Clinical Manifestations
The clinical manifestations of UTIs depend on the child’s age. In newborn infants and children less than 2 years of age the signs are characteristically nonspecific. They more nearly resemble gastrointestinal tract disorders: failure to thrive, feeding problems, vomiting, diarrhea, abdominal distention, and jaundice. Newborns may have fever, hypothermia, or sepsis. Other evidence includes frequent or infrequent voiding, constant squirming and irritability, strong-smelling urine, and an abnormal stream. A persistent diaper rash may also be a helpful clue.
The classic symptoms of UTI are often observed in children more than 2 years of age. There include enuresis or daytime incontinence in the child who has been toilet trained, fever, strong or foul- smelling urine, increased frequency of urination, dysuria, or urgency. The children may also complain of abdominal pain or costovertebral angle tenderness (flank pain). Some will be seen with hematuria; preschoolers may vomit. There is a high frequency of obstructive uropathy in young infants and boys, which is characterized by dribbling of urine, straining with urination, or a decrease in the force and size of the urinary stream. High fever and chills accompanied by flank pain, severe abdominal pain, and leukocytosis suggest pyelonephritis. However, flank pain and tenderness may be the only indication of pyelonephritis on physical examination.
Manifestations in adolescents are more specific. Symptoms of lower tract infections include frequency and painful urination of a small amount of turbulent urine that may be grossly bloody. Fever, chills, flank pain, and lower tract symptoms, which may appear 1 or 2 days after the upper tract symptoms.
Many UTIs in children are asymptomatic or atypical in clinical presentation, and many complaints may be unrelated to the urinary tract. Many are treated as respiratory or gastrointestinal infections. It is important that these children be identified so that treatment can be initiated. Significant scarring can occur, especially in infants and very young children.