- a urinary tract infection is an important diagnosis in a child not to miss because infection may damage the developing kidney
- as with adults, a urinary tract infection in children is defined as more than 10 to the power 5 organisms per ml in voided urine (studies on urine specimens from large numbers of hospital patients confirm that a pure growth of 10^5 organisms per ml or greater is indicative of infection (1)
- about 2% of boys and 8% or more of girls will develop a urinary tract infection during childhood
Note that in some children, especially boys, the child may not retain urine in the bladder for a long enough period for multiplication to a pure growth of 10^5 organisms per ml to occur. In these cases a pure growth of 10^4-10^5 organisms may indicate infection.
NICE note that clinical features suggestive of UTI, in a child less than 5 years, are:
- poor feeding
- abdominal pain or tenderness
- urinary frequency or dysuria
- offensive urine or haematuria
NICE now state if suspected UTI is an infants younger than 3 months then:
- there are concerns about sepsis in infants under 3 months with suspected UTI, and usual practice is referral rather than the GP managing symptoms. So the committee recommended that all children under 3 months should be referred to specialist paediatric care and have a urine sample sent for urgent microscopy and culture
- infants and children presenting with unexplained fever of 38°C or higher
should have a urine sample tested within 24 hours
- infants and children with an alternative site of infection should not have a urine sample tested. When infants and children with an alternative site of infection remain unwell, urine testing should be considered after 24 hours at the latest
- NICE (September 2017). Feverish illness in children Assessment and initial management in children younger than 5 years
- Prescriber 2000;11 (18): 21-37.
- Jantauch, B.A.t al.. Association of Lewis blood group with urinary tract infection in children. J. Pediatrics 1994;124:863-868
- Drug and Therapeutics Bulletin, 35, 65-9.