When grown-ups get a urinary tract infection, they can usually tell you exactly what's wrong. Young children can't. A baby may only cry, run a fever or refuse to feed. A four-year-old might say their tummy hurts. A nine-year-old girl may put up with the discomfort for days because she's too embarrassed to bring it up. So in childhood, the same infection looks different depending on how old the child is.
The clinic's medical team put this guide together for the parents and grandparents raising kids in Lawndale and across the East End. It doesn't replace having your child examined, but it should help you know what to watch for and when waiting is not an option.
Why kids get them
The urinary tract (kidneys, ureters, bladder and urethra) is normally free of bacteria. An infection starts when germs from the bowel travel up the urethra into the bladder and sometimes on to a kidney. In childhood, girls get UTIs more often because their urethra is short and close to the anus. In boys, they are most common during the first year of life.
A few things make an infection more likely in any child:
- Constipation. A full bowel presses on the bladder and keeps it from emptying completely.
- Holding it in. Plenty of school-age kids avoid the school restroom or don't want to stop playing, so urine sits in the bladder for hours.
- Wiping back to front once they start using the toilet on their own.
- Bubble baths, scented soaps or very tight underwear, which irritate the area in girls.
- A difference in how the urinary tract is built, such as urine flowing backward from the bladder toward a kidney (reflux), sometimes discovered only after a first infection.
The signs shift as children grow
The chart below sums up what tends to show up at each stage. Treat it as a map, not a diagnosis: a child may have just one of these signs.
| Age | What you may notice | What's most concerning |
|---|---|---|
| Babies (up to age 2) | Fever with no cough or runny nose to explain it, fussiness, refusing the bottle or breast, vomiting, a diaper that smells unusually strong | Any fever under 3 months old, a listless baby, or fewer wet diapers |
| Preschoolers (ages 2 to 5) | Crying or complaining while peeing, going constantly, daytime accidents after being potty trained, tummy ache, fever | High fever with vomiting or with pain in the back or side |
| School-age kids (6 and up) | Burning when they pee, urgency, passing only a little at a time, pain below the belly button, wetting the bed again, cloudy or pinkish urine | Fever with chills and side pain, which suggest the kidney is involved |
Babies: fever may be the only clue
In the first months of life, a UTI rarely looks like a "urine problem." What you usually see is a temperature of 100.4 °F (38 °C) or higher with no other obvious source: no cold, no diarrhea, ears look fine. Some babies just seem sleepier, feed less or stop gaining weight the way they were. In newborns, yellowish skin can come along with it.
If your baby is younger than 3 months and has a fever, go to the emergency room or call your pediatrician right away. At that age every fever gets checked as soon as it appears, without waiting to see whether medicine brings it down.
Preschoolers: "my tummy hurts"
Between two and five, children do complain, but they don't always point to the right spot. Notice whether your child dashes to the bathroom and barely pees, cries on the potty, keeps touching the genital area, or suddenly starts having accidents after months out of diapers. That setback isn't stubbornness: an irritated bladder doesn't give them time to make it.
School-age kids: they'll tell you if they feel safe
From about six on, the signs look more like an adult's: burning, urgency, strong-smelling or cloudy urine, pain low in the belly. One clue that throws a lot of parents off is a child who starts wetting the bed again after years of dry nights. Ask gently and without scolding; at this age embarrassment keeps many kids quiet.
How a urine sample is collected from a child
Confirming a UTI takes urine, and how it's collected matters a lot, because a sample contaminated by skin bacteria can give a misleading result. Broadly speaking:
- Kids who are potty trained. The "clean catch" method is used: rinse the genital area with water, start peeing into the toilet, catch the middle part of the stream in the sterile cup, and finish in the toilet. Girls often find it easier to sit backward on the seat, facing the tank, with knees apart. Help younger children through it.
- Babies and toddlers in diapers. Sometimes a small adhesive bag is used; it can help rule an infection out but is easily contaminated. When an infection has to be confirmed, especially in a feverish baby, your pediatrician's office or the ER will usually collect urine with a very thin catheter. It's the most reliable method at that age.
- The culture. Besides the urinalysis, children almost always get a urine culture, which identifies the bacteria and the antibiotic that will work best. That result takes a few days, and if it points to a different medicine, you'll be contacted.
After a first UTI with fever in a young child, your pediatrician may order a kidney ultrasound to make sure everything is formed normally.
Signs your child needs the ER or 911
If you see any of these, skip the clinic and get emergency care:
- A fever and is younger than 3 months.
- A high temperature with shaking chills and side pain that keeps them curled up.
- Vomiting that won't let them keep down water or an electrolyte drink.
- No urine for many hours, or a baby with dry diapers.
- Extreme drowsiness, confusion, trouble waking up, or fainting.
When the clinic is the right stop
The clinic sees children and adults. If your daughter or son uses the toilet independently, can give a clean sample and has none of the warning signs above, you can bring them to our urinary tract infection service: we run the urine test at the clinic and, if there is an infection, you leave with your treatment the same day, dosed for your child's weight, along with clear instructions on giving it at home, how quickly they should perk up, and which changes mean coming back. When the situation calls for it, a culture is sent and we help arrange a referral to a children's urinary specialist.
If your child needs treatment, the prescription is sent electronically to the pharmacy of your choice, so you can pick it up at whichever one sits on your way home through the East End instead of juggling paper slips with a tired, warm little one buckled in behind you. And if the fever comes with a very sore throat and no cough, the problem may not be urinary at all: our rapid strep test helps sort that out.
Keeping it from coming back
- Offer water throughout the day and pack a refillable bottle for school.
- Teach your child to use the bathroom every few hours, even mid-game, rather than holding it.
- Deal with constipation: fruit, vegetables, water and active play. If it lingers, bring it up at the visit.
- Teach girls to wipe front to back, and choose cotton underwear.
- Swap bubble bath for plain water and a mild soap.
If your child needs a school physical, use that visit to mention whether they avoid the school restroom or have started wetting the bed again.
You'll find us in Lawndale, ZIP code 77023, with free parking so you can get your little one out of the car without rushing. Walk in, or call (832) 530-4188 to set a time, and if you're unsure whether your child's symptoms belong at the clinic or the ER, ask over the phone before you head out.
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