Topic Overview
Is this topic for you?
This topic is about urinary
tract infections in children. For information about these infections in teens
and adults, see the topic
Urinary Tract Infections in Teens and Adults.
What are urinary tract infections?
The
urinary tract is the part of the body that makes urine
and carries it out of the body. It includes the
bladder and kidneys and the tubes that connect them. When germs (called
bacteria) get into the urinary tract, they can cause an infection.
How serious are the infections in children?
Urinary infections in children usually go away quickly if they get medical care
right away. But if your child keeps getting infections, your doctor may suggest tests to rule out more serious problems.
Urinary infections can lead to a serious
infection throughout the body called
sepsis. Problems from a urinary infection are more
likely to happen in babies born too soon, in newborns, and in infants who have
something blocking the flow of urine.
What causes the infections in children?
Germs
that live in the
large intestine and are in stool can get in the
urethra. This is the tube that carries urine from the
bladder to the outside of the body. Then germs can get
into the bladder and
kidneys.
What are the symptoms?
Babies and young children
may not have the most common symptoms, such as pain or burning when they
urinate. Also, they can't tell you what they feel. In a baby or a young child,
look for:
- A fever not caused by the flu or another
known illness.
- Urine that has a strange smell.
- Vomiting.
- The
child not being hungry.
- The child acting
fussy.
Older children are more likely to have common symptoms,
such as:
- Pain or burning when they
urinate.
- Needing to urinate often.
- Loss of bladder
control.
- Red, pink, cloudy, or foul-smelling urine.
- Pain in the flank, which is felt just below the rib cage and above the waist on one or both sides of the back.
- Lower belly pain.
How are the infections diagnosed?
The doctor will
give your child a physical exam and ask about his or her symptoms. Your child
also will have lab tests, such as a
urinalysis and a urine
culture, to check for germs in the urine. It takes 1 to 2 days to get the results of a
urine culture, so many doctors will prescribe medicine to fight the infection
without waiting for the results. This is because a child's symptoms and the
urinalysis may be enough to show an infection.
After your child
gets better, the doctor may have him or her tested to find out if there is a
problem with the urinary tract. For example, urine might flow backward from the
bladder into the kidneys. Problems like this can make a child more likely to
get an infection in the bladder or kidneys.
How are they treated?
Your child will take
antibiotics for a urinary tract infection. Give this
medicine to your child as your doctor says. Do not stop it just because your
child feels better. He or she needs to take all the medicine to get better. The
number of days a child will need to take the medicine depends on the illness,
the child's age, and the type of antibiotic.
Have your child drink extra fluids to flush out the
germs. Remind your older child to go to the bathroom often and to empty the
bladder each time.
Call the doctor if your child isn't feeling
better within 2 days after starting the medicine. Your doctor may give your
child a different medicine. It is important to treat urinary infections quickly
in children to prevent other serious health problems. Sometimes a baby younger
than 3 months may need to get medicine through a vein (IV) and stay in
the hospital for a while. A child who is too sick to take medicine by mouth or
has trouble fighting infections also may need to stay in the hospital.
Frequently Asked Questions
Learning about urinary tract infections: | |
Being diagnosed: | |
Getting treatment: | |
Cause
Most
urinary tract infections (UTIs) in children are caused
by bacteria that enter the
urethra and travel up the
urinary tract. Bacteria that normally live in the
large intestine and are present in stool (feces) are
the most common cause of infection. Sometimes bacteria traveling through the
blood or
lymph system to the
urinary tract are the cause of kidney or bladder
infections.
The ways that bacteria buildup can occur
include:
- Not properly wiping the bottom after a bowel movement. Bacteria may get into the urethra and cause
a UTI.
- Constipation.
- Not completely emptying the
bladder. This can cause bacteria to build up in urine.
Problems with the structure or function of the urinary
tract commonly contribute to UTIs in infants and young children. Problems that
limit the body's ability to eliminate urine completely include:
Symptoms
Urinary tract infections (UTIs) in
children may not cause obvious urinary symptoms. Symptoms of a UTI in an infant
or young child may include:
- Fever. This may be the only symptom in
infants.
- Irritability.
- Lack of
appetite.
- Failure to gain weight or develop
normally.
- Foul-smelling urine.
- Crying during
urination.
- Vomiting or diarrhea.
