Urinary Tract Infections in Children
A urinary tract infection (UTI) is a bacterial infection in the urinary tract. UTIs are more common in girls, because girls have a shorter urethra. Uncircumcised boys are more likely to develop a UTI than circumcised boys. Children with a complete or partial blockage in the urinary tract are more likely to develop a UTI.
Children who frequently delay a trip to the bathroom are more likely to develop UTI.
Normal urine contains no bacteria (germs). An infection occurs when bacteria, usually from the digestive tract, cling to the opening of the urethra, the hollow tube that carries urine from the bladder to the outside of the body, and travel back into the bladder where they begin to multiply.
When this happens, the bacteria can infect and inflame the bladder. Regular urination helps keep the urinary tract sterile by flushing away bacteria.
Most common Types of Urinary Tract Infections
- Urethritis — an infection of the urethra
- Cystitis — a bacterial infection in the bladder that often has moved up from the urethra
- Pyelonephritis — a urinary infection of the kidneys that is usually a result of an infection that has spread up the urinary tract to the kidney.
Symptoms and Signs
What are the symptoms of a UTI?
Each child is different. Some symptoms include:
- Abdominal fullness
- Abdominal pain
- Foul-smelling urine
- Poor feeding
- Poor growth
- Weight loss or failure to gain weight
- Blood in the urine
- Discomfort above the pubic bone
- Foul-smelling urine
- Frequent urination
- Incontinence during day and/or night
- Nausea and/or vomiting
- Pain in the back or side below the ribs
- Painful or difficult urination
- Small amount of pee while urinating despite feeling of urgency
- Urgency to urinate
Diagnosing a Urinary Tract Infection
Your child's physician may diagnose a urinary tract infection based on a description of symptoms and a physical examination.
Lab studies used to diagnose a UTI include a urinalysis (a laboratory examination of urine for various cells and chemicals, such as red blood cells, white blood cells, infection or excessive protein) and a culture that can detect the presence of bacteria.
When to See a Pediatric Urologist
When a child has had one or more documented urinary tract infections, referral to a pediatric urologist or nurse practitioner specializing in pediatric urology may be recommended.
Testing and Treatment
Urine specimen collection
- A mid-stream, clean catch specimen may be obtained from a child with urinary control (pee into a cup).
- Bagged urine specimen- In a diapered child, we may place a small adhesive urine collection bag over the genital area to collect some urine
- Urethral catheterization may be used in the infant or child unable to void on request
For this test, we will request that your child drinks plenty of liquids before the appointment and arrives in clinic with a full bladder.
In a private bathroom, your child urinates into a special toilet that records information about the urine stream, amount of urine and rate of urine flow. After this test, a quick in-clinic bladder ultrasound may be done to determine if all of the urine drained from the bladder. Gel is used on the abdomen over the bladder area when this test is performed.
Children with a confirmed urinary tract infection may require a renal and bladder ultrasound. This is a diagnostic imaging technique that uses sound waves and a computer to image the urinary tract.
If your child has a history of having a fever with the urinary tract infection, a VCUG may be needed to evaluate your child’s bladder and urethra as well as to detect possible vesicoureteral reflux, in which urine backs up to the kidneys. A VCUG is a specific X-ray that examines the urinary tract. The images will show if there is any reverse flow of urine into the ureters and kidneys and how well the bladder empties. It is also used to determine if there is obstruction in the urethra. This test may require sedation depending on the child’s age.