• Suspect UTI if the child has any combination of:
• Frequency, dysuria (most common presentation in verbal children).
• Fever without an obvious cause (most common presentation in preverbal children).
• Fever with a presumed cause but poor response to treatment.
• Abdominal pain, loin tenderness. Vomiting, poor feeding. Malaise, lethargy, irritability. Haematuria, offensive urine, cloudy urine. Failure to thrive.
• Dysfunctional voiding (voluntary withholding of urine or faeces), incontinence of urine or faeces. New onset of bedwetting.

In depth

• Make a preliminary diagnosis on the basis of the clinical symptoms and urine dipstick test (or, if available, urgent microscopy).
• Confirm the diagnosis with urine culture.

In depth

• Children with suspected urinary tract infection (UTI) are at high risk of serious illness if:
• They are systemically unwell, dehydrated, or vomiting and cannot tolerate oral fluids and medication.
• Have a history or clinical features suggesting urinary tract obstruction.
• Children with suspected UTI are at intermediate risk of serious illness if:
• They are not at high risk, and they do not satisfy all the criteria for being at low risk.
• Children with suspected UTI are at low risk of serious illness if:
• Temperature is less than 38°C with no history of fever and there is no loin pain/tenderness.
• Colour, cry, responsiveness, and hydration are normal.

In depth

• Make a working diagnosis of upper UTI (acute pyelonephritis) if there is:
• Fever of greater than 38°C (or history of fever) and bacteriuria, or
• Fever of less than 38°C (and no history of fever), loin tenderness, and bacteriuria.
• Otherwise, diagnose lower UTI (cystitis), which in older children usually presents with specific symptoms (frequency, dysuria, lower abdominal pain).

In depth