In an older child with a UTI, symptoms are usually easier
to recognize and may include:
- Pain or burning when
urinating.
- Urge to urinate frequently but usually passing only
small amounts of urine.
- Loss of bladder control, new
bed-wetting, or other changes in urination
habits.
- Pain in the lower abdomen.
- Reddish, pinkish, or
cloudy urine.
- Foul-smelling urine.
- Pain in the flank, which is felt just below the rib cage and above the waist on one or both sides of the back.
A doctor's evaluation can determine whether a UTI or
another condition is causing your child's symptoms.
What Happens
In a
urinary tract infection (UTI), bacteria usually enter
the urinary tract through the
urethra. They may then travel up the urinary tract and
infect the bladder (cystitis) and the kidneys (pyelonephritis). Most UTIs in children clear up
quickly with proper
antibiotic treatment.
The biggest concern
over UTIs in children is that they can cause permanent kidney damage and
scarring. Repeated scarring can lead to
high blood pressure and reduced kidney function,
including
kidney failure. Infants and young children seem to be
at higher risk for this complication.
The risk of irreversible
kidney damage makes early medical evaluation and treatment of UTIs in infants
and young children very important. Unfortunately, detecting UTIs in infants and
young children can be difficult. Unlike symptoms in older children and adults,
symptoms in the very young can be vague and inconsistent.
Serious
short-term complications of UTIs are unusual but do occur. They include an
abscess in the urinary tract, acute kidney injury,
and widespread infection (sepsis), which can be life-threatening.
These complications are more likely in
premature infants and newborns and in infants with
urinary tract obstructions.
Recurrent UTIs
Infants and young children often
get another UTI during the months after their first UTI. If an infection
comes back (recurs), it usually happens within the same year as the first UTI.
Recurrent UTIs in a child can mean that there is a problem with
the structure or function of the urinary tract. Because repeated infections
increase the risk of permanent kidney damage, your child's doctor will evaluate
and monitor any structural or functional problems. In some cases, your child
may need surgery.
What Increases Your Risk
Risk factors (things that increase a
child's risk) of
urinary tract infection (UTI) include:
- Abnormalities of the urinary tract, including
kidney stones and other
urinary obstructions. Structural or functional
problems that limit the kidneys' or the bladder's ability to eliminate urine
properly can increase the risk of UTIs. These problems may be present at birth
or may develop soon after.
- Infrequent urination, incomplete
emptying of the bladder, or constipation. These patterns are common during
toilet training and make it easier for bacteria to
build up in the urine.
- An uncircumcised penis. The foreskin can
trap bacteria, which can then enter the
urinary tract and cause infection.
- Catheterization, which is used
in a hospital when a child is unable to urinate on his or her own. Bacteria can
enter the
catheter and start an infection.
- Previous
UTIs. The risk for future infections increases with each additional
infection.
- History of UTI or the backward flow of urine from the
bladder into the kidneys (vesicoureteral reflux) in a parent or
sibling.
Infants and young children who have UTIs often have
vesicoureteral reflux (VUR).
When To Call a Doctor
Urinary tract infections (UTI) in infants and young children need early evaluation and
treatment. Call your doctor to make an appointment within 24 hours if your child has:
- Unexplained fever.
- Vomiting.
- Urine that looks pink, red, brown, or cloudy or is
foul-smelling.
- Burning pain with urination.
- Frequent
need to urinate without being able to pass much urine.
- Pain in the flank, which is felt just below the rib cage and above the waist on one or both sides of the back.
- Vaginal discharge with urinary
symptoms.
- Symptoms similar to those of a previous UTI.
Call the doctor if your child isn't feeling better within
48 hours after starting an
antibiotic.
Watchful waiting
Watchful waiting is not
appropriate if you suspect your child has a urinary tract infection. Untreated
UTIs in children can lead to permanent kidney damage,
high blood pressure, and other serious
complications.
Who to see
The following health
professionals can treat UTIs in children:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Initial tests
If your child has symptoms of a
urinary tract infection (UTI), the doctor's first
evaluation will probably include:
- A
medical history and physical exam.
- Urinalysis, which measures different parts of urine to
help detect a UTI.
- Urine culture, which identifies the
bacteria that are causing a UTI.
