Clinical features

The symptoms of a childhood urinary tract infection are often non-specific and the younger the child the more likely this is to be true.

In neonates and infants the presentation may be of failure to thrive, poor feeding, vomiting, diarrhoea, or even neurological symptoms. Jaundice and septicaemia may occur in neonates with a urinary tract infection.

In the non verbal child there may be crying on passing urine, straining, and loss of appetite.

The older the child the more specific the symptomatology. An older child may present with symptoms such as fever, loin pain and tenderness, dysuria and urinary frequency.

NICE have outlined possible symptoms with respect to age groups (1):

• infants younger than 3 months
  • most common symptoms
    • fever
    • vomiting
    • lethargy
    • irritability
  • moderately common
    • poor feeding
    • failure to thrive
  • least common
    • abdominal pain
    • jaundice
    • haematuria
    • offensive urine
      
      
• infants and children, 3 months or older
  
  
  • preverbal
    • most common
      • fever
    • moderately common
      • abdominal pain
      • loin tenderness
      • vomiting
      • poor feeding
    • least common
      • lethargy
      • irritability
      • haematuria
      • offensive urine
      • failure to thrive
        
        
  • verbal
    • most common
      • frequency
      • dysuria
    • moderately common
      • dysfunctional voiding
      • changes to continence
      • abdominal pain
      • loin tenderness
    • least common
      • fever
      • malaise
      • vomiting
      • haematuria
      • offensive urine
      • cloudy urine

Notes:

• Symptoms and signs
  • 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

Reference:

1. NICE (September 2017).Urinary tract infection in children: diagnosis, treatment and long-term management .