When Your Child Has a Urinary Tract Infection (UTI)

What is the urinary tract?

These body parts make up the urinary tract:

• Kidneys. These 2 organs filter waste from the blood and make urine.

• Ureters. These 2 tubes carry urine from the kidneys to the bladder.

• Bladder. This is the pouch that stores urine.

• Urethra. This tube carries urine from the bladder to outside the body when you pee.

What causes a UTI?

Most UTIs are caused by bacteria. It gets into the urinary tract through the urethra. The urinary tracts of boys and girls are a bit different. The urethra is shorter in girls. This makes it easier for bacteria to enter. As a result, girls are more likely than boys to get UTIs. Other causes of UTI include:

• Not emptying the bladder fully.

• Not keeping the area clean.

• Trouble pooping enough (constipation).

• Tight foreskin on the penis.

• Urine that flows back up the ureters (vesicoureteral reflux).

• Birth defect of the urinary system.

• Having a bladder catheter for a long time.

Sometimes the cause of a UTI is unknown.

What are the symptoms of a UTI?

The symptoms of a UTI in the bladder (cystitis) include:

• Pain when peeing.

• Peeing often.

• Urgent need to pee.

• Foul-smelling or cloudy pee.

• Blood in the urine.

• New daytime wetting or nighttime bedwetting.

• Fever.

A UTI in the kidneys (pyelonephritis), has the same symptoms. But it can also include:

• Fever.

• Belly (abdominal) pain.

• Upset stomach (nausea) and vomiting.

• Cloudy urine.

• Strong-smelling urine.

How is a UTI diagnosed?

The health care provider will ask about your child’s symptoms and health history. They will give your child an exam.

You will need to help your child give a pee (urine) sample.

• Older children can pee into a sterile cup (clean catch).

• Younger children who aren't toilet trained can give a urine sample that is collected into a plastic bag placed over their genitals to collect the urine. This is not the best method because the sample may become contaminated.

• Children who wear diapers can have a thin sterile tube (catheter) inserted into their urethra and bladder to collect the sample.

• In infants, the provider can place a needle straight into the bladder through the stomach to get the sample.

The urine is checked for bacteria and other signs of infection. The urine is also sent for a culture. This is a test that shows what kind of bacteria is in the urine. It can take 1 to 3 days to get results back. If the provider thinks your child has a UTI, they will likely start treatment before the results of the culture come back.

If your child has severe symptoms, they may need other tests. You will be told more about this, if needed.

The following imaging studies may be done:

• Ultrasonography. This test can show if a child's urinary system did not form correctly before birth.

• Voiding cystourethrogram. This test can show if urine flows from the bladder backwards into the ureters or kidneys. Having vesicoureteral reflux increases a child's chance of having kidney infection.

• Radionuclide cystography. This is similar to voiding cystourethrography except that a radioactive agent is placed in the bladder and images are taken using a nuclear scanner.

How is a UTI treated?

The provider will prescribe antibiotic medicine for your child. Make sure your child takes all of the medicine. They need to take it even when they start feeling better. Symptoms of a UTI usually go away within 24 to 72 hours of starting treatment.

To help ease your child’s symptoms:

• Give your child over-the-counter medicines, such as ibuprofen or acetaminophen, to manage pain and fever. Don't give ibuprofen to a baby who is younger than 6 months old, or to a child who is dehydrated or constantly vomiting. Don't give aspirin to children or teens unless your child’s doctor says it is safe. Aspirin can put your child at risk for Reye syndrome, a rare but serious condition.

• Ask the provider about medicines that can ease pain when peeing.

• Give your child plenty of fluids to drink. Cranberry juice may help ease some pain.

For follow-up care:

• If a urine culture was done, call for the results from the provider.

• Make an appointment about 1 week after your child has finished the antibiotic medicine.

When to contact your child's doctor

Contact the provider if:

• Symptoms don't get better within  48 hours of starting treatment.

• Your child has a fever (see "Fever and children" below).

• Your child has a fever that goes away but returns after starting treatment.

• Your child has worse belly or back pain.

• Your child has signs of dehydration, such as very dark or little urine, a lot of thirst, dry mouth, or dizziness.

• Your child vomits.

• Your child has trouble taking the antibiotic medicine.

• Your child starts acting sicker.

How is a UTI prevented?

• Make sure your child drinks plenty of fluids.

• Tell your child to empty their bladder fully when peeing.

• Teach girls to wipe from front to back when using the bathroom. This reduces the chance of bacteria entering the urethral opening.

• Don't bathe them in bubble bath.

• Have your child wear loose-fitting underpants and clothing.

• Make sure your child does not get constipated. Talk with their provider for help if constipation is a problem.

In some cases, a child may need ultrasound of the kidneys and bladder. This is a painless test. It helps the provider look for anatomy problems that could cause a UTI. If problems are found, or if your child has repeated UTIs, more imaging tests may be needed.

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

• Rectal. For children younger than 3 months, a rectal temperature is the most accurate.

• Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.

• Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.

• Armpit (axillary). This is the least reliable. but it may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.

• Mouth (oral). Don’t use a thermometer in your child’s mouth until they are at least 4 years old.

Use a rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the provider what type to use instead. When you talk with any provider about your child’s fever, tell them which type you used.

Below is when to call the provider if your child has a fever. Your child’s health care provider may give you different numbers. Follow their instructions.

When to call a provider about your child’s fever

First, ask your child’s provider how you should take the temperature.

For a baby under 3 months old:

• Rectal or forehead: 100.4°F (38°C) or higher

• Armpit: 99°F (37.2°C) or higher

• A fever of ___________as advised by the provider

For a child age 3 months to 36 months (3 years):

• Rectal or forehead: 102°F (38.9°C) or higher

• Ear (only for use over age 6 months): 102°F (38.9°C) or higher

• A fever of ___________ as advised by the provider

In these cases:

• Armpit temperature of 103°F (39.4°C) or higher in a child of any age

• Temperature of 104°F (40°C) or higher in a child of any age

• A fever of ___________ as advised by the provider