What are the key clinical features to consider when diagnosing a urinary tract infection in children?

When diagnosing a urinary tract infection (UTI) in children, key clinical features to consider include:

• Painful urination (dysuria)
• More frequent urination
• New bedwetting
• Foul smelling (malodorous) urine
• Darker or cloudy urine
• Visible blood in urine (frank haematuria)
• Reduced fluid intake
• Fever
• Shivering
• Abdominal pain
• Loin or suprapubic tenderness
• Capillary refill longer than 3 seconds
• Previous history of confirmed UTI

These symptoms and signs increase the likelihood of a UTI and should prompt urine testing in babies, children, and young people ¹.

Conversely, the absence of painful urination, presence of nappy rash, breathing difficulties, abnormal chest or ear examination, or fever with a known alternative cause decrease the likelihood of UTI and suggest considering alternative diagnoses ¹.

In babies under 3 months with suspected UTI, urgent referral to paediatric specialist care and urine testing is recommended due to higher risk ¹.