine
• Fever or chills
• Vomiting
• Diarrhea
• Fussiness
• Poor appetite or less active
• Going through more diapers than usual
• Wetting clothes even though they are potty trained

Contact your doctor right away if you think your child has a UTI. The doctor will review symptoms and do a physical exam. The doctor also will do a urine test (urinalysis) to confirm the diagnosis. Getting a sample of urine can be hard in young children. There are several ways a doctor can collect urine.

• Catheterized specimen urine culture: The doctor places a thin plastic tube (catheter) into the child’s bladder.
• Subrapubic urine collection: The doctor inserts a thin needle through the child’s lower stomach into their bladder. This is usually a last resort when other methods have failed.
• Urine collection bag: The doctor places a plastic bag beneath the child’s vagina or penis to collect urine. This method is the least reliable.

Based on the test result, the doctor may perform other tests to rule out conditions similar to UTIs or determine the cause.

If your child has frequent infections, your family doctor may order an ultrasound or voiding cysto-urethrogram (VCUG) before referring you to a specialist. A VCUG allows your doctor to evaluate your child’s bladder and urethra using contrast and X-rays.

Treatment for a UTI depends on the cause and your child’s age. Infants often require treatment in the hospital. This is because they need antibiotics through an IV (intravenous) or catheter. Older children can take medicine at home.

Things to consider

There are several things you can do to help prevent UTIs in children.

• Keep your child’s genital area clean. This helps prevent bacteria from forming or spreading.
• Have your child drink plenty of non-sugar-sweetened fluids, especially water.
• Teach your child not to hold it too long when they need to go to the bathroom. A backup of urine in the bladder can lead to bacteria growth.
• Teach your child to wipe from front to back when they go to the bathroom. This is especially important for girls.
• Do not dress your child in clothes that are too tight.
• Always bathe your child after swimming or being active.

When to see a doctor

Call the doctor if your child’s symptoms don’t improve or get worse with medicine. If your child gets a UTI more than once in 6 months, the doctor may want to switch treatments.

Questions to ask your doctor

• How did my child get a UTI?
• How long will my child need to take antibiotics?
• What is the risk of my child getting more UTIs in the future?
• Does treatment vary if my child gets UTIs often?
• What conditions are related to UTIs?

Resources

Urology Care Foundation: Urinary Tract Infections in Children