Urinary Tract Infections in Children

Urinary tract infections (UTIs) in children are fairly common, but not usually serious. They can be effectively treated with antibiotics.

A UTI may be classed as either:

an upper UTI – if it's a kidney infection or an infection of the ureters, the tubes connecting the kidneys to the bladder
a lower UTI – if it's a bladder infection (cystitis) or an infection of the urethra, the tube that carries urine from the bladder out of the body

When to seek medical advice

If you think your child is unwell and could have a UTI, contact your Paediatrician as soon as possible. Although UTIs aren't normally a serious type of infection, they should be diagnosed and treated quickly to reduce the risk of complications.

Symptoms of a UTI in children

It can be difficult to tell whether your child has a UTI, as the symptoms can be vague and young children can't easily communicate how they feel.

General signs that may suggest your child is unwell include:

a high temperature (fever)
vomiting
tiredness and lack of energy (lethargy)
irritability
poor feeding
not gaining weight properly

More specific signs that your child may have a UTI include:

pain or a burning sensation when passing urine
needing to pass urine frequently
deliberately holding in their urine
a change in their normal toilet habits, such as wetting themselves or wetting the bed
pain in their tummy (abdomen), side or lower back
unpleasant-smelling urine
blood in their urine
cloudy urine

Diagnosing UTIs in children

In most cases, your Doctor can diagnose a UTI by asking about your child's symptoms, examining them, and arranging for a sample of their pee to be tested. Treatment usually begins soon after a urine sample has been taken, and your child won't need any further tests. In a few circumstances, further tests may be needed in hospital to check for abnormalities. Your Doctor may refer you straight to hospital if your child is very young.

Causes of UTIs in children

Most UTIs in children are caused by bacteria from the digestive system entering the urethra. There are many ways this can happen, including:

when a child wipes their bottom and soiled toilet paper comes into contact with their genitals – this is more of a problem for girls than boys because girls' bottoms are much nearer the urethra
babies getting small particles of poo in their urethra when they soil their nappies – particularly if they squirm a lot when being changed

There's often no obvious reason why some children develop UTIs and others don't. However, some children may be more vulnerable to UTIs because of a problem with emptying their bladder, such as:

constipation – this can sometimes cause part of the large intestine to swell, which can put pressure on the bladder and prevent it emptying normally
dysfunctional elimination syndrome – a relatively common childhood condition where a child "holds on" to their pee, even though they have the urge to pee
vesicoureteral reflux – an uncommon condition where urine leaks back up from the bladder into the ureters and kidneys; this occurs as a result of a problem with the valves in the ureters where they enter the bladder

Treating UTIs in children

Most childhood UTIs clear up within 24 to 48 hours of treatment with antibiotics and won't cause any long-term problems. In many cases, treatment involves your child taking a course of antibiotic at home. As a precaution, babies under three months old and children with more severe symptoms are usually admitted to hospital for a few days to receive antibiotics directly into a vein (intravenous antibiotics).

Preventing UTIs in children

It isn't possible to prevent all childhood UTIs, but there are some things you can do to reduce the risk of your child getting one. The following advice may help:

if possible, exclusively breastfeed your baby for the first six months after they're born – this can help improve your baby's immune system and reduce their risk of constipation
encourage girls to wipe their bottom from front to back – this helps to minimise the chances of bacteria entering the urethra
make sure your child is well hydrated and goes to the toilet regularly – not urinating regularly and "holding in" urine can make it easier for bacteria to infect the urinary tract
avoid nylon and other types of synthetic underwear – these can help promote the growth of bacteria; loose-fitting cotton underwear should be worn instead
avoid using scented soaps or bubble baths – these can increase your child's risk of developing a UTI
take steps to reduce your child's risk of constipation – make sure they drink enough to keep their urine pale and clear during the day, and speak to your Doctor about medications that can help if constipation is a persistent problem

Recurrent UTIs in children

A small number of children have recurring UTIs. If your child's had a UTI before, it's important that both of you watch for the return of any associated symptoms. Tell your Doctor about any symptoms as soon as possible so a diagnosis can be confirmed and treatment can begin. If your child has a problem that increases their risk of UTIs, such as faulty valves that allow urine to flow the wrong way, they may be prescribed low-dose antibiotics as a long-term measure to prevent further infections.

