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Urinary Tract Infection (UTI) in Children

  • Condition in which there is an Infection along the urinary tract
  • Symptoms in children include crying while urinating, foul-smelling urine or diapers, and fever
  • Treatments include antibiotics
  • Involves Pediatric Urology
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Overview

Children can get urinary tract infections (UTIs), just like adults. This condition causes the urinary tract (bladder, urethra, ureters, and/or kidneys) to become irritated and inflamed. Like adults, a child may experience burning and stinging while urinating. The challenge is, however, that your child may only be able to vaguely describe his or her discomfort—or could be too young to tell you at all.  

With a UTI, it’s important to get treatment as soon as possible. About 8 in 100 girls and 2 in 100 boys will experience a UTI (usually affecting the bladder) before turning 5. Children with a UTI may cry when urinating or suddenly start needing to go often, but with little coming out. Their urine or diapers may have a bad odor, and they might have unexplained grumpiness or a fever.  

The urinary tract is the body’s plumbing system—it drains excess waste and water from the body in the form of urine. UTIs occur when a large population of bacteria concentrates in the urine and invades the tissues of the urinary tract. (A small percentage of people can have bacteria in their urine and not have an infection.) Almost all infections originate in the bladder and travel up through the urinary tract to the kidneys. 

Early treatment is important. “The longer the infection is in the bladder, the greater the likelihood that it can move up the ureters and affect the kidneys,” says Israel Franco, MD, a Yale Medicine pediatric urologist. “When the infection penetrates the kidney, inflammation can lead to high fevers and renal damage. Recurrent or untreated UTI’s could also lead to kidney damage. The younger the child, the more at risk they are for damage.” 

What is a UTI?

Any infection along the urinary tract is known as a UTI. It causes irritation in the linings of the bladder, kidneys, urethra (the tube that carries urine out of the body during urination), or ureter (a duct that carries urine from the kidney to the bladder). In children, these infections are likeliest to occur in the bladder. 

There are some specific medical names that identify which part of the urinary tract is affected (if it can be determined):

  • Cystitis. A bladder infection or inflammation
  • Urethritis. An infection or inflammation in the urethra 
  • Pyelonephritis. An infection of the kidney

If an actual infection exists and a high fever is present, the kidneys are likely involved, which means prompt treatment is vital. In children who are unable to drink due to vomiting or severe pain, hospitalization may be needed. (Clinical studies have shown that prompt treatment with oral antibiotics is just as effective as intravenous antibiotics in avoiding kidney damage, dispelling old beliefs that children needed to be hospitalized for all UTIs with high fever.)

What causes UTIs?

“There is new data using genomic analysis that shows that urine almost always has bacteria present in very small numbers,” says Dr. Franco; urinary stasis (incomplete emptying or holding urine for too long) is what leads to UTIs. “We protect ourselves from infections by urinating frequently and completely, thereby lowering the number of bacteria to as close to zero as possible,” says Dr. Franco. “When we do not do this, we put ourselves at risk for infection.” 

The most common organism that causes a UTI is Escherichia coli (E. coli), which exists in our gut and, therefore, in feces. Teaching children to wipe themselves from back to front when using the bathroom helps minimize risk of transmission. But, says Dr. Franco, “bacteria are incredibly adept at getting from the perineum into the urethra and bladder by using methods to propel themselves into the bladder. Some people are more at risk of infection than others because certain receptors in skin and bladder cells allow bacteria to hang on to the tissue better in some people than in others.” 

UTIs are more common in girls because they have shorter urethras than boys do. There is, however, a greater risk of UTI in uncircumcised boys under 1 year of age, but that risk goes down as the boys mature, regardless if they are circumcised or not.  

What are the symptoms of UTIs?

The symptoms of a urinary tract infection can be hard to recognize in children less than 6 months of age because they’re unable to tell you what they’re feeling, and because in these children, fever can be a late sign of infection. In children less than 2 months of age, parents should be on alert if they notice lethargy, poor feeding, or floppy limbs. These are signs that call for a pediatrician visit, where you can expect your child to have a urinalysis and urine culture. In children older than 6 months of age, a fever is a more reliable indication of infection. Still, parents should look for changes in their child’s feeding behavior, lethargy, and vomiting. In some cases, if your child pulls his legs up when he uses the bathroom, it can also be a sign of infection.   

if you notice your child has the following symptoms, talk to your pediatrician, who may refer your child to a pediatric urologist:

  • Crying when urinating
  • Foul-smelling urine or diapers
  • Frequent urge to urinate but with little output
  • New onset of bedwetting or daytime accidents in potty-trained children
  • Burning and stinging sensation during urination
  • Fever
  • Back pain with fever
  • Pain or discomfort over the bladder area, even when not urinating
  • Nausea or vomiting  
  • Chills
  • Cloudy urine
  • Blood in the urine

Can UTIs be avoided in children?

Urologists recommend some precautions that can help minimize the chances of getting a UTI (or a recurrent one):

  • Keep children well hydrated. 
  • Make sure children are not constipated and are having bowel movements at least three to four times per week.
  • Make sure that your child urinates between four and seven times per day; infrequent urination is a major cause of infection.
  • Do not allow children to get into a habit of postponing urination, especially when playing video games or other activities.  
  • If you notice your child sitting on their heels, they may be trying to avoid urination. 

How are UTIs diagnosed?

Your child’s pediatrician or urologist will request a urine sample. Once collected, the urine sample is analyzed in the laboratory (urinalysis) to look for white blood cells or bacteria, which can signal an infection. An additional test, a urine culture, may also be performed to identify exactly which bacteria are present in the urine, as well as to quantify the amount so that your doctor can more accurately treat the infection.    

An ultrasound of the bladder and kidneys is usually the first study performed when evaluating children with what’s called a febrile UTI (a severe UTI) or repeat infections. If there is an abnormality or if the doctor suspects the child will have vesicoureteral reflux (a condition in which the urine travels backwards from the bladder to ureters), he or she may perform a voiding cystourethrogram to look for abnormalities in the bladder. Rarely, a CT scan or MRI can be used to diagnose complex or difficult-to-treat UTIs. Sometimes doctors will perform a cystoscopy, which involves inserting a narrow tube into the urethra, to look at the bladder and kidneys for signs of inflammation and redness.  

How are UTIs treated in children?

Antibiotics are prescribed to treat UTIs, which should clear up in about a week. It’s important to give the full course as instructed by your doctor and pharmacist. If symptoms persist, contact your child’s doctor. Most children will have uncomplicated UTIs, because they most commonly are caused by abnormal urination patterns and infrequent urination. (Correction of these issues is essential to prevent recurrent infections.) A smaller percentage of children will have vesicoureteral reflux or some other anatomic abnormality that may require surgical intervention. 

What is unique about Yale Medicine Urology’s approach to treating UTIs and other urinary problems?

Yale Medicine's Pediatric Urology offers specialized care for children with urologic concerns, including UTIs. The Bladder and Continence program specializes in treating children with recurrent infections who do not have anatomic problems.  For children with anatomic problems that require surgery, “we have expertise in using the most advanced minimally invasive techniques available, including robotic and laparoscopic surgery," says Dr. Franco. "For children with recurrent infections and no anatomic problems, we employ state-of-the-art techniques such as electrical stimulation and biofeedback, expediting the correction of the voiding problem and reducing the need for children to stay on prophylactic antibiotics. It is our goal to improve your child’s urinary health—and life.”