Urinary tract infections in children and adolescents

Last updated: September 1, 2023

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Summarytoggle arrow icon

A urinary tract infection is an infection of the bladder, urethra, ureters, and/or kidneys and is a common infection in infancy and childhood. Risk factors include congenital anomalies of the kidneys and urinary tract (CAKUT), female sex, lack of circumcision in young boys, and bladder and bowel dysfunction. As in adults, the most common causative pathogen is Escherichia coli. Children and adolescents often present with classic symptoms of UTI (e.g., dysuria, urinary frequency). However, nonverbal and/or young children often have nonspecific symptoms, which may include fever, irritability, poor feeding, and new-onset urinary incontinence. Diagnosis is based on symptoms and urinalysis and urine culture results. Imaging is not required for diagnosis but is used to evaluate for suspected acute complications (e.g., renal abscess) and underlying structural anomalies (e.g., vesicoureteral reflux). The first-line imaging modality is renal and bladder ultrasound (RBUS); further imaging depends on the patient's history, ultrasound results, and/or specialist recommendations. Treatment of pediatric UTIs involves antibiotics (oral or IV) and management of any underlying causes. Recurrent UTIs are common in children, and patients and/or their caregivers should be educated on preventive measures. Complications of pediatric UTIs, especially if severe or recurrent, include sepsis, renal scarring, chronic kidney disease, and hypertension.

UTI in adults is discussed in a separate article; see “Urinary tract infections.”

Epidemiologytoggle arrow icon

  • UTIs are common in children: Up to 7% of girls and 2% of boys are diagnosed with a UTI by 6 years of age. [2]
  • < 12 months of age: > [3]
  • ≥ 12 months of age: >> [3]

Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon

Pathogens [3][4]

UTIs caused by a pathogen other than E. coli are considered atypical pediatric UTIs. [5][6]

Risk factors for pediatric UTI [3]

Although uncircumcised young boys are at an increased risk for UTIs, the preventative effect of circumcision on UTI development is not considered sufficient to recommend circumcision for all patients. [11]

Clinical featurestoggle arrow icon

Symptoms of a pediatric UTI may be nonspecific; fever may be the only sign, particularly in neonates. [2][3]

Subtypes and variantstoggle arrow icon

Atypical pediatric UTI [2][3][6]

Diagnosticstoggle arrow icon

Approach [2][14][15]

Urine studies [2][3]

The diagnosis of UTI typically involves urinalysis (may detect bacteria and/or pyuria) and urine culture (confirms bacteriuria) [2][3][14]

Collection methods [3][14]

Urinalysis [3]

Urine culture

Consider testing for sexually transmitted infections in adolescent patients with symptoms of a UTI, especially if they report prior sexual activity and/or sterile pyuria is present. [19]

Imaging in pediatric UTI

Approach [2][5][14]

RBUS should be performed during acute illness for children with persistent high fever or severe illness; for other children delaying imaging by up to 6 months may allow for better visualization. [3][14]

Most abnormalities can be detected on RBUS but VCUG is required if vesicoureteral reflux is suspected; see “Diagnostics of VUR” for further information.

Renal bladder ultrasound (RBUS) [2][3][5][14]

Voiding cystourethrography [2][5][14]

Advanced imaging [3][7]

DMSA scans should be delayed until 4–6 months after UTI resolution to prevent acute inflammation being mistaken for scarring. [3]

Treatmenttoggle arrow icon

Approach [2][14][15]

Admission criteria for pediatric UTI [3][12][14]

Antibiotic therapy

  • Follow local guidelines and protocols if available.
  • Always check local resistance patterns before initiating treatment.
Empiric antibiotics for pediatric UTI [2][3][14]
Indications Recommended antibiotics Duration [2]
  • Neonates [16]
  • Severe illness [12]
  • Inability to tolerate oral fluids or antibiotics [3][12][14]
  • Unsuccessful outpatient treatment [3][12][14]
  • 7–14 days [2][3][6]
  • 7–14 days
  • Typically for 3–5 days [6][20]

Avoid empiric antibiotic monotherapy with amoxicillin or other penicillins because of resistance. [3]

Repeat urine culture is not necessary unless symptoms persist. [3]

Differential diagnosestoggle arrow icon

Consider sexual assault in all pediatric patients presenting with genital injury or sexually transmitted infections; in adolescents, screen for signs of human trafficking.

