Urinary tract infections (UTI) in children

A urinary tract infection (UTI) is an infection anywhere in the urinary tract. The urinary tract includes the kidneys, ureters, bladder and the urethra.

The urinary tract in a child. 

Causes

A UTI is usually caused by specific bacteria infecting the bladder or urethra. The most common cause of UTIs in children are Escherichia coli (E. coli) bacteria, which are normally present in poo (faeces). Other bacteria known to cause UTIs include Klebsiella, Proteus mirabilis, Pseudomonas, Streptococci, and Staphylococcus aureus.

Signs and symptoms

Younger children often have non-specific symptoms when they have a UTI. These symptoms include fever, vomiting, poor feeding and irritability.

In older children, symptoms may include:

• Frequent and urgent urination;
• Pain or a burning sensation while urinating;
• Abdominal or loin pain;
• Fatigue, and;
• Blood in the urine.

Infection may spread to the blood, causing the child to become very unwell. Symptoms of this include fever, extreme lethargy, pale skin and cold hands and feet.

Methods for diagnosis

Urine testing

Urine culture is the gold standard for diagnosing UTIs. A diagnosis is usually made on the basis of urine culture results and the presence of symptoms. Since this test can take a few days to produce results, your doctor may prescribe antibiotic treatment before the test results are in.

Your doctor may also perform a rapid test (known as a dipstick urine test) to check whether there are any features of a urinary tract infection. This test is often used only to support suspicion of a urinary tract infection, and it cannot be entirely relied upon for a diagnosis.

In infants and some young children, it can be difficult to obtain an uncontaminated specimen of urine. A clean bag may be attached over the genitals to help capture the urine. Or alternatively, your doctor may suggest inserting a small plastic tube called a catheter into the bladder, or a needle through the lower abdominal wall to draw urine directly from the bladder (suprapubic urine collection).

A urinary tract infection is typically diagnosed from a urine sample. 

Scans

The most common imaging method used in assessing a UTI is an ultrasound scan of the kidneys, ureters and bladder. It is performed to determine if the urinary system has formed normally. It is recommended for all children under six months of age and any child who has recurrent UTIs.

A test called a 'voiding cystourethrogram' is sometimes performed on children who have multiple UTIs. This is an X-ray that shows the outline of the bladder and urethra. If the X-ray is taken while the child is peeing, it can show if urine is travelling backwards from the bladder to the kidneys (a disorder known as vesicoureteral reflux).

Types of treatment

UTIs in children require prompt treatment with antibiotics to protect the kidneys from damage. It is important to also drink plenty of water during a urinary tract infection.

In some cases children will need to be hospitalised and given antibiotics and fluids intravenously. Children with repeat infections or vesicoureteral reflux may receive preventative antibiotic treatment.

Complications

UTI complications are rare if the infection is treated in time. However, if left untreated, UTIs can cause a serious kidney infection or sepsis. These complications are more likely in recurrent infections.

Prognosis

With treatment the UTI is cleared and, most of the time, repeat infections are prevented. Symptoms are usually gone 1-2 days after treatment starts, but the full course of antibiotics should be continued until finished, even after symptoms have disappeared.