UTI in Children: What Are the Symptoms and How Is It Treated?

What Are the Symptoms of UTI in Children?

Common UTI symptoms in older children include painful or burning urination, frequent need to urinate, abdominal pain, and sometimes low-grade fever. In infants and toddlers, symptoms may be less specific and include unexplained fever, irritability, and poor feeding.

Urinary tract infection symptoms can vary significantly depending on the child's age and whether the infection is in the lower urinary tract (bladder and urethra) or upper urinary tract (kidneys). Understanding these symptoms helps parents recognize when their child may need medical attention and enables faster treatment, which is important for preventing complications.

Lower Urinary Tract Infection (Cystitis)

When the infection affects the bladder and urethra, children typically experience one or more of the following symptoms:

• Painful or burning urination (dysuria) - Your child may cry or complain of pain when urinating, or may try to avoid going to the bathroom.
• Frequent urination - Needing to urinate much more often than usual, sometimes every few minutes.
• Urinary urgency - A sudden, intense need to urinate that is difficult to control.
• Urinary incontinence - Accidents in children who were previously toilet-trained, particularly during the day.
• Abdominal pain - Discomfort or pain in the lower abdomen, above the pubic bone.
• Foul-smelling urine - Urine may have an unusually strong or unpleasant odor.
• Cloudy or bloody urine - Visible changes in urine appearance; blood may cause pink, red, or brown discoloration.
• Low-grade fever - Temperature below 38.5C (101.3F) may occur but is not always present.

Upper Urinary Tract Infection (Pyelonephritis)

When bacteria spread to the kidneys, the infection is called pyelonephritis. This is more serious and typically causes more severe symptoms. Children with kidney infection often appear quite ill and may have:

• High fever - Temperature often above 38.5C (101.3F), sometimes reaching 40C (104F).
• Chills and shaking - Often accompanying the fever.
• Flank or back pain - Pain on one side of the back, below the ribs, where the kidney is located.
• Nausea and vomiting - Gastrointestinal symptoms are common with kidney infection.
• Severe fatigue and malaise - The child appears very tired, lethargic, or unwell.
• Decreased appetite - Little interest in eating or drinking.
• Irritability - The child may be unusually fussy or difficult to console.

Symptoms in Infants and Young Toddlers

Recognizing UTI in babies and young toddlers can be challenging because they cannot describe their symptoms. Infants under 2 years old may show only nonspecific signs of illness. Parents should watch for:

• Unexplained fever - Fever without other obvious source of infection is a common presentation of UTI in infants.
• Poor feeding or refusal to eat - The baby may not be interested in feeding or may eat much less than usual.
• Irritability and fussiness - Crying more than usual or being difficult to comfort.
• Excessive sleepiness - Sleeping more than normal or being harder to wake.
• Failure to thrive - Not gaining weight as expected.
• Jaundice - In newborns, UTI can sometimes cause yellowing of the skin.
• Strong-smelling urine - Diapers may smell unusually strong or unpleasant.

When Symptoms May Be Something Else

Sometimes symptoms that seem like UTI may have other causes. For example:

• Vulvovaginitis - Irritation of the external genitalia in girls can cause similar discomfort with urination.
• Bubble bath irritation - Soaps and bubble baths can irritate the urethra, causing burning without infection.
• Constipation - Can cause urinary symptoms including urgency and frequency.
• Colored urine from food - Beets, berries, and some medications can change urine color without indicating blood.

A urine test is the only way to confirm whether symptoms are caused by a bacterial infection requiring antibiotic treatment.

When Should You Seek Medical Care for Your Child?

Always seek medical care if you suspect your child has a UTI. Seek same-day or emergency care for children under 2 years, those with high fever, severe pain, vomiting, or signs of severe illness.

All suspected urinary tract infections in children should be evaluated by a healthcare provider because proper diagnosis requires a urine test, and treatment with the right antibiotic is necessary to clear the infection and prevent complications. However, the urgency of seeking care depends on your child's age and symptoms.