If the doctor suspects that your child has a UTI, a
urinalysis will help point to a diagnosis. A urine culture can confirm the
diagnosis and identify what is causing the infection. But the results usually
are not available for a couple of days. Rather than delay treatment to wait
for the results of the urine culture, the doctor probably will start your child
on
antibiotics if your child's symptoms, history, and
urinalysis show that a UTI is likely.
A urine sample will be collected.
- Older children may urinate into a container.
- In
babies and young children, the doctor may:
- Insert a
catheter through the
urethra and into the bladder to collect
urine.
- Collect urine by attaching a bag around the child's genitals
until the child urinates. The risk of having other substances get into
(contaminate) the urine sample is extremely high with this
method.
- Insert a needle through the abdomen directly into the
bladder (suprapubic aspiration) to get the sample.
If your child is younger than 2 years, has a UTI, and has a fever, your doctor may order a kidney and bladder ultrasound test.
The doctor may do other tests if your child has a UTI
and:
- Does not improve after 4 days of medicine.
- Has a known abnormality of the urinary tract or a
history of certain kidney or bladder problems that could make the infection
harder to treat.
- May be infected with unusual bacteria that won't
respond to the usual treatment.
- Shows signs of
kidney injury.
Other tests
Other common tests
include:
- Kidney (renal) ultrasound. The doctor may
order a renal ultrasound or may review a
fetal ultrasound that was done during the mother's
third trimester of pregnancy, if available.
- Cystourethrogram, also called a voiding cystourethrogram (VCUG). This is an X-ray test that takes pictures of your child's bladder and urethra
during urination.
If an ultrasound shows problems, then a VCUG may be done. VCUG
can identify vesicoureteral reflux, abnormalities of the
urinary tract, and other conditions that may make your
child more prone to kidney infections. If the test finds any of these
conditions, the doctor can watch and give preventive treatment, if needed, to
your child.
The doctor may do a
kidney scan (renal scintigram) to evaluate persistent
kidney infection or to evaluate kidney scarring or damage caused by previous
infection.
Treatment Overview
Antibiotic medicine and home care
are effective in treating most
urinary tract infections (UTIs) in infants and
children. The main goal of treatment is to prevent kidney damage and its short-term
and long-term complications by eliminating the infection quickly and
completely. Early evaluation and treatment are very important. Do not delay
calling a doctor if you think your baby or young child may have a UTI.
Initial treatment
Infants and young children with
urinary tract infections (UTIs) need early treatment to prevent kidney damage.
Your doctor is likely to base the first treatment decision on your child's
symptoms and
urinalysis results rather than waiting for the results
of a urine culture.
Treatment for most children with UTIs is oral
antibiotics and home care.
If your child is younger
than 3 months, is too nauseated or sick to take oral medicines, or has an
impaired immune system, the doctor may give your child a shot of antibiotics. Or your child may need a brief hospital stay and a
short course of
intravenous (IV) antibiotics. After your
child's fever and other symptoms improve and your child is feeling better, the
doctor may prescribe oral antibiotics.
The number of days a child will need to
take these medicines depends on the illness, the child's age, and the type of
antibiotic.
Treatment if the condition gets worse or recurs
If
your child's urinary tract infection (UTI) does not improve after treatment
with antibiotics, your child needs further evaluation and may need more
antibiotics. Your child may have a structural problem that is making
the infection hard to treat. Or the cause of the infection may be
different from the types of bacteria that usually cause UTIs.
If
the infection spreads and affects kidney function or causes widespread
infection (sepsis), your child may be hospitalized. These
complications are rare, but they can be very serious. Children with impaired
immune systems, untreated
urinary tract obstructions, and other conditions that
affect the kidneys or bladder are at higher risk for complications.
If tests show a structural problem in the urinary tract (such as vesicoureteral reflux) that increases your child's risk for recurrent UTIs, the doctor may consider preventive antibiotics.
Prevention
Urinary tract infections (UTIs) are hard to prevent in children who seem to get them
easily. The doctor may prescribe
antibiotics to prevent repeat infection while waiting
for test results after your child's first UTI. If test results show
abnormalities of the urinary tract that raise the risk for repeat infections,
the doctor may recommend long-term antibiotic treatment.
Some
evidence suggests that
breastfeeding may help prevent UTIs during the first
6 months of life.footnote 1, footnote 2
After learning to use the toilet, some children may not empty their
bladders often enough. Without regular bladder emptying, which flushes out the
germs in urine, children may be more likely to get a UTI. Encourage a schedule
of bladder emptying to help lower this risk.
