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Urinary Tract Infection (UTI) in Children

General Information


  • An infection of the urinary tract, which may include bladder, kidney, ureter, and/or urethra, in infants and children. This is the most common bacterial infection in children < 2 years old.1,3

Also Called

  • UTI
  • lower UTI
  • cystitis
  • acute cystitis
  • pyelonephritis
  • acute pyelonephritis


  • classification by site of infection1,5
    • lower urinary tract infection (cystitis) - infection of urinary bladder mucosa
    • upper urinary tract infection (pyelonephritis) - infection of renal pelvis and parenchyma
  • classification by severity1
    • simple UTI - mild pyrexia, good fluid intake, slight dehydration, and good treatment compliance expected
    • severe UTI - fever of ≥ 39 degrees C (102.2 degrees F), persistent vomiting, moderate or severe dehydration, and poor treatment compliance
  • classification according to complicating factors1
    • uncomplicated UTI - normal upper and lower urinary tract, normal renal function, and competent immune system
    • complicated UTI - any UTI in neonate, patients with clinical evidence of pyelonephritis, and all children with known mechanical or functional obstructions of urinary tract


General References Used

  1. Radmayr C, Bogaert G, Dogan HS, et al. European Society for Paediatric Urology/European Association of Urology (ESPU/EAU) guidelines on paediatric urology. ESPU/EAU 2019 Mar
  2. American Academy of Pediatrics Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011 Sep;128(3):595-610, commentary can be found in Pediatrics 2012 Apr;129(4):e1051, reaffirmation can be found in Pediatrics 2016 Dec;138(6):pii.e20163026full-text
  3. Chang SL, Shortliffe LD. Pediatric urinary tract infections. Pediatr Clin North Am. 2006 Jun;53(3):379-400, vi
  4. Koyle MA, Shifrin D. Issues in febrile urinary tract infection management. Pediatr Clin North Am. 2012 Aug;59(4):909-22, editorial can be found in Pediatr Clin North Am 2012 Aug;59(4):923
  5. National Institute for Health and Care Excellence (NICE) guideline on urinary tract infection in children under 16 years: diagnosis and management can be found at NICE 2007 Aug 22:CG54PDF, updated October 2018

Recommendation Grading Systems Used

  • American Academy of Pediatrics (AAP) guideline grading system
    • grades of recommendation
      • Strong recommendation if both
        • preponderance of benefit or harm
        • evidence quality A, B, or X
      • Recommendation if both
        • preponderance of benefit or harm
        • evidence quality B, C, or X
      • Option if either
        • preponderance of benefit or harm with evidence quality D
        • balance of benefit and harm with evidence quality A, B, or C
      • No Recommendation if both
        • balance of evidence and harm
        • evidence quality D
    • levels of evidence quality
      • Evidence Quality A - well-designed randomized controlled trials or diagnostic studies on relevant population
      • Evidence Quality B - randomized controlled trials with minor limitations; overwhelmingly consistent evidence from observational studies
      • Evidence Quality C - observational studies (case-control and cohort design)
      • Evidence Quality D - expert opinion, case reports, and reasoning from first principles
      • Evidence Quality X - exceptional situations where validating studies cannot be performed and there is a clear preponderance of benefit or harm
    • Reference - AAP clinical practice guideline on diagnosis and management of initial UTI in febrile infants and children aged 2-24 months (21873693Pediatrics 2011 Sep;128(3):595)
  • European Society for Paediatric Urology/European Association of Urology (ESPU/EAU) grading system for recommendations
    • grades of recommendation
      • Grade A - based on clinical studies of good quality and consistency addressing the specific recommendations and including ≥ 1 randomized trial
      • Grade B - based on well-conducted clinical studies, but without randomized clinical trials
      • Grade C - made despite the absence of directly applicable clinical studies of good quality
    • levels of evidence
      • Level 1a - evidence obtained from meta-analysis of randomized trials
      • Level 1b - evidence obtained from ≥ 1 randomized trial
      • Level 2a - evidence obtained from ≥ 1 well-designed controlled study without randomization
      • Level 2b - evidence obtained from ≥ 1 other type of well-designed quasi-experimental study
      • Level 3 - evidence obtained from well-designed nonexperimental studies, such as comparative studies, correlation studies, and case reports
      • Level 4 - evidence obtained from expert committee reports or opinions or clinical experience of respected authorities
    • References -

Synthesized Recommendation Grading System for DynaMed Content

  • The DynaMed Team systematically monitors clinical evidence to continuously provide a synthesis of the most valid relevant evidence to support clinical decision-making (see 7-Step Evidence-Based Methodology).
  • Guideline recommendations summarized in the body of a DynaMed topic are provided with the recommendation grading system used in the original guideline(s), and allow users to quickly see where guidelines agree and where guidelines differ from each other and from the current evidence.
  • In DynaMed content, we synthesize the current evidence, current guidelines from leading authorities, and clinical expertise to provide recommendations to support clinical decision-making in the Overview & Recommendations section.
  • We use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to classify synthesized recommendations as Strong or Weak.
    • Strong recommendations are used when, based on the available evidence, clinicians (without conflicts of interest) consistently have a high degree of confidence that the desirable consequences (health benefits, decreased costs and burdens) outweigh the undesirable consequences (harms, costs, burdens).
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  • DynaMed topics are written and edited through the collaborative efforts of the above individuals. Deputy Editors, Section Editors, and Topic Editors are active in clinical or academic medical practice. Recommendations Editors are actively involved in development and/or evaluation of guidelines.
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    Topic Editors define the scope and focus of each topic by formulating a set of clinical questions and suggesting important guidelines, clinical trials, and other data to be addressed within each topic. Topic Editors also serve as consultants for the internal DynaMed Editorial Team during the writing and editing process, and review the final topic drafts prior to publication.
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How to cite

National Library of Medicine, or "Vancouver style" (International Committee of Medical Journal Editors):

  • DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115591, Urinary Tract Infection (UTI) in Children ; [updated 2018 Nov 30, cited place cited date here]. Available from Registration and login required.

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