Seek Emergency or Same-Day Care If:

• Your child is under 2 years old and has symptoms of UTI, including unexplained fever
• Your child has high fever (above 38.5C/101.3F) regardless of age
• Your child has pain in the back or side
• Your child is vomiting and cannot keep fluids down
• Your child appears very ill, lethargic, or is difficult to arouse
• Your child shows signs of dehydration
• Your child is under 3 months old with any fever

Schedule a Prompt Appointment (Within 1-2 Days) If:

• Your child is 2 years or older with typical UTI symptoms (painful urination, frequency, urgency)
• Your child has low-grade fever with urinary symptoms
• Your toilet-trained child is having daytime accidents
• Your child's urine has an unusual odor or appearance

What to Expect at the Medical Visit

When you bring your child in for a suspected UTI, the healthcare provider will:

1. Ask about your child's symptoms, when they started, and how severe they are
2. Ask about your child's medical history and any previous UTIs
3. Perform a physical examination
4. Request a urine sample for testing
5. Possibly order additional tests if indicated

Being prepared with information about your child's symptoms and when they began will help the healthcare provider make an accurate diagnosis and choose the most appropriate treatment.

What Causes UTI in Children?

UTI is caused by bacteria, most commonly E. coli from the intestines, entering the urinary tract through the urethra. Girls are more susceptible because of their shorter urethra. Risk factors include holding urine, constipation, and incomplete bladder emptying.

Understanding what causes urinary tract infections helps parents take steps to reduce their child's risk and recognize when their child may be more vulnerable to infection. UTI occurs when bacteria enter the normally sterile urinary tract and multiply, triggering the body's immune response and causing the symptoms associated with infection.

How Bacteria Enter the Urinary Tract

The urinary tract includes the kidneys, ureters (tubes connecting kidneys to bladder), bladder, and urethra (tube from bladder to outside). Under normal circumstances, urine is sterile - free of bacteria. Infection occurs when bacteria from outside the body travel up through the urethra into the bladder.

The most common culprit is Escherichia coli (E. coli), a bacteria that normally lives harmlessly in the intestines. E. coli causes 80-90% of UTIs in children. The bacteria can spread from the anal area to the urethral opening, particularly when:

• Wiping from back to front after a bowel movement (in girls)
• Bacteria from stool contaminate the genital area
• The child sits in a wet or soiled diaper for extended periods

Other bacteria that can cause UTI include Klebsiella, Proteus, Enterococcus, and Staphylococcus species.

Why Girls Get UTIs More Often

After infancy, girls are significantly more likely to develop UTI than boys. This is primarily due to anatomical differences:

• Shorter urethra - Girls have a much shorter urethra (about 4 cm) compared to boys (about 8-10 cm in older children), giving bacteria a shorter distance to travel to reach the bladder.
• Proximity of urethra to anus - In girls, the urethral opening is close to the anal area, making it easier for bacteria to spread from the intestines to the urinary tract.

However, in infants under 6 months, UTI is actually more common in boys, particularly those who are uncircumcised.

Risk Factors for UTI in Children

Incomplete Bladder Emptying

When children don't empty their bladder completely, residual urine provides an environment where bacteria can multiply. Children who rush through urination or don't relax their pelvic muscles may not fully empty their bladder.

Holding Urine Too Long

Children who delay going to the bathroom - whether because they're busy playing, don't want to use unfamiliar toilets, or for other reasons - are at higher risk. Regular urination helps flush bacteria from the urinary tract before they can cause infection.

Constipation

Chronic constipation is an important and often overlooked risk factor for UTI. A full rectum can press against the bladder, preventing complete emptying and making it harder for the child to sense when they need to urinate. Constipated children also tend to hold their urine longer.

Vesicoureteral Reflux (VUR)

Some children are born with a condition where urine flows backward from the bladder toward the kidneys. This makes it easier for bacteria to reach the kidneys and can lead to recurrent UTIs. VUR is found in about 30-40% of children being evaluated for their first UTI with fever.