Babies younger than 4 months get all the fluids they need from breast milk or formula. But for older children, extra fluids may help. Offer your child drinks (such as
water) throughout the day. Drinking enough fluids fills the bladder and can
help your child empty the bladder more often.
Constipation can
also put a child at risk of a UTI. Regular toileting habits and a
nonconstipating diet are the best ways to prevent constipation. For more
information, see the topics
Constipation, Age 11 and Younger and
Constipation, Age 12 and Older.
Early
diagnosis and early treatment are the most important steps in preventing
UTI-caused kidney damage.
Home Treatment
Home care isn't a substitute for medical care when it comes to treating a urinary tract infection (UTI). If you think your
child may have a UTI, a doctor should see him or her right away.
But along with seeing the doctor, there are things you can do at home that may help your child.
- Encourage-but do not force-your child to drink
extra fluids as soon as you notice the symptoms and for the next 24 hours.
This will help make the urine less concentrated and wash out the infection-causing bacteria. Do not give your child caffeinated or carbonated
beverages, which can irritate the bladder.
- Encourage your child to
urinate often and to empty his or her bladder each time.
Medications
Oral
antibiotic medicine usually is effective in treating
urinary tract infections (UTIs). In many cases, if the
symptoms and
urinalysis suggest a UTI, the doctor will start
medicine without waiting for the results of a
urine culture.
The doctor may give
intravenous (IV) antibiotics if your baby is:
- Younger than 3 months.
- Too ill or nauseated to take
oral medicine.
- Very sick with a severe kidney infection.
The doctor will stop the IV medicine and begin oral
medicine treatment after your child is stabilized and feeling better.
Preventive antibiotics
The doctor may consider preventive antibiotics if tests show a structural problem in the urinary tract, such as vesicoureteral reflux, that increases the child's risk for recurrent UTIs.
Preventive treatment may last 3 months or longer. Some doctors are more hesitant about prescribing antibiotics for
long-term use because of increasing concern about the growth of
antibiotic-resistant bacteria.
Medicine choices
Antibiotics are used to kill the bacteria that cause
UTIs.
What to think about
Give your child the antibiotics
as directed. Do not stop using them just because your child feels better. Your
child needs to take the full course of medicine. Your child may begin to feel
better soon after starting the medicine. But if you stop giving your child the
medicine too soon, the infection may return or get worse. Also, not taking the
full course of medicine encourages the development of bacteria that are
resistant to antibiotics. This makes antibiotics less effective and future
bacterial infections harder to treat.
Surgery
Surgery is not used to treat
urinary tract infections (UTIs) in children.
If there
is a problem with the structure of the urinary tract that is causing frequent,
severe infections and increasing the child's risk of long-term complications,
the doctor may consider surgery to correct the problem. For instance, children
with severe
vesicoureteral reflux may benefit from surgery. For
more information, see the topic
Vesicoureteral Reflux (VUR).
Other Treatment
There is no other treatment for
urinary tract infections (UTIs) in children at this
time.
Other Places To Get Help
Organizations
HealthyChildren.org (U.S.)
www.healthychildren.org
Urology Care Foundation (U.S.)
www.urologyhealth.org
References
Citations
- Shortliffe LMD (2012). Infection and inflammation of the pediatric genitourinary tract. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 4, pp. 3085-3122. Philadelphia: Saunders.
- Elder JS (2011). Urinary tract infections. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 1829-1834. Philadelphia: Saunders Elsevier.
Other Works Consulted
- Hannula A, et al. (2012). Long-term follow-up of patients after childhood urinary tract infection. Archives of Pediatric and Adolescent Medicine, 166(12): 1117-1122. Also available online: http://archpedi.jamanetwork.com/article.aspx?articleid=1378179.
- Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management (2011). Urinary tract infection: Clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics, 128(3): 595-610. DOI: 10.1542/peds.2011-1330. Accessed June 9, 2016.
Credits
ByHealthwise Staff
Primary Medical ReviewerJohn Pope, MD - Pediatrics
E. Gregory Thompson, MD - Internal Medicine
Adam Husney, MD - Family Medicine
Specialist Medical ReviewerSusan C. Kim, MD - Pediatrics