Urinary Tract Infections in Children

UTIs occur in as many as 5% of female and 1% to 2% of male children.22 As many as 80% of children with uncomplicated UTIs have recurrences. Children who are at increased risk for bacteriuria or symptomatic UTIs are premature babies discharged from neonatal intensive care units; children with systemic or immunologic disease or urinary tract abnormalities such as neurogenic bladder or vesicoureteral reflux; those with a family history of UTIor urinary tract anomalies with reflux; and girls younger than age 5 with a history of UTI. 

Many neonates with UTIs have bacteremia and may show signs and symptoms of septicemia, including fever, hypothermia, apneic spells, poor skin perfusion, abdominal distention, diarrhea, vomiting, lethargy, and irritability. Older infants may present with feeding problems, failure to thrive, diarrhea, vomiting, fever, and foul-smelling urine. Many toddlers present with abdominal pain, vomiting, diarrhea, abnormal voiding patterns, foul-smelling urine, fever, and poor growth. In older children with lower UTIs, the classic features—enuresis, frequency; dysuria, and suprapubic discomfort are more common. Fever, chills, nausea, vomiting, and flank pain occur in children with upper UTIs. 

Diagnosis is based on a careful history of voiding patterns and symptomatology; physical examination to determine fever, hypertension, abdominal or suprapubic tenderness, and other manifestations of UT!; and urinalysis to determine bacteriuria, pyuria, proteinuria, and hematuria. A positive urine culture that is obtained correctly is essential for the diagnosis. Additional diagnostic methods may be needed to determine the cause of the disorder. Urinary symptoms in the absence of bacteriuria suggests vaginitis, urethritis, sexual molestation, the use of irritating bubble baths, pinworms, or viral cystitis. In adolescent girls, a history of dysuria and vaginal discharge makes vaginitis or vulvitis a consideration.