Diagnosis

Urinary tract infections (UTIs) in children can usually be diagnosed by your Doctor. They'll carry out a physical examination, ask about your child's symptoms, and request a urine sample. You may be asked to collect the urine sample yourself. These tests help your Doctor identify what's causing the infection and determine whether it's in the lower or upper part of the urinary tract. If your child is less than three months old, your GP may refer you straight to hospital to see a specialist in caring for children (paediatrician) without asking for a urine sample.

Collecting a urine sample

Collecting a urine sample from a child can sometimes be difficult, especially in babies and young children. If you're not sure what to do or need some help collecting the urine sample, ask a doctor or nurse for advice. In young children who are toilet trained, you'll usually be asked to collect a urine sample using a sterile bottle provided by laboratory. Collect a sample by holding the bottle in the stream of urine while your child is urinating. Make sure nothing touches the open rim of the bottle, as this could affect the result. Do not take the whole urine in the bottle, avoid initial urine and last few drops of urine.

Further tests

In most cases, treatment begins soon after a urine sample has been taken and your child won't need any further tests. However, there are some circumstances where further tests may be carried out, including if:

your child is less than six months old
there's no improvement in your child's symptoms within 24 to 48 hours of treatment
your child has any unusual symptoms, such as reduced urine flow, high blood pressure (hypertension), or a noticeable lump or mass in your child's tummy (abdomen) or bladder
your child has repeated UTIs

In these cases, doctors may recommend carrying out some scans to look for any abnormalities.

Scans

There are many different scans that may be carried out to check for problems in your child's urinary tract, including:

an ultrasound scan – where sound waves emitted by a special probe move over your child's skin and are used to build up a picture of the inside of your child's body
a micturating cystourethrogram (MCUG) – where a catheter is used to pass a special type of liquid (contrast agent) that shows up clearly on X-rays into your child's bladder while a series of X-rays are taken; the contrast agent will pass harmlessly out of your child's body in their urine
a dimercaptosuccinic acid (DMSA) scan – where your child is injected with a slightly radioactive substance called DMSA that shows up on a special device called a gamma camera, which takes pictures of your child's kidneys; after the scan, the DMSA will pass harmlessly out of your child's body in their urine

The type of scans used and when they're carried out depends on your child's specific circumstances. In some cases, these scans may be carried out a few weeks or months after your child originally developed the infection.

Treatment

Most urinary tract infections (UTIs) in children can be effectively treated with antibiotic medication. This medication can often be given at home, although there are some situations where it may be necessary for your child to stay in hospital for a few days.

Treatment at home

If your child is over three months old and not thought to be at risk of serious illness, they can usually be treated at home with antibiotics. The recommended length of treatment depends on whether your child has:

a lower UTI – usually a 3-day course
an upper UTI – usually a 7- to 10-day course

Your child may experience some side effects while taking antibiotics, but these are usually mild and should pass once they stop taking the medication. Your child's condition will usually improve within 24 to 48 hours of treatment. However, it's very important they finish the whole prescribed course of antibiotics to prevent the infection recurring.

Treatment in hospital

If your child is less than three months old or it's thought their condition could get worse, they'll be referred to hospital for treatment. Doctors may feel your child is at risk of becoming more seriously ill without hospital treatment if:

they appear to be very unwell, or they are dehydrated or unable to keep down oral medication because they keep vomiting
they display unusual symptoms, such as reduced urine flow, high blood pressure (hypertension), or a noticeable lump or mass in your child's tummy (abdomen) or bladder
they were previously diagnosed with a condition that affects their urinary system

In these cases, your child usually needs to stay in hospital for a few days to receive antibiotics directly into a vein (intravenous antibiotics). As with cases treated at home, your child should improve within 24 to 48 hours.

Follow-up

Most UTIs in children clear up within a day or two and won't cause any long-term problems. Go back to your Doctor if your child isn't showing any signs of improvement by this point. In many cases, your child won't need to be seen again once they've recovered. However, doctors may recommend carrying out some scans to check for any problems in your child's urinary tract that could have contributed to the infection. Situations where further tests may be recommended include when:

your child is less than six months old
there's no improvement in your child's symptoms within 24 to 48 hours of treatment
your child has any unusual symptoms, such as reduced urine flow, high blood pressure, or a noticeable lump or mass in your child's abdomen or bladder
your child has repeated UTIs

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Urinary Tract Infections in Children