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Urinary Tract Infections in Children: Why They Occur and How to Prevent Them
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Am Fam Physician. 1998 May 15;57(10):2452-2454.
See related article on urinary tract infections.
The urinary tract has these parts:
The kidneys, where urine is made.
The ureters, tubes that carry urine from each kidney to the bladder.
The bladder, where urine is stored.
The urethra, a tube that carries urine from the bladder to the outside of the body. The opening is at the end of the penis in boys and near the vagina in girls.
What is a urinary tract infection?
A urinary tract infection (or UTI, for short) can occur in any of the parts of the urinary tract (see the box above). Normally, urine in the kidneys, the ureters and the bladder doesn't have any bacteria (germs) in it. Bacteria are normally present only at the very end of the urethra and on the skin around the opening of the urethra. The bacteria that are normally present around the urethra don't usually cause an infection. When harmful bacteria get into the urinary tract, though, they may cause an infection. The bacteria that cause a UTI can get into the urinary tract at the opening of the urethra.
If bacteria get into your child's bladder, they can cause a bladder infection. The medical word for a bladder infection is cystitis. When bacteria are in the bladder, they can irritate the bladder. The irritation makes it hurt when your child urinates. Your child might have a burning feeling when he or she urinates. Your child may also have a constant feeling of needing to urinate. Sometimes, children with a bladder infection lose control and wet themselves. There is usually little or no fever with a bladder infection.
If the bacteria travel from the bladder up the ureters to the kidneys, they may cause a kidney infection. The medical word for a kidney infection is pyelonephritis (say: pie-ell-oh-nef-right-us). A kidney infection is more serious than a bladder infection. The kidneys might be damaged if the infection isn't treated with medicine. A kidney infection can cause fever. Your child might also have pain in the side or the back. This infection can make your child feel really sick. It's possible to have the symptoms of both a bladder infection and a kidney infection.
How do I know if my child has a urinary tract infection?
UTIs are sometimes hard to diagnose in babies and young children, because they can't tell us how they're feeling. Therefore, urine should be tested in a baby or a young child who has an unexplained fever for three days. A UTI may be the cause of the fever. Fever might be the only symptom in a baby with pyelonephritis.
An older child might be able to tell you that it hurts to urinate. Children who have a sudden need to urinate and who hold themselves or squat to keep from urinating might have a UTI. If your child has a kidney infection, you may be able to tell that he or she is sick. Your child may act tired, or have a fever, or have nausea and vomiting.
Of course, babies and children can get a fever from many other illnesses, such as colds, ear infections and the flu. Also, other things can cause pain with urination or loss of urine control. Irritation at the opening of the urethra (for example, from wearing tight panties or leotards) may cause pain with urination. Bubble baths can irritate the tender skin around the urethra and make urination hurt. Dirty diapers or underpants can irritate the skin around the genital area and cause pain. (But dirty diapers and dirty underwear don't cause a UTI).
If you think your child has a UTI, call your doctor.
How does my doctor find out my child has a UTI?
Your doctor can find out if your child has a UTI by testing some of your child's urine. A test called a “culture” can tell the doctor if there are bacteria in the urine. If bacteria are in the urine, your child has a UTI.
What if my child has had quite a few bladder or kidney infections?
If your child has had pyelonephritis or cystitis more than a few times, your doctor may want to get x-rays of your child's urinary tract. The x-rays would show the bladder, the ureters and the kidneys. Or your doctor might get a sonogram. The x-ray or the sonogram can show if there is a problem in the kidneys, the ureters or the bladder that causes infections. Your doctor may refer your child to a special doctor who treats urinary tract problems. Sometimes taking a low dose of an antibiotic for a long time can stop repeat infections.
Most children who have many UTIs don't have a problem in the urinary tract. Instead, they have poor urinary habits. Teaching your child good bathroom habits can help prevent UTIs.
What are some good bathroom habits that my child should follow?
Teach your daughter to wipe herself from front to back after she goes to the bathroom.
Teach your daughter to lower her pants and underpants to her ankles and to sit comfortably on the toilet. If her feet don't touch the floor, put a step stool in front of the toilet, so she can put her feet on it and be comfortable.
Teach your son to completely open his pants and underpants so his penis isn't pressed by clothing when he is urinating.
Teach your child to urinate regularly. Tell your child to not hold in urine for a long time. Going to the bathroom frequently can help prevent UTIs. Children who have had repeat UTIs should urinate every 1½ to 2 hours during the day. Drinking lots of fluids will help your child urinate more often.
Treat constipation. Constipation can give your child a sudden need to urinate.
Teach your child to empty the bladder all the way when he or she urinates. No “quickie” bathroom visits during a TV commercial!
Give your child antibiotics only when your doctor tells you to. Antibiotics can kill the good bacteria that normally live on the skin of the genital area. When the good, protective bacteria are gone, harmful bacteria can grow and cause a UTI.
This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the AAFP online at http://familydoctor.org.
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.
Copyright © 1998 by the American Academy of Family Physicians.
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