Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Practice

Urinary tract infection in children

Alexandra Hudson, Rodrigo L.P. Romao and Dawn MacLellan
CMAJ April 24, 2017 189 (16) E608; DOI: https://doi.org/10.1503/cmaj.160656
Alexandra Hudson
Dalhousie Medical School (Hudson); Departments of Surgery and Urology (Romao), and of Urology and Pathology (MacLellan), Faculty of Medicine, Dalhousie University, Halifax, NS
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Rodrigo L.P. Romao
Dalhousie Medical School (Hudson); Departments of Surgery and Urology (Romao), and of Urology and Pathology (MacLellan), Faculty of Medicine, Dalhousie University, Halifax, NS
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Dawn MacLellan
Dalhousie Medical School (Hudson); Departments of Surgery and Urology (Romao), and of Urology and Pathology (MacLellan), Faculty of Medicine, Dalhousie University, Halifax, NS
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: Dawn.MacLellan@iwk.nshealth.ca
  • Article
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF
Loading

Children with urinary tract infection usually present with nonspecific signs and symptoms

In children less than two years of age, a fever (> 39°C) without an apparent source is the most common sign of urinary tract infection (likelihood ratio 4.0).1 Abnormal or strong urinary odour has poor predictive accuracy (i.e., sensitivity 43%, specificity 48%; Appendix 1, available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.160656/-/DC1).2

The gold standard for diagnosis in children is positive test results for both urinalysis and urine culture

According to the Canadian Paediatric Society guidelines, a positive urinalysis (i.e., dipstick test) result for leukocyte esterase and/or nitrites (specificity 87% and 98%, respectively) and a positive urine culture result for growth of a single uropathogenic bacteria (≥ 105 CFU/mL) are required for diagnosis of urinary tract infection in children.3,4

Urine collection in children who are not toilet-trained requires urethral catheterization or suprapubic aspirate (uncommon)

These methods for urine collection are reserved for cases in which an initial bag-specimen urinalysis is abnormal.3 Alternatively, the Canadian Paediatric Society recommends leaving the child with the diaper off and collecting a clean-catch urine sample while the child voids.3 If there is a positive result for urinalysis, treatment with antibiotics should start empirically and be adjusted subsequently based on the results of the urine culture.1

Anatomic abnormalities should be ruled out in children less than two years of age after their first urinary tract infection with fever4

Children less than two years of age with a diagnosis of urinary tract infection with fever should undergo renal and bladder ultrasonography to rule out anatomic abnormalities.4 Further testing may be required if ultrasonography results are abnormal, and these children should be referred to a specialist (e.g., pediatric urologist).

Bowel and bladder dysfunction can contribute to urinary tract infection in children

Dysfunction of the bladder and bowel is present in 44% of preschool-aged and school-aged children presenting with urinary tract infection.1 It promotes urinary stasis, which predisposes to a urinary tract infection if there are bacteria in the bladder. Treatment involves optimizing bladder and bowel elimination, with timed voiding schedules (e.g., every four hours while awake) and prevention of constipation.1

Footnotes

  • Competing interests: None declared.

  • This article has been peer reviewed.

References

  1. ↵
    1. Cooper CS,
    2. Storm DW
    . Infection and inflammation of the pediatric genitourinary tract. In: Campbell-Walsh Urology, 11th edition. Philadelphia: Elsevier; 2016;127:2926–48.e7. doi:10.1016/B978-1-4557-7567-5.00127-8.
    OpenUrlCrossRef
  2. ↵
    1. Struthers S,
    2. Scanlon J,
    3. Parker K,
    4. et al
    . Parental reporting of smelly urine and urinary tract infection. Arch Dis Child 2003; 88:250–2.
    OpenUrlAbstract/FREE Full Text
  3. ↵
    1. Robinson JL,
    2. Finlay JC,
    3. Lang ME,
    4. et al.
    Canadian Paediatric Society, Community Paediatrics Committee, Infectious Diseases and Immunization Committee. Urinary tract infection in infants and children: diagnosis and management. Paediatr Child Health 2014;19:315–25.
    OpenUrlPubMed
  4. ↵
    Subcomittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management; Roberts KB. 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; 128:595–610.
    OpenUrlAbstract/FREE Full Text
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 189 (16)
CMAJ
Vol. 189, Issue 16
24 Apr 2017
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Urinary tract infection in children
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Urinary tract infection in children
Alexandra Hudson, Rodrigo L.P. Romao, Dawn MacLellan
CMAJ Apr 2017, 189 (16) E608; DOI: 10.1503/cmaj.160656

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Urinary tract infection in children
Alexandra Hudson, Rodrigo L.P. Romao, Dawn MacLellan
CMAJ Apr 2017, 189 (16) E608; DOI: 10.1503/cmaj.160656
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Children with urinary tract infection usually present with nonspecific signs and symptoms
    • The gold standard for diagnosis in children is positive test results for both urinalysis and urine culture
    • Urine collection in children who are not toilet-trained requires urethral catheterization or suprapubic aspirate (uncommon)
    • Anatomic abnormalities should be ruled out in children less than two years of age after their first urinary tract infection with fever4
    • Bowel and bladder dysfunction can contribute to urinary tract infection in children
    • Footnotes
    • References
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF

Related Articles

  • Quick and easy methods for “clean-catch” urine samples
  • PubMed
  • Google Scholar

Cited By...

  • Quick and easy methods for "clean-catch" urine samples
  • Google Scholar

More in this TOC Section

  • Management of γ-hydroxybutyrate intoxication and withdrawal
  • Tuberculous monoarthritis of the knee joint
  • Vulvar condyloma lata as a first presentation of syphilis
Show more Practice

Similar Articles

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

CMA Civility, Accessibility, Privacy

 

Powered by HighWire