The differential diagnoses listed here are not exhaustive.

Complicationstoggle arrow icon

We list the most important complications. The selection is not exhaustive.

Preventiontoggle arrow icon

UTI 1-year recurrence rates are as high as 30%. Children with a history of UTIs should be seen within 48 hours if they experience an unexplained fever or symptoms of a pediatric UTI. [2][3][14]

Referencestoggle arrow icon

  1. Mattoo TK, Shaikh N, Nelson CP. Contemporary Management of Urinary Tract Infection in Children. Pediatrics. 2021; 147 (2).doi: 10.1542/peds.2020-012138 . | Open in Read by QxMD
  2. Veauthier B, Miller MV. Urinary Tract Infections in Young Children and Infants: Common Questions and Answers. Am Fam Physician. 2020; 102 (5): p.278-285.
  3. Okarska-Napierała M, Wasilewska A, Kuchar E. Urinary tract infection in children: Diagnosis, treatment, imaging – Comparison of current guidelines. J Pediatr Urol. 2017; 13 (6): p.567-573.doi: 10.1016/j.jpurol.2017.07.018 . | Open in Read by QxMD
  4. Karmazyn BK, Alazraki AL, Anupindi SA, et al. ACR Appropriateness Criteria ® Urinary Tract Infection—Child. J Am Coll Radiol. 2017; 14 (5): p.S362-S371.doi: 10.1016/j.jacr.2017.02.028 . | Open in Read by QxMD
  5. Leung AKC, Wong AHC, Leung AAM, et al. Urinary Tract Infection in Children. Recent Pat Inflamm Allergy Drug DIscov. 2019; 13 (1): p.2-18.doi: 10.2174/1872213x13666181228154940 . | Open in Read by QxMD
  6. Santos JD, Lopes RI, Koyle MA. Bladder and bowel dysfunction in children: An update on the diagnosis and treatment of a common, but underdiagnosed pediatric problem. Can Urol Assoc J. ; 11 (1-2Suppl1): p.S64-S72.doi: 10.5489/cuaj.4411 . | Open in Read by QxMD
  7. Schmidt B, Copp HL. Work-up of Pediatric Urinary Tract Infection. Urol Clin North Am. 2015; 42 (4): p.519-526.doi: 10.1016/j.ucl.2015.05.011 . | Open in Read by QxMD
  8. Shapiro E. American academy of pediatrics policy statements on circumcision and urinary tract infection. Rev Urol. 1999; 1 (3): p.154-6.
  9. Olson P, Dudley AG, Rowe CK. Contemporary Management of Urinary Tract Infections in Children. Current Treatment Options in Pediatrics. 2022.doi: 10.1007/s40746-022-00242-1 . | Open in Read by QxMD
  10. AAFP policy on Neonatal Circumcision. . Accessed: September 13, 2022.
  11. Kaufman J, Temple-Smith M, Sanci L. Urinary tract infections in children: an overview of diagnosis and management. BMJ Paediatr Open. 2019; 3 (1): p.e000487.doi: 10.1136/bmjpo-2019-000487 . | Open in Read by QxMD
  12. Chang PW, Schroeder AR, Lucas BP, McDaniel CE. Impact of Diagnostic Criteria on UTI Prevalence in Young Infants With Jaundice: A Meta-analysis. Hosp Pediatr. 2022; 12 (4): p.425-440.doi: 10.1542/hpeds.2021-006382 . | Open in Read by QxMD
  13. American Academy of Pediatrics. Reaffirmation of AAP Clinical Practice Guideline: The Diagnosis and Management of the Initial Urinary Tract Infection in Febrile Infants and Young Children 2-24 Months of Age. Pediatrics. 2016; 138 (6): p.e20163026-e20163026.doi: 10.1542/peds.2016-3026 . | Open in Read by QxMD
  14. Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management. Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months. Pediatrics. 2011; 128 (3): p.595-610.doi: 10.1542/peds.2011-1330 . | Open in Read by QxMD