Structural Abnormalities

Rarely, anatomical problems with the urinary tract can increase UTI risk. These may include blockages, duplicated ureters, or other developmental variations.

Recent Antibiotic Use

Antibiotics can disrupt the normal bacterial balance in the body, including protective bacteria around the genital area. This can make it easier for UTI-causing bacteria to colonize and cause infection.

How Is UTI Diagnosed in Children?

UTI is diagnosed through urine testing. A urinalysis looks for signs of infection, while a urine culture identifies the specific bacteria and determines which antibiotics will be effective. Proper urine collection is important for accurate results.

An accurate diagnosis of urinary tract infection requires laboratory testing of your child's urine. While symptoms may strongly suggest UTI, only urine tests can confirm the diagnosis and guide appropriate treatment.

Urine Collection Methods

How urine is collected depends on your child's age and toilet-training status:

For Toilet-Trained Children: Midstream Clean-Catch

This is the preferred method for children who can urinate on command:

1. The child's genital area is cleaned with soap and water or provided wipes
2. For girls: wipe from front to back
3. For boys: clean the tip of the penis (retract foreskin if uncircumcised)
4. The child starts urinating into the toilet
5. After a few seconds, a sterile container is placed in the stream to collect the middle portion of urine
6. The container is removed before urination ends

For Infants and Non-Toilet-Trained Children

Several methods may be used:

• Catheterization - A small, soft tube is briefly inserted through the urethra to collect urine directly from the bladder. This is the most accurate method for young children.
• Suprapubic aspiration - A needle is inserted through the skin above the pubic bone to collect urine directly from the bladder. Though it sounds uncomfortable, it's quick and very accurate.
• Urine collection bag - A sticky bag is placed over the genital area to collect urine. This method has higher contamination rates and may need to be repeated if results are unclear.

Types of Urine Tests

Urinalysis (Dipstick Test)

This rapid test uses a chemically treated strip dipped in urine to detect:

• Leukocyte esterase - Indicates white blood cells in urine, suggesting infection
• Nitrites - Produced by many bacteria that cause UTI; a positive result strongly suggests infection
• Blood - May be present with infection
• Protein - Can indicate kidney involvement

Results are available within minutes and can guide initial treatment decisions.

Microscopic Examination

Urine is examined under a microscope to look for:

• White blood cells (pyuria)
• Red blood cells
• Bacteria
• Other cellular elements

Urine Culture

This definitive test identifies the specific bacteria causing the infection and determines which antibiotics will be effective (antibiotic sensitivity). A sample of urine is placed in conditions that allow bacteria to grow. Results typically take 24-48 hours.

Additional Testing

Some children may need additional tests, particularly those with:

• Kidney infection (pyelonephritis)
• Recurrent UTIs
• Unusual bacteria or treatment failure
• Suspected structural abnormalities

Renal and Bladder Ultrasound

This painless imaging test uses sound waves to visualize the kidneys and bladder. It can detect structural abnormalities, kidney swelling, or other problems. Guidelines vary, but ultrasound is often recommended for:

• All children under 2 years with first febrile UTI
• Children of any age with recurrent UTI
• Children who don't respond to treatment as expected

Voiding Cystourethrogram (VCUG)

This X-ray test checks for vesicoureteral reflux (urine flowing backward toward kidneys). It involves placing a catheter and filling the bladder with contrast dye while taking X-ray images during urination. It's not routinely performed after first UTI but may be recommended for certain children.

DMSA Renal Scan

This nuclear medicine test can show kidney scarring or acute kidney infection. It may be used to assess for kidney damage in children with recurrent infections.

How Is UTI in Children Treated?

UTI is treated with antibiotics, typically for 7-14 days depending on the type and severity. Most children feel better within 1-2 days of starting treatment. It's essential to complete the full antibiotic course even when symptoms improve.

