Pediatric Urinary Tract Infection

Basic Facts

  • A urinary tract infection (UTI) is a bacterial infection in any part of the urinary tract (urethra, bladder, ureters, kidneys).
  • The most common cause of UTIs is Escherichia coli, bacteria found naturally in the intestinal tract.
  • UTIs affect more boys than girls in the first year of life. As children age, the risk increases in girls and decreases in boys.

A urinary tract infection (UTI) is a common bacterial infection in any part of the child’s urinary tract.

Several bacteria can cause a urinary tract infection; however, the most common is Escherichia coli (E. coli), found in the intestinal tract.

A UTI that affects the lower urinary tract (urethra and bladder) can lead to an upper UTI. An upper UTI can scar the kidney.

Pediatric UTIs are categorized into the following four types:

  • First infection;
  • Unresolved infection;
  • Persistent infection; and
  • Reinfections.


Fever is often the first indication that something is wrong with the infant. Other symptoms in children under age 2 include:

  • Irritability;
  • Lack of appetite;
  • Vomiting;
  • Diarrhea;
  • Foul-smelling urine;
  • Abdominal swelling; or
  • Yellow skin, called jaundice.

In older, toilet-trained children, symptoms may include:

  • Fever;
  • Painful urination;
  • Cloudy urine;
  • Pain in pubic area;
  • Pain in lower back;
  • Problems urinating;
  • Incontinence; and
  • Nighttime bedwetting.


The most common cause of a UTI is bacteria, such as E. coli, that enter the urinary tract. Factors that increase an infant or child’s risk of developing a UTI include:

  • Family history;
  • Age (newborns have the highest rate);
  • Undeveloped natural immunity in newborns;
  • Gender (boys age 1 and younger are at higher risk than girls the same age. As children age, however, girls become more at risk);
  • Boys who are uncircumcised. However, the risk decreases after 6 months of age;
  • Periurethral colonization;
  • Abnormal fecal flora;
  • Constipation;
  • Vesicoureteral reflux;
  • Urinary obstruction;
  • Bladder instability;
  • Poor hygiene; and
  • Bubble baths.


Because of the potential damage to the kidneys, it is important that UTIs be diagnosed early. To diagnose UTI, the physician will begin with a physical examination and patient history. Other tests that the physician may recommend to help diagnose a UTI include:

  • Urine test; and
  • Urine culture.

If the physician suspects an abnormality in the urinary tract, he or she may recommend one of the following tests:

  • Voiding cystourethrography (VCUG);
  • Renal and bladder ultrasound; or
  • Kidney scan.


The physician may recommend hospitalizing an infant younger than 3 months. In the hospital, the physician may prescribe intravenous antibiotics if the infant is diagnosed with UTI and has fever, pain in his or her side and is unable to take liquids. The physician may prescribe one of the following antibiotics for intravenous treatment:

  • Aminoglycosides;
  • Penicillins; or
  • Cephalosporins.

In children younger than age 5 with no systemic symptoms, such as fever, nausea, or flank pain, and boys older than age 5 with no systemic symptoms, the physician may prescribe oral antibiotics for 10 to 14 days.

In girls older than age 5 with no systemic symptoms, the physician may prescribe oral antibiotics for 7 to 10 days.

Physician may prescribe one of the following oral medications:

  • Penicillins;
  • Cephalosporins; or
  • Sulfonamides.
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