Urinary tract infection (UTI)

A urinary tract infection (UTI) is a common infection that causes illness in babies and children. It happens when germs get into the urine (wee) and travel into the urinary tract. Some babies and children with UTIs may become irritable, have a fever, have pain when they wee, feel sick or be sick.

The information covers:

• what a UTI is, and what may cause it
• how your doctor can find out whether your child has a UTI
• treatment that your child may need
• how to help protect your child against UTI
• monitoring UTI, especially if it keeps coming back or the infection passes to the kidneys

About the urinary system

The urinary system gets rid of things that the body no longer needs, so that we can grow and stay healthy.

• The kidneys are bean-shaped organs. They filter blood and remove extra water and waste in urine (wee). Most of us have two kidneys. They are at the back on either side of our spine (backbone), near the bottom edge of our ribs.
• The two ureters are long tubes that carry urine from the kidneys to the bladder.
• The bladder is a muscular bag that stores urine until we are ready to urinate (wee). It sits low down in the pelvis.
• The urethra is a tube that carries urine from the bladder to the outside of the body. We urinate through the opening.

About the urinary system and kidneys

Symptoms and signs

• Babies and young children with a UTI may have fever (temperature over 38ºC), be sick (vomit), feel tired or irritable and not feed well.
• Older children with a UTI may have pain or a stinging/ burning feeling when passing urine (dysuria), may need to go to the toilet more often than usual (frequency), or hold on because it is painful to go, or may wet themselves more often than usual.

If you think that your child may have a UTI, contact your doctor. If you cannot reach your doctor straight away, contact 111 or NHS Direct or your local out-of-hours GP service.

More about symptoms and signs

Causes

A urinary tract infection (UTI) happens when bacteria (germs) get into the urine and travel into the urinary tract. This causes inflammation (like a swelling) in part of the urinary tract.

Types of UTI

• A lower UTI is an infections in the lower parts of the urinary tract, the urethra and the bladder. This is called cystitis.
• An upper UTI is an infection in the upper parts of the urinary tract, especially the kidneys. This is called pyelonephritis.

How common are UTIs in children?

UTI is a common infection in babies and children. It is more common in girls. It is estimated that:

• one out of 10 girls will have had a UTI by the age of 16 years
• one out of 30 boys will have had a UTI by the age of 16 years
• about one out of 50 babies and young children ill have had a UTI by the age of 2 years¹

Recurrent UTIs

Some children have recurrent UTIs, which keep coming back even after proper treatment.

These children often have other problems with their urinary system, such as vesicoureteral reflux (VUR). As children with VUR urinate, some urine refluxes (goes back up) towards the kidneys. This makes it easier for germs that cause UTI to travel all the way up to the kidneys, where they cause a more serious infection and illness.

Tests and diagnosis

If you think that your child may have a UTI, take him or her to your doctor. They can find out if there is a UTI by doing a urine test and finding out about their symptoms.

More information about tests & diagnosis

Treatment

More information about treatment

Prevention

There are some things that you and your child can do help prevent or reduce the frequency of UTIs:

• Encourage your child to go to the toilet regularly – every 3 to 4 hours during the day, before having a bath and before going to bed
• Change your baby’s nappies regularly.
• Help your child avoid constipation – speak with your doctor or nurse for more information.
• Make sure your child drinks plenty of fluids, especially water, eats a healthy diet, is active and gets regular sleep.

More information about prevention

About the future

Children who are treated for UTIs with antibiotics usually get better. In most children the UTI does not keep coming back, and there is very little risk of long-term problems.

A few children need to have follow-up appointments or further treatment.

More information about the future

Urinary tract infection: diagnosis, treatment and long-term management of urinary tract infection in children. Clinical Guideline. National Collaborating Centre for Women’s and Children’s Health. August 2007

Symptoms and signs

Symptoms are what your child feels or complains about. Signs are what you, your child or a healthcare professional can see or detect

Common symptoms and signs in babies and young children

• Fever (temperature over 38^oC)
• Being sick (vomiting)
• Feeling tired (lethargy)
• Being irritable
• Poor feeding

Common symptoms and signs in older children

• Pain or a stinging/burning feeling when passing urine (dysuria)
• Going to the toilet more often than usual (frequency) or holding on because it is painful to go
• Wetting the bed more often than usual, or wetting themselves because they cannot get to the toilet in time.

