Urinary tract infections in children

Last reviewed: 4 Jun 2022
Last updated: 26 Apr 2022

Summary

Definition

History and exam

Key diagnostic factors

  • fever >102.2°F (>39°C)
  • irritability (neonates and infants)
  • poor feeding (neonates and infants)
  • suprapubic tenderness
  • costovertebral angle tenderness
More key diagnostic factors

Other diagnostic factors

  • foul-smelling urine (infants, older children, and adolescents)
  • dysuria (preschool age, older children, and adolescents)
  • urinary frequency (older children and adolescents)
  • abdominal/flank pain (infants, older children, and adolescents)
  • vomiting
  • ill appearance (neonates)
  • gross hematuria (older children and adolescents)
  • new-onset urinary incontinence (toddlers, older children, and adolescents)
Other diagnostic factors

Risk factors

  • age <1 year
  • female sex
  • white children
  • uncircumcised boys in the first year of life
  • previous UTI
  • bladder bowel dysfunction
  • vesicoureteral reflux
  • sexual activity
  • no history of breastfeeding
  • anatomic abnormalities or previous surgery to the urinary tract
  • immunosuppression
  • protein-energy malnutrition
More risk factors

Diagnostic investigations

1st investigations to order

  • urine dipstick
  • urine microscopy
  • urine culture
More 1st investigations to order

Investigations to consider

  • blood culture
  • complete blood count
  • inflammatory markers
  • cerebrospinal fluid (CSF) analysis
  • fungus urine culture
  • serum creatinine, BUN and electrolytes
  • renal ultrasound
  • dimercaptosuccinic acid (DMSA) scan
  • voiding cystourethrogram
  • CT scan abdomen (contrast-enhanced)
  • abdominal MRI (contrast-enhanced)
More investigations to consider

Emerging tests

  • enhanced urinalysis

Treatment algorithm

INITIAL

vesicoureteral reflux: no history of febrile UTIs

ACUTE

age ≤2 months

age >2 months

ONGOING

recurrent UTIs

Contributors

Authors

Joana Dos Santos, MD, MHSc, FRCPC

Assistant Professor of Pediatrics

Staff Medical Urologist

The Hospital for Sick Children

Toronto

Ontario

Canada

Disclosures

JDS declares that she has no competing interests.

Acknowledgements

Dr Joana Dos Santos would like to gratefully acknowledge Dr Beatrice Goilav, Dr Frederick Kaskel, Dr Mary Anne Jackson, and Dr Rene VanDeVoorde, previous contributors to this topic.

Disclosures

BG, FK, MAJ, and RV declare that they have no competing interests.

Peer reviewers

Martin Koyle, MD, MSc, FAAP, FACS, FRCS(Eng), FRCSC

Professor

Department of Surgery and Institute of Health Policy, Management and Evaluation

Staff Pediatric Urologist

The Hospital for Sick Children

Toronto

Ontario

Canada

Disclosures

MK declares that he has no competing interests.

Daniel T. Keefe, MD, FRCSC

Pediatric Urology Fellow

The Hospital for Sick Children

Toronto

Ontario

Canada

Disclosures

DTK declares that he has no competing interests.

  • Urinary tract infections in children images
  • Differentials

    • Appendicitis
    • Gastroenteritis
    • Kawasaki disease
    More Differentials
  • Guidelines

    • Evaluation and management of well-appearing febrile infants 8 to 60 days old
    • Guidelines on paediatric urology: urinary tract infections in children
    More Guidelines
  • Patient leaflets

    Urinary tract infections in children

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer