Urinary tract infections (UTIs) are common in children, affecting around eight percent of girls and one to two percent of boys by age five
Show me a squirming toddler with fever and no other symptoms and I’m likely to send you to the restroom with a urine sample cup. Urinary tract infections (UTIs) are common in children, affecting around eight percent of girls and one to two percent of boys by age five. UTIs can range from mild bladder infections (cystitis) to more severe kidney infections (pyelonephritis). Unlike viral infections that resolve without antibiotics, timely UTI diagnosis and treatment with antibiotics is necessary to avoid bladder and kidney scarring.
UTIs are more prevalent in girls. Common risk factors are constipation, long baths (especially with bubbles), remaining in wet clothes or bathing suits, inadequate fluid intake, and holding in of urine. Less common causes are anatomic abnormalities like vesicoureteral reflux (VUR) — backflow of urine from the bladder to the kidneys — and urinary tract abnormalities like obstructions or neurogenic bladder. These are often diagnosed after a child experiences recurrent UTIs.
Symptoms can be nonspecific, especially in younger children. Fever, irritability, vomiting, poor feeding, and abdominal pain may be the only signs. Older children may report urinary frequency, urgency, or burning with urination. Any unexplained fever in an infant warrants evaluation for a UTI.
Diagnosis requires symptoms as well as a positive urine culture from a properly collected sample. I commonly see “contaminated” urine samples, which means bacteria is growing that is most likely a result of a poorly obtained sample. A “midstream catch” is the best way to get a sample from an older child. Babies and toddlers who are in diapers should ideally have a catheterized sample. However, that is not always practical or available.
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