• Fever (temperature over 38ºC) that is constantly spiking (keeps going up) in spite of giving medicines such as paracetamol (including Calpol®)

• Shaking or shivering (rigor), sometimes with a fever

• Signs of dehydration (not enough water in the body) – children may be thirstier than usual, and babies may have a soft sunken spot (fontanelle) on their head

• Pain in the back

• Blood in the urine (haematuria) – sometimes the urine is coloured red or dark brown

• Cloudy urine

• Yellowing of the skin (jaundice) in babies – this is a very rare symptom

It is important to find out if your child has a UTI quickly, so it can be treated.

Examination

Risk factors

Children with abnormal urinary tracts are at higher risk of getting UTIs. Tell your doctor if your child has:

• any problems when passing urine, or a poor urine flow
• fever (temperature over 38^oF) that keeps coming back
• abnormalities of one or both kidneys found before or at birth
• a family history of vesicoureteral reflux or kidney disease
• constipation (difficulties doing a poo)
• history of bladder dysfunction (the bladder does not completely empty when passing urine), such as neuropathic bladder
• an injury in the spine (backbone)
• poor growth
• high blood pressure (hypertension)

Urine test

Getting a urine sample

Your child’s doctor or nurse will give you a sterile (completely clean) container to get a small amount of urine. You may need to do this at the clinic, or take the container home and bring it back. 

When getting a urine sample, it is important to make sure it is not contaminated - this means that there is no dirt or bacteria (germs) in the urine sample.

Testing urine

Getting a urine sample from a child

To help make sure the urine sample does not have any bacteria that may be on your or your child’s skin, you will need to get a mid-stream sample. This is from the middle part of the urine flow.

• Your child should start weeing into a toilet bowl or potty.
• After one or two seconds, catch some of the urine directly into the container.
• Take the container away before your child stops urinating.
• Screw the lid on tight.

Getting a urine sample from a teenage girls

Teenage girls need to be especially careful when getting a mid-stream sample.

• Your daughter should wash her hands and her genitals, and dry with a clean towel.
• She should sit on the toilet with her legs wide apart.
• Before weeing she should separate her labia – these are the pieces of skin around her genitals.

Getting a urine sample from a baby or young child

The best way is usually the clean catch method. The urine is less likely to be contaminated than other methods. You will need to wait up to an hour for your child to wee and catch it in a container. Good times are after a bottle feed, during a nappy change, or before a bath

Urine microscopy

In some hospitals the urine will be examined under a microscope. This gives immediate information, and also helps find out if the sample is contaminated by germs from the skin. If that happens, you may need to get a new urine sample.

Other tests

Some children will need more tests to help find out what is causing the UTI if they have recurrent UTIs (that keep coming back) or if the infection has passed to your child’s kidneys.

Imaging tests

Blood tests

Blood tests

Questions to ask the doctor or nurse

• What other tests will my child need?
• How do I help prepare my child for the tests? What can I do to make them more comfortable?
• Why does my child have a UTI?
• How will you know if my child has an underlying condition that is causing the UTI? How can I get more information about that condition?

Where will my child be treated?

Most children with UTIs can be treated by their family doctor, or general practitioner (GP).

Referral to specialist services

Depending on the results of the tests or whether your child has recurrent UTIs (that keep coming back), your doctor may refer your child to a paediatrician, a children’s doctor, or a paediatric nephrologist, a doctor who treats children with kidney problems.

Hospital treatment

A few children need to go to the hospital for treatment. This is especially the case for:

• babies under 3 months with serious UTI
• children with, or at risk of, a kidney infection (pyelonephritis).

Antibiotics to treat UTI

UTIs are usually caused by bacteria. Your child will be prescribed an antibiotic, a medicine that kills the bacteria. Your doctor will decide which antibiotic is best for your child.

Your doctor will usually give you a prescription so your child can start taking the medicine straight away and continue it at home. Antibiotics are normally given by mouth – as liquid medicine, tablets or capsules.

Your child will normally need to take the medicine for a set number of days, depending on his or her symptoms when they first see the doctor – this is usually between three and 10 days .

Medicines for Children | General information about antibiotics

Changing antibiotics

Your doctor will want to start the antibiotic treatment straight away. However, it may take a few days to get the results of the urine culture, which will find out which bacteria are causing the infection. After getting the results of the urine culture, your doctor may want to give your child a different antibiotic if he or she thinks it will work better.

How long will it take for my child to get better?

Your child should start to feel better 1 or 2 days after starting treatment with antibiotics. They should continue taking the antibiotics until the course is completed.