Prompt treatment of urinary tract infection is important to relieve your child's symptoms and prevent the infection from spreading to the kidneys. Antibiotics are the cornerstone of treatment, and the specific choice depends on the likely bacteria, local resistance patterns, and whether the infection involves the kidneys.

Antibiotic Treatment

For Lower UTI (Cystitis)

Children with bladder infections typically receive oral antibiotics for 7-10 days. Common choices include:

• Trimethoprim-sulfamethoxazole (Bactrim, Septra)
• Amoxicillin-clavulanate (Augmentin)
• Cephalexin (Keflex)
• Nitrofurantoin (Macrobid)

The specific antibiotic chosen depends on local bacteria resistance patterns and your child's medical history and allergies.

For Upper UTI (Pyelonephritis)

Kidney infections require more aggressive treatment, typically for 10-14 days. Treatment approach depends on the child's age and how ill they appear:

• Oral antibiotics at home - For children who are not severely ill, can take medications by mouth, and can be monitored closely
• Intravenous antibiotics in hospital - Required for very ill children, those who cannot keep oral medications down, infants under 2-3 months, or when oral treatment isn't working

What to Expect During Treatment

• Days 1-2: Most children start feeling better. Fever typically resolves within 24-48 hours.
• Days 2-3: Painful urination and urgency usually improve significantly.
• Full course (7-14 days): Continue all medications even if symptoms are gone.

When to Return to the Doctor

Contact your healthcare provider if:

• Fever persists after 48 hours of antibiotic treatment
• Symptoms don't improve after 2 days of treatment
• Symptoms worsen at any time during treatment
• Your child cannot take the medication (due to vomiting or refusal)
• New symptoms develop

Supportive Care at Home

In addition to antibiotics, these measures can help your child feel more comfortable:

• Encourage fluids - Drinking plenty of water helps flush bacteria from the urinary tract
• Pain relief - Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can help with pain and fever; follow age-appropriate dosing
• Regular bathroom breaks - Encourage frequent urination to help clear bacteria
• Warm compresses - A warm (not hot) compress on the lower abdomen may help relieve discomfort
• Rest - Let your child rest as needed, especially during the first few days

Hospital Treatment

Some children need to be treated in the hospital. This is more common for:

• Infants under 2-3 months old
• Children who are severely ill or dehydrated
• Children who cannot take oral medications
• Children whose infection doesn't respond to oral antibiotics

Hospital treatment typically involves intravenous antibiotics until the child improves enough to switch to oral medication at home. Parents can stay with their child during hospitalization.

Antibiotic Resistance Considerations

Sometimes the bacteria causing UTI may be resistant to the initial antibiotic prescribed. This is why urine culture is important - it shows which antibiotics will work against the specific bacteria. If your child isn't improving, the doctor may need to change the antibiotic based on culture results.

Preventive Antibiotic Therapy

For children with recurrent UTIs, doctors may recommend low-dose preventive antibiotics taken daily for several months to a year. This approach:

• Uses much lower doses than treatment doses
• Helps prevent bacteria from establishing infection
• May be particularly helpful for children with vesicoureteral reflux
• Is carefully balanced against risks of long-term antibiotic use

How Can You Prevent UTI in Children?

Prevention focuses on good hygiene practices, regular bathroom habits, adequate fluid intake, and treating constipation. Teaching proper wiping technique and encouraging regular, unhurried urination are key preventive measures.

While not all urinary tract infections can be prevented, many simple strategies can significantly reduce your child's risk. These habits are especially important for children who have had previous UTIs.

Proper Hygiene and Wiping Technique

Teach girls to always wipe from front to back after using the toilet. This prevents bacteria from the anal area from spreading toward the urethra. For younger children:

• Assist with wiping until they can do it correctly on their own
• Use the phrase "front to back" as a reminder
• Check occasionally to make sure they're doing it right

Encourage Regular Bathroom Breaks

Regular urination is one of the most effective ways to prevent UTI. Urine flow helps flush bacteria from the urinary tract before they can multiply and cause infection.

