Clinical Notes : Urology

155. UTI in Infants and Children

under 16 years

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UTI in infants and children under 16 years


UTI in infants and children under 16 years

onsider UTI in any sick child and every young child with unexplained fever


Flowchart for infants/children under 16 years with suspected UTI

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UTI = Urinary Tract Infection

NICE = National Institute for Health and Care Excellence

PHE = Public Health England

CG - Clinical Guidance

Key points for infants/children under 16 years with suspected UTI

  • Sampling in children:

  • If sending a urine culture, obtain sample before starting antibiotics

  • If child has alternative site of infection do not test urine unless remain unwell—then test within 24 hour

  • In infants/toddlers, clean catch urine advised; gentle suprapubic cutaneous stimulation using gauze soaked in cold fluid helps trigger voiding; clean catch urine using potties cleaned in hot water with washing up liquid; nappy pads cause more contamination, and parents find bags more distressing

  • If non-invasive not possible consider: catheter sample, or suprapubic aspirate (with ultrasound guidance)

  • Culture urine within 4 hours of collection, if this is not possible refrigerate, or use boric acid preservative. Boric acid can cause false negative culture if urine not filled to correct mark on specimen bottle


  • Interpretation of culture results in children:

  • Single organism ≥106 cfu/L (103 cfu/mL) may indicate UTI in voided urine

  • Any growth from a suprapubic aspirate is significant

  • Pyuria ≥107 WBC/L (104 WBC/mL) usually indicate UTI, especially with clinical symptoms but may be absent


  • Other diagnostic tests

  • Do not use CRP to differentiate upper UTI from lower UTI



  • Ultrasound:

  • If proven UTI is atypical (seriously ill, poor urine flow, abdominal or bladder mass, raised creatinine, septicaemia, failure to respond to antibiotic within 48 hours, non-E.coli infection): ultrasound all children in acute phase and undertake renal imaging within 4–6 months if under 3 years

  • All ages with recurrent UTI

  • For children under 6 months OR those with non-E.coli UTI: ultrasound within 6 weeks if UTI not atypical and responding to antibiotics

  • Refer to NICE CG54 for other things to consider in suspected UTI in children

BMJ Best Practice.png

Diagnosis of urinary tract infections

Public Health England. 

November 2018


Guidelines on paediatric urology: urinary tract infections in children

​European Association of Urology



UTI in children and young people

National Institute for Health and Care Excellence

October 2017


Urinary tract infection in under 16s: diagnosis and management

National Institute for Health and Care Excellence


Updated October 2018


Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months..

American Academy of Pediatrics. .

Pediatrics. 2011 Sep;128(3):595-610


Management of suspected bacterial urinary tract infection in adults.

Scottish Intercollegiate Guidelines Network (SIGN).

July 2012


Urinary tract infections in children

BMJ Best Practice

Last updated: October 2018

Last reviewed: March 2019


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