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Urinary tract infection in children
Short Text
Introduction
This pathway covers the diagnosis, treatment and management of urinary tract infections in children.
UTI is a common bacterial infection causing illness in infants and children. It may be difficult to recognise UTI in children because the presenting symptoms and signs are non-specific, particularly in infants and children under 3 years. Current management, which includes imaging, prophylaxis and prolonged follow-up, has placed a heavy burden on NHS primary and secondary care resources. It is costly, based on limited evidence and is unpleasant for children and distressing for their parents or carers. The aim of this pathway is to achieve more consistent clinical practice, based on accurate diagnosis and effective management.
Source guidance
The NICE guidance that was used to create the pathway.
Urinary tract infection in children. NICE clinical guideline 54 (2007)
Quality standards
Quality statements
Effective interventions library
Successful effective interventions library details
Implementation
Commissioning
These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.
Education and learning
NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.
Service improvement and audit
These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.
Pathway information
Information for the public
NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on:
Patient-centred care
Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If someone does not have the capacity to make decisions, healthcare professionals should follow the Department of Health's advice on consent, the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards. In Wales, healthcare professionals should follow advice on consent from the Welsh Government.
If the person is under 16, healthcare professionals should follow the guidelines in Seeking consent: working with children. If a young person is moving between paediatric and adult services their care should be planned and managed according to the best practice guidance described in the Department of Health's Transition: getting it right for young people.
Updates to this pathway
26 February 2013 Minor maintenance updates.
Supporting information
Glossary
Seriously ill (for more information refer to 'Feverish illness in children' [NICE clinical guideline 47])
Poor urine flow
Abdominal or bladder mass
Raised creatinine
Septicaemia
Failure to respond to treatment with suitable antibiotics within 48 hours
Infection with non-E. coli organisms.
Two or more episodes of UTI with acute pyelonephritis/upper urinary tract infection, or
One episode of UTI with acute pyelonephritis/upper urinary tract infection plus one or more episode of UTI with cystitis/lower urinary tract infection, or
Three or more episodes of UTI with cystitis/lower urinary tract infection.
Dimercaptosuccinic acid (DMSA) scintigraphy scan
Micturating cystourethrogram
Urinary tract infection
Vesicoureteric reflux
Child presents with suspected urinary tract infection
Child presents with suspected urinary tract infection
Information and advice following a urinary tract infection
Information and advice following a urinary tract infection
Information and advice following a urinary tract infection
Give children, parents and carers information and advice about the following:
- the need for treatment, the importance of completing treatment and advice about prevention and long-term management (if appropriate)
- the possibility of a UTI recurring, and the importance of being vigilant and seeking prompt treatment from a healthcare professional
- recognising symptoms quickly
- urine collection, storage and testing
- treatment
- prevention
- the nature of and reason for UTIs
- prognosis
- long-term management (if required).
NICE has written information for the public explaining the guidance on urinary tract infection in children.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodePreventing recurrence
Preventing recurrence
Preventing recurrence
Address dysfunctional elimination syndromes and constipation.
Encourage children to drink an adequate amount.
Emphasise the importance of not delaying voiding.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeFollow-up
Follow-up
Follow-up
Agree how to communicate the results of imaging tests with the parents or carers (or young person if appropriate).
No follow-up
Infants and children who do not undergo imaging investigations should not routinely be followed up.
When results are normal, a follow-up outpatient appointment is not routinely required. Inform parents or carers of the results of all the investigations in writing.
Infants and children who are asymptomatic following an episode of UTI should not routinely have their urine re-tested for infection.
Asymptomatic bacteriuria is not an indication for follow-up.
Referral and assessment
Infants and children who have recurrent UTI or abnormal imaging results should be assessed by a paediatric specialist.
Assessment of infants and children with renal parenchymal defects should include height, weight, blood pressure and routine testing for proteinuria.
Infants and children with a minor, unilateral renal parenchymal defect do not need long-term follow-up unless they have recurrent UTI or family history or lifestyle risk factors for hypertension.
Long-term follow-up
Infants and children who have bilateral renal abnormalities, impaired kidney function, raised blood pressure and/or proteinuria should receive monitoring and appropriate management by a paediatric nephrologist to slow the progression of chronic kidney disease.
Surgical intervention
Surgical management of VUR is not routinely recommended.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodePaths in this pathway
- Diagnosis of urinary tract infection in children
- Acute management of urinary tract infection in children
- Imaging tests for children with a urinary tract infection
Pathway created: August 2012 Last updated: February 2013
Copyright © 2013 National Institute for Health and Care Excellence. All Rights Reserved.