  15. Pantell RH, Roberts KB, Adams WG, et al. Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old. Pediatrics. 2021; 148 (2).doi: 10.1542/peds.2021-052228 . | Open in Read by QxMD
  16. Shaikh N, Hoberman A, Hum SW, et al. Development and Validation of a Calculator for Estimating the Probability of Urinary Tract Infection in Young Febrile Children. JAMA Pediatr. 2018; 172 (6): p.550.doi: 10.1001/jamapediatrics.2018.0217 . | Open in Read by QxMD
  17. Gorelick MH, Hoberman A, Kearney D, Wald E, Shaw KN. Validation of a decision rule identifying febrile young girls at high risk for urinary tract infection. Pediatr Emerg Care. 2003; 19 (3): p.162-164.doi: 10.1097/01.pec.0000081238.98249.40 . | Open in Read by QxMD
  18. Wise GJ, Schlegel PN. Sterile Pyuria. N Engl J Med. 2015; 372 (11): p.1048-1054.doi: 10.1056/nejmra1410052 . | Open in Read by QxMD
  19. AAP Committee on Infectious Diseases. Red Book: 2021–2024 Report of the Committee on Infectious Diseases. American Academy of Pediatrics ; 2021
  20. Fasugba O, Mitchell BG, McInnes E, et al. Increased fluid intake for the prevention of urinary tract infection in adults and children in all settings: a systematic review. J Hosp Infect. 2020; 104 (1): p.68-77.doi: 10.1016/j.jhin.2019.08.016 . | Open in Read by QxMD
  21. Williams G, Craig JC. Long-term antibiotics for preventing recurrent urinary tract infection in children. Cochrane Database Syst Rev. 2019.doi: 10.1002/14651858.cd001534.pub4 . | Open in Read by QxMD
  22. Williams G, Hodson EM, Craig JC. Interventions for primary vesicoureteric reflux. Cochrane Database Syst Rev. 2019; 2019 (2).doi: 10.1002/14651858.cd001532.pub5 . | Open in Read by QxMD
  23. Meena J, Thomas CC, Kumar J, Raut S, Hari P. Non-antibiotic interventions for prevention of urinary tract infections in children: a systematic review and meta-analysis of randomized controlled trials. Eur J Pediatr. 2021; 180 (12): p.3535-3545.doi: 10.1007/s00431-021-04091-2 . | Open in Read by QxMD
  24. $Contributor Disclosures - Urinary tract infections in children and adolescents. All of the relevant financial relationships listed for the following individuals have been mitigated: Alexandra Willis (copyeditor, was previously employed by OPEN Health Communications). None of the other individuals in control of the content for this article reported relevant financial relationships with ineligible companies. For details, please review our full conflict of interest (COI) policy:.
  25. Bergelson J, Zaoutis T, Shah SS. Pediatric Infectious Diseases E-Book. Elsevier Health Sciences ; 2008
  26. Marcdante K, Kliegman RM. Nelson Essentials of Pediatrics E-Book. Elsevier Health Sciences ; 2018
  27. Walls R, Hockberger R, Gausche-Hill M. Rosen's Emergency Medicine. Elsevier Health Sciences ; 2018
  28. Fan SM, Grigorian A, Chaudhry HH, et al. Female pediatric and adolescent genitalia trauma: a retrospective analysis of the National Trauma Data Bank. Pediatr Surg Int. 2020; 36 (10): p.1235-1241.doi: 10.1007/s00383-020-04736-7 . | Open in Read by QxMD

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