When they start to feel better, they can go to school or nursery. You cannot “catch” UTIs, so your child will not be infectious.

If your child does not get start to get better after 1 or 2 days, contact your doctor for advice.

Other medicines

Medicines for Children | Paracetamol for mild-to-moderate pain

Drinking fluids

Antibiotics to prevent future UTIs

Some children may benefit from a very small amount of antibiotic to be taken every night. This is called a prophylactic antibiotic – prophylactic means preventing. Taking a small dose of prophylactic antibiotic will help to prevent further infections. Because the dose is small, there is little chance of developing antibiotic resistance.

Your doctor may prescribe this to your child if they have:

• recurrent UTIs
• structural problems of the urinary system –including vesico-ureteral reflux or other types of reflux
• other problems weeing, such as not being able to empty the bladder

If you think they have a UTI

If your child is taking a prophylactic antibiotic and you think that they have a UTI, follow these steps.

• do not give more of the prophylactic antibiotic or any other antibiotic.
• Contact your doctor  - you will need to get another urine sample to be tested.
• If your child does have a UTI, your doctor will prescribe a suitable antibiotic.
• You may wish to write down the date of the UTI, the urine culture results and the treatment..

Questions to ask the doctor or nurse

• What treatment will my child need?
• How will this help my child?
• What happens next if the first treatment does not work for my child?

There are some things that you and your child can do help reduce the frequency of UTIs.

Going to the toilet

• Encourage your child to go to the toilet regularly. Children should wee every 3 to 4 hours during the day, before having a bath and before going to bed. Your child should not ‘hold on’. In some children, this can increase the risk of getting UTIs.
• Change your baby’s nappies regularly.
• Avoid constipation. If your child has difficulty doing a poo, speak with your doctor or pharmacist about how to help your child manage this.
• If your child has bladder dysfunction (the bladder does not completely empty when passing urine), your doctor or nurse may suggest double voiding. This means your child goes for a wee twice to help empty his or her bladder. Your child should go for a wee standing up (including girls) and then try again after a few moments, while sitting down.

Eating and drinking

• Make sure your child drinks plenty of fluids, especially water.
• Make sure your child eats lots of fruit and vegetables, is physically active and gets regular sleep. A fit and healthy child is better able to fight off infections.

Outside the home

• Talk with other people who look after your child – family members, childminders and teachers at school – to help make sure they give your child regular drinks, encourage him or her to go to the toilet often, and are aware of any medicines that your child is taking to prevent or treat UTIs.

For girls

• After she does a bowel movement (does a poo), make sure she wipes her bottom from the front towards the back. If she wipes her bottom from the back towards the front, any bacteria that is in the bowel can get into the urethra and cause a UTI.

For boys

• Boys have a foreskin, a sleeve of skin that surrounds the head of the penis. Make sure to clean the area that you can easily reach, but do not force it back, as this can cause damage.
• Some boys with recurrent UTIs, especially if they have structural abnormalities of the urinary system, need a circumcision, an operation to remove the foreskin from the penis.

Will my child get better?

Children who are treated for UTIs with antibiotics usually get better. In most children the UTI does not keep coming back, and there is very little risk of long-term problems.

Kidney infection

In a few children, the infection can travel to the kidneys (pyelonephritis). This may cause damage to the kidneys.

Kidney damage

A very small number of children with UTIs that are recurrent (keep coming back) or are caused by structural problems in the urinary system develop scars and long-term damage to the kidneys.

In serious cases, this can lead to:

• chronic kidney disease (CKD) – when the kidneys stop working as well as they should – this usually happens slowly, often over many years
• acute kidney injury (AKI) – when the kidneys stop working as well as they should over a short period of time; when associated with UTI, the kidney function is normally affected only while they are unwell.

These children will need to go back to the hospital clinic for follow-up appointments and specialist care.

Follow up

Your child will be need to go to follow up appointments if he or she has:

• recurrent UTIs
• structural problems in their urinary system, such as reflux or a bladder that does not empty properly
• abnormal results on the imaging tests – some children may need surgery to treat these problems.

At these appointments, your child may have:

• their height and weight checked
• a physical examination
• urine tests – to check for blood, protein and other substances in the urine
• blood tests – to check for the amount of protein and other substances in the blood, and measure the kidney function
• blood pressure measured.

Impact on our child and our family

This may be a stressful experience for your child and the whole family, including other children.

If you have any concerns or need additional support, speak with your doctor or nurse.

Further information