Understanding Urinary Tract Infections in Children: What Parents Should Know
One of the most common concerns I hear from parents is about urinary tract infections (UTIs) in young children. These infections can range from mild to serious; knowing what to look for—and when to act—can make all the difference in protecting your child’s health.
I'm Dr. Scott Berkman, I'm a pediatric urologist with Saint Francis Children's Physicians, and here we'll outline key information for parents and caregivers. Urinary tract infections can be viral, bacterial, or parasitic. Here, we’re just going to talk about bacterial infections, the most common of the three.
UTI Symptoms in Infants and Children
The urinary tract starts at the kidney. Urine is made in the kidney; the urine travels down the ureter (the tube from kidney to bladder) and ends up in the bladder before emptying through the urethra. Any infection along that path is considered a urinary tract infection.
UTIs fall into two main categories: lower urinary tract infections and upper urinary tract infections.
Lower UTIs involve the bladder and urethra. These typically present with symptoms such as:
- Dysuria (burning during urination)
- Urgency or frequency (needing to go often, suddenly needing to go urgently)
- Urinary incontinence (leaking urine)
- Blood in the urine
Upper UTIs, which affect areas above the bladder—such as the kidneys—are more serious. These often come with:
- flank pain (pain in the side or abdomen)
- fever,
- nausea, and vomiting.
If your child has these symptoms, it’s time to call the doctor. We’ll likely start with a urinalysis and may recommend imaging to check for complications.
Infants present a unique challenge because they can’t tell us what hurts. Often, the first sign is fever without an obvious source. If your baby has a fever and you can’t pinpoint why, it’s important to have their urine checked as part of the fever workup.
An infant with fever needs to be treated within 48 hours, regardless of other symptoms.
Watch for subtle signs of discomfort like grimacing or irritability. Once children are old enough to communicate, they’ll usually tell you if urination is painful—at that point, a call to your pediatrician is warranted.
The worst-case scenario is if a child has a kidney stone obstructing the urinary tract, which gets infected. In those situations, a child would come in with pain in their side, fever, nausea and vomiting, and we would start with imaging studies. A urinary tract infection with obstruction plus infection requires emergency care—it really needs to be drained right away.
Preventing UTIs for Kids
Prevention is always better than treatment. For little girls, I recommend avoiding bubble baths, which can disrupt the natural defenses of the urethra and allow bacteria to enter. Teach proper hygiene—wiping front to back—to prevent bacteria from moving toward the urinary tract.
Another key factor is what we call elimination health—regular urination and bowel movements. Children who don’t empty their bladders completely or who struggle with constipation are at higher risk for UTIs. Encourage regular bathroom habits, good hygiene and address constipation promptly.
If your child experiences recurrent infections, we may need to investigate further with imaging to rule out anatomical abnormalities.
Diagnosing a Pediatric UTI
If your child shows symptoms of a UTI, we’ll collect a urine sample for urinalysis as the first step. Usually your pediatrician will do that—as a pediatric urologist, I get involved if the infection is recurring or if the child is sick enough to be admitted to the hospital.
Once we have a good urine sample, if we see signs of infection—such as pus or bacteria—we send a urine culture to identify the specific organism. This allows us to prescribe culture-specific antibiotics for effective treatment. From there, your provider will prescribe a course of antibiotics and continue to follow up with you until your child is recovered.
For toilet-trained children, obtaining a urine sample is pretty straightforward. For infants and toddlers, it’s more complex. We often need a catheterized urine sample or, in rare cases, a suprapubic aspiration (directly accessing the bladder through the abdomen) to ensure accuracy.
Bag specimens—where a collection bag is placed over the urethra—are prone to contamination; the only time a bag specimen is helpful is when it’s completely clear, indicating no infection.
If your child is very ill with fever, we prefer a catheterized sample before starting antibiotics. Once antibiotics are given, urine culture results can be skewed, making diagnosis harder.
Understanding Recurrent UTIs
A recurrent UTI is defined as two lower urinary tract infections within six months or three within a year. If your child experiences repeated symptoms—burning, urgency, blood in the urine—and the doctor keeps finding bacteria, that’s a recurrent UTI.
UTIs with fever (febrile UTIs) are more concerning because they often indicate an upper urinary tract infection involving the kidneys.
Current guidelines suggest that after one febrile UTI, we may monitor closely, but if a second occurs, we recommend imaging studies such as an ultrasound or a voiding cystourethrogram (VCUG) to check for conditions like vesicoureteral reflux, where urine flows backward into the kidneys.
Treatment Options
Most UTIs are treated with antibiotics prescribed based on the type of bacteria in the urine culture. If your child can take oral medication and isn’t vomiting, we’ll start with oral antibiotics. If they’re very sick and unable to keep anything down, hospitalization for IV antibiotics is necessary.
For children with anatomical abnormalities or severe reflux, surgery may be needed—but this is a rare, extreme case.
As I often tell parents, I’m essentially a “human plumber.” If reflux is present, I create a longer tunnel in the bladder to prevent urine from flowing backward. If there’s an obstruction, I remove it to restore normal flow. These procedures usually resolve pain and prevent future infections.
UTIs and Pediatric Kidney Health
Our ultimate goal is to keep kids healthy and protect their kidneys. Unlike the liver, which can regenerate after injury, kidneys do not regenerate.
Once scarring occurs, that tissue is permanently lost. Recurrent infections can lead to kidney damage, loss of kidney function, or even the loss of one or both kidneys. That’s why early detection, proper treatment, and prevention are so critical.
Key Considerations for Parents
Prevention is the most important thing; maintain good hygiene.
Proper elimination is also important in young kids. It’s common for kids to hold their urine for various reasons; they should be voiding their bladder at least every 3-4 hours. At the other end of the spectrum is overactive bladder; some kids need medication to relax the bladder and allow a multi-hour window between voids.
If you see either of these extremes in your child, it needs to be addressed.
Constipation is very common in kids struggling with elimination, so be mindful of both urinary and bowel issues.
Lastly, watch for signs and symptoms of UTI such as burning, urgency, blood in urine, and especially fever of unknown origin. If you see those signs, it’s time to see your pediatrician.
