Urinary Tract Infections (UTIs) in Children

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Medical Author:

John Mersch, MD, FAAP

John Mersch, MD, FAAP

Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

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Medical Editor:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Urinary tract infections are a fairly common problem in childhood and may have either a benign course responding to simple antibiotic therapy or be associated with significant disruption in either the anatomy or function of a child's urinary system. This article will focus on UTIs affecting children, with an emphasis on those less than 2 years of age. Because of their more unique and complicated nature, neonatal (less than 28 days of age) UTIs will not be addressed as a specific issue. The principles discussed below, however, are applicable to that age group.

The urinary tract is commonly divided into two areas. The upper urinary tract consists of the kidneys and the delicate tubular structure (ureter) that runs from the kidney to the bladder. The lower tract includes the bladder and the urethra (the tube from the bladder to the outside of the body).

A urinary tract infection is an infection of the bladder (cystitis) or kidney(s) (pyelonephritis). Cystitis is considerably more common than the more severe and more serious pyelonephritis.

Bacteria cause the large majority of urinary tract infections in children. Viral infection of the bladder is less common, while fungal infections of the urinary tract are rare and occur most commonly in immunocompromised individuals (for example, those with HIV/AIDS, chemotherapy recipients).

Characteristic symptoms of a urinary tract infection include pain with urination (dysuria), urinary frequency (needing to urinate frequently) and urgency (feeling a compelling urge to urinate) and loss of previously established urinary control (for example, bedwetting). Nonspecific but common symptoms include fever (especially >102.2 F or 39 C) and abdominal pain. For some children less than 2 years of age, these more subtle problems may be the only indicator of a UTI. Associated symptoms of concern include flank pain, fever, and vomiting. Obvious blood in the urine (gross hematuria) as well as a positive family history for childhood urinary tract infections (especially in siblings) are also red flags and should raise the level of concern. Interestingly, the odor and color (with the exception of obvious blood) of the urine are not predictors of a UTI.