February 20, 2025, 3:24 am | Read time: 8 minutes

A urinary tract infection is very unpleasant: It burns terribly when urinating, and you constantly feel the need to go to the bathroom. This is also a torment for children. Moreover, if left untreated, such an infection can lead to serious health problems. Parents should therefore recognize the symptoms early.

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How common is a bladder infection in children?

Urinary tract infections are very common in children: By the age of seven, about eight percent of girls and two percent of boys have had at least one urinary tract infection.¹ They are among the most common bacterial infections in infants and children. In the first six months of life, boys are more often affected by urinary tract infections, but later, girls are 10 to 20 times more likely to get them than boys.² Children who still wear diapers are also at increased risk because moisture and lack of ventilation promote bacterial growth.

Frequent urinary tract infections can also indicate congenital urinary tract defects, which are clarified using an ultrasound.³

What are the causes of a bladder infection in children?

Bladder infections are caused by bacteria from the intestines. Escherichia coli is the most common pathogen.⁴ In our intestines, the bacterium is a normal “resident.” But when it travels, it causes problems: It can colonize the urinary tract and cause inflammation. Incorrect wiping technique (from back to front) after using the toilet can promote the entry of bacteria. Wet diapers are also a breeding ground for germs.⁵ In a small study, particularly absorbent diapers were found to be less favorable: They may provide insufficient air circulation and also lead to less frequent diaper changes.⁶

Additionally, there are congenital factors that can promote urinary tract infections. Children with a condition called vesicoureteral reflux, a malformation that causes urine to flow back into the ureters, have a particularly high risk of frequent urinary tract infections. An ultrasound examination can clarify whether such an anomaly is present. A weakened immune system due to infections or other illnesses can also lead to easier bacterial growth.⁷

Another risk factor is hypothermia. Children who sit on cold surfaces for long periods or wear wet clothing are more susceptible to bladder infections. The blood vessels constrict due to the cold, resulting in poorer blood circulation in the urethra and weakened immune defense.⁸

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Symptoms of a bladder infection in children

The symptoms of a urinary tract infection vary depending on age. In infants and toddlers, the signs are often not clear: fever, restlessness, loss of appetite, and a noticeable urine odor can be early indicators. Some babies cry when urinating, which suggests pain. Children who were already “dry” may start wetting themselves again during a urinary tract infection.

Older children, on the other hand, often complain of burning pain when urinating and feel the need to go to the bathroom frequently, even though only small amounts of urine are passed. The urine may be cloudy or even bloody. Sometimes abdominal or back pain occurs, especially if the infection spreads to the kidneys.⁹

What complications can arise from a bladder infection?

If a bladder infection is left untreated, it can develop into a kidney infection (pyelonephritis). This serious infection can have lasting consequences if untreated. Babies and toddlers are particularly at risk: Their kidneys are not yet fully developed. As a result, bacteria from a bladder infection can more easily spread to the renal pelvis and cause inflammation there. This can lead to long-term kidney damage. Signs of a kidney infection include severe abdominal, back, or side pain, high fever or chills, vomiting, a general feeling of illness, and blood in the urine.¹⁰ To prevent a bladder infection from worsening into a kidney infection, suspicious symptoms in children should always be promptly evaluated by a pediatrician.

How is a bladder infection diagnosed?

A urine sample can reveal whether the pain during urination is due to a bacterial infection of the urinary tract. Therefore, it’s best to bring a cup of urine to the doctor’s visit. Otherwise, the urine sample will be taken at the practice. The urine is tested for bacteria, inflammatory cells, and nitrite.¹¹ In older children, a so-called midstream urine sample can be used, while in younger children, urine is often collected using a special urine bag. If a complicated urinary tract infection is suspected, an ultrasound examination of the kidneys and bladder can help. In more severe cases or with repeated infections, a cystoscopy or an X-ray examination with contrast medium may be necessary to make an accurate diagnosis. Additionally, a urine culture is sometimes created to identify the specific bacterium and enable targeted antibiotic therapy, especially if a urinary tract infection has occurred frequently.

When should a child with a bladder infection see a doctor?

In general: always. A bladder infection should always be medically evaluated because, if untreated, it can lead to more severe infections. A doctor can perform the necessary urine analysis and determine whether it is a urinary tract infection or another issue–especially in young children who cannot accurately describe how they feel. Finally, there are many different causes for abdominal pain or fever.¹² Additionally, a prescription antibiotic is usually necessary to clear the infection. The mandatory doctor’s visit applies not only to children but also to pregnant women. Also, if infections recur or if symptoms do not subside despite adequate fluid intake and warmth, a doctor should be consulted immediately.

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Treatment: What helps with a bladder infection?

The standard therapy usually involves administering an appropriate antibiotic that specifically targets the causative bacteria. It is important not to stop the antibiotic course prematurely, even if the symptoms have already subsided, as this can lead to resistance.¹³ This means certain antibiotics are then no longer effective–a development affecting more and more people worldwide.¹⁴ Special diuretics are not suitable until school age, as they can irritate the bladder too much and worsen the symptoms. Additionally, doctors can prescribe child-friendly pain relievers (such as specific dosages of ibuprofen or acetaminophen) if needed.¹⁵

In addition to medication therapy, it’s crucial to: Drink, drink, drink! This helps flush the bladder and urinary tract, expelling bacteria from the body more quickly. Warm sitz baths with chamomile or a hot water bottle on the lower abdomen can also help alleviate symptoms.

Prevention: How can bladder infections be prevented?

Good hygiene is the best protection against a bladder infection. For girls, this means always wiping from front to back after using the toilet. Also, when you “have to go”–go to the bathroom as soon as possible and don’t hold it in for too long. When urinating, always empty the entire bladder–bacteria can quickly accumulate in residual urine. Constipation should also be avoided. The Bristol Stool Scale can help determine what the “result” on the toilet should ideally look like.

Appropriate clothing is also important. Warm underwear and dry clothing can help prevent hypothermia. Especially feet and the lower abdomen should not get cold–so no walking barefoot in winter, and don’t sit on damp or cold surfaces. Children should also get used to drinking plenty of fluids early on. This helps keep the urinary tract and kidneys healthy.

According to recent studies, cranberry juice can also help prevent urinary tract infections. The juice from the tart berry has shown such good results, especially in women and children, that an international research group has now issued a recommendation for it. However, probiotics, which are products containing specific bacterial cultures, have not been found to have a clearly demonstrable effect in preventing urinary tract infections.¹⁶