• Encourage your child to urinate every 2-3 hours during the day
• Don't let your child "hold it" for long periods
• Remind children to use the bathroom at natural transition times: before leaving home, after arriving at school, after meals, before bed
• Address any anxieties about using school or public bathrooms

Ensure Complete Bladder Emptying

Children sometimes rush through urination without fully emptying their bladder. Teach your child to:

• Sit comfortably and relaxed on the toilet (feet supported if needed)
• Take time to urinate completely rather than rushing
• Try the "double void" technique: urinate, wait a moment, then try again to get any remaining urine

Promote Adequate Fluid Intake

Drinking enough fluids increases urine production, which helps flush the urinary tract. Encourage your child to:

• Drink water throughout the day
• Carry a water bottle to school
• Have water available during activities

Water is the best choice. Limit sugary drinks and caffeine, which can irritate the bladder.

Prevent and Treat Constipation

Constipation is an often-overlooked contributor to recurrent UTIs. A full rectum can press on the bladder and prevent complete emptying. To prevent constipation:

• Include plenty of fiber in your child's diet (fruits, vegetables, whole grains)
• Ensure adequate fluid intake
• Encourage regular physical activity
• Establish a regular bathroom routine for bowel movements
• Consult your doctor if constipation is persistent - treatment may be needed

Clothing and Diaper Considerations

• Choose cotton underwear, which allows better air circulation
• Avoid tight-fitting pants or underwear
• Change wet or soiled diapers promptly
• Change out of wet swimsuits or sweaty clothes

Bathing Practices

• Avoid bubble baths and harsh soaps in the genital area, which can cause irritation
• Rinse well after bathing
• Don't let children sit in soapy bathwater for extended periods

What Complications Can UTI Cause in Children?

Most UTIs resolve completely with treatment and cause no lasting problems. However, untreated or recurrent kidney infections can potentially cause kidney scarring, which may increase the risk of high blood pressure later in life. Rarely, severe infection can spread to the bloodstream (sepsis).

With prompt and appropriate treatment, the vast majority of urinary tract infections in children heal completely without complications. Understanding potential risks helps emphasize the importance of seeking timely medical care and completing treatment.

Kidney Scarring

Repeated kidney infections or a severe first infection can sometimes cause scarring of kidney tissue, called renal scarring or nephropathy. Factors that increase this risk include:

• Delayed treatment of kidney infection
• Recurrent kidney infections
• Vesicoureteral reflux (VUR)
• Young age at first infection

Kidney scarring is usually detected through specialized imaging tests. Most children with minor scarring have no symptoms and normal kidney function. More extensive scarring, though rare, can potentially lead to:

• High blood pressure (hypertension) in childhood or adulthood
• Reduced kidney function (rare)
• Pregnancy complications in women (rare)

Sepsis

In severe cases, bacteria from a kidney infection can enter the bloodstream, causing sepsis - a serious, potentially life-threatening condition. Sepsis is more common in:

• Very young infants (especially under 3 months)
• Children with weakened immune systems
• Delayed or inadequate treatment

Signs that may indicate sepsis include:

• Very high or very low body temperature
• Rapid breathing and heart rate
• Confusion or altered mental state
• Extreme fatigue or difficulty arousing
• Reduced urination
• Mottled or pale skin

Sepsis is a medical emergency requiring immediate hospital treatment with intravenous antibiotics.

Recurrent Infections

Some children are prone to getting multiple UTIs. Recurrent infections are defined as:

• Two or more infections in 6 months, or
• Three or more infections in 12 months

Children with recurrent UTIs may need evaluation for underlying causes and may benefit from preventive measures or prophylactic antibiotics.

Why Early Treatment Matters

The best way to prevent complications is prompt treatment. When UTI is diagnosed and treated early:

• The infection is cleared before it can spread to the kidneys
• Risk of kidney damage is minimized
• Risk of bloodstream infection is reduced
• Your child feels better quickly