Urinary tract infection in children

Causes and risk

In a child presenting with dysuria the causes divide into infectious and non-infectious. The infectious ones are cystitis, pyelonephritis, urethritis, and balanitis and balanoposthitis. The non-infectious ones are vesicoureteral reflux, urinary tract stones, irritants, trauma, labial adhesions and tumours. Sexual activity and pregnancy are named among the factors that predispose to cystitis, pyelonephritis, urethritis and asymptomatic bacteriuria.

One line of the material cuts against what is usually expected of sex: before age 1, boys are more likely than girls to get UTI.

The anatomic risk factor to name is vesicoureteral reflux, and it is the one that carries an antibiotic prophylaxis with it.

How it presents

In neonates the symptoms are vague: fever, dehydration, fussy. The single most useful line in the whole topic sits here, because it converts a symptom into a level of the tract: if fever is present it is pyelonephritis, and cystitis has NO fever.

History taking asks for the typical presenting features that distinguish cystitis, pyelonephritis and urethritis from each other; it asks as well about dysuria, frequency, urgency, suprapubic pain and haematuria. The signs and symptoms of bacteraemia and sepsis are looked for alongside them, and in the wider list of causes of dysuria sit urinary tract stones, prostatitis, urethritis, vaginitis, genital herpes and balanitis, each with its own signs.