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
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)
Risk factors
- age <1 year
- female sex
- uncircumcised boys in the first year of life
- previous UTI
- bladder and bowel dysfunction
- vesicoureteral reflux
- sexual activity
- no history of breastfeeding
- anatomic abnormalities or previous surgery to the urinary tract
- immunosuppression
- protein-energy malnutrition
Diagnostic tests
1st tests to order
- urine dipstick
- urine microscopy
- urine culture
Tests to consider
- urine flow cytometry
- blood culture
- complete blood count
- inflammatory markers
- fungus urine culture
- serum creatinine, BUN and electrolytes
- renal and/or bladder ultrasound
- dimercaptosuccinic acid (DMSA) scan
- voiding cystourethrogram (VCUG)
Treatment algorithm
vesicoureteral reflux: no history of febrile UTIs
age ≤2 months
age >2 months
recurrent UTIs
Contributors
Authors
Joana Dos Santos, MD, MHSc, FRCPC
Assistant Professor of Pediatrics
Medical Pediatric 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.
References
Key articles
European Association of Urology. Guidelines on paediatric urology. 2024 [internet publication].Full text
National Institute for Health and Care Excellence. Urinary tract infection in under 16s: diagnosis and management. Jul 2022 [internet publication].Full text
Mattoo TK, Shaikh N, Nelson CP. Contemporary management of urinary tract infection in children. Pediatrics. 2021 Feb;147(2):e2020012138.Full text Abstract
American College of Radiology. ACR appropriateness criteria: urinary tract infection - child. 2023 [internet publication].Full text
Peters CA, Skoog SJ, Arant BS Jr, et al; American Urological Association. Management and screening of primary vesicoureteral reflux in children: AUA guideline. 2017 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Appendicitis
- Gastroenteritis
- Kawasaki disease
More DifferentialsGuidelines
- Paediatric urology: urinary tract infections in children
- Guidelines on paediatric urology: urinary tract infections in children
More GuidelinesPatient information
Urinary tract infections in children
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