Clinical Reference Systems: Pediatric Advisor 10.0
Urinary Tract Infection
Description (Diagnosis must be confirmed by a physician.)
A urinary tract infection (UTI) is an infection of the
bladder and sometimes the kidneys. If the bladder is
infected, it is called cystitis. If the kidneys are
infected, it is called pyelonephritis. It is important to
treat UTIs so that the kidneys are not damaged.
Various symptoms are possible:
- painful urination
- an urgent need to urinate
- frequent urination
- daytime and nighttime wetting
- foul-smelling urine
- stomachaches (especially lower abdomen)
Urinary tract infections are caused by bacteria. The
bacteria enter the bladder by traveling up the urethra. In
general, the urethra is protected, but if the opening of the
urethra (or the vulva in girls) becomes irritated, bacteria
can grow there. Common irritants are bubble bath and
shampoos. Careless wiping after a bowel movement might also
cause irritation. A rare cause of UTIs (1% of girls and 5%
of boys) is obstruction of the urinary tract, which results
in incomplete emptying of the bladder.
With treatment, your child's fever should be gone and
symptoms should be better by 48 hours after starting the
antibiotic. The chances of getting another UTI are about
50%. Read the advice on preventing UTIs to decrease your
Your child needs the antibiotic prescribed by your
physician. This medicine will kill the bacteria that
are causing the UTI.
If the medicine is liquid, store it in the refrigerator
and shake the bottle well before you measure a dose.
Use a measuring spoon to be sure that you give the right
Try not to forget any of the doses. If your child goes
to school or a baby sitter, arrange for someone to give
the afternoon dose. Give the medicine until all the
pills are gone or the bottle is empty. Even though your
child will feel better in a few days, give the
antibiotic for the full 10 days to keep the UTI from
flaring up again.
- Extra fluids
Encourage your child to drink extra fluids to help clear
- Fever and pain relief
Give your child acetaminophen or ibuprofen for the
painful urination or for fever over 102 degrees F
(39 degrees C).
- Medical follow-up
Two days after your child begins antibiotics, it is
important to contact your child's physician to find out
the results of the urine culture and make sure that your
child's symptoms are responding to the antibiotic.
About 2 weeks after your initial visit your physician
will want to see your child for another urine culture.
Because the chances are high that your daughter will
develop a second infection (50% of cases), your
physician will probably also want to check her urine 1,
4, and 12 months after the first infection has cleared
- Instructions for collecting a midstream, clean-catch
urine specimen at home
If you are asked to bring a urine sample to your
physician's office, try to collect the urine when your
child first urinates in the morning. Use a jar and lid
that has been sterilized by boiling for 10 minutes.
Wash the genital area several times with cotton balls
and warm water. Your child should then sit on the
toilet seat with her legs spread widely so that the
labia (skin folds of the vagina) don't touch. After she
starts to urinate into the toilet, place the clean
container directly in line with the stream of urine.
Remove it after you have collected a few ounces but
before she stops urinating. (The first or last drops
that come out of the bladder may be contaminated with
Keep the urine in the refrigerator until you take it to
your physician's office. Try to keep it chilled when
you bring it to the office (that is, put the jar in a
plastic bag with some ice).
Prevention of Urinary Tract Infections
- When your child bathes, wash the genital area with water,
- Don't use bubble bath before puberty; it's extremely
irritating. Don't put shampoo or other soaps into the
bathwater. Don't let a bar of soap float around the tub.
- Keep bathtime less than 15 minutes. Your child should
urinate after baths.
- Teach your daughter to wipe herself correctly from front
to back, especially after a bowel movement.
- Try not to let your child become constipated.
- Encourage your child to drink enough fluids each day to
keep the urine light-colored.
- Encourage your child to urinate at least every 3 to
4 hours during the day and not "hold back."
- Your daughter should wear loose cotton underpants.
Discourage wearing underpants at night.
Call Your Child's Physician Immediately If:
- Your child has back pain.
- Your child starts acting very sick.
Call Your Child's Physician During Office Hours If:
- Fever or painful urination lasts more than 48 hours
after your child starts taking an antibiotic.
- You have other concerns or questions.