How do I know if my child has a urinary tract infection? Urinary tract infections are very common in infants, and 16% of children with an emergency fever have a urinary tract infection. On average, about 1 in 100 children have a urinary tract infection (under 1 year old: 2.7% of boys and 0.4% of girls). At this age, babies cannot express themselves, so how do they know it’s a urinary tract infection? History and symptoms The mother or an elderly person or aunt with the baby may find that the baby is irritable, does not take milk well, or even spits up milk. Sometimes the fever lasts for more than two days. The child does not have a cough or shortness of breath (pneumonia), nor does he or she have diarrhea (gastroenteritis), so there is no explanation for the child’s behavior. A talking child may also tell you that “it hurts to pee,” that his or her stomach hurts, or that “his or her back hurts. Those with children may notice that the child is urinating urgently, frequently, and see cloudy, “smelly” urine. Physicians should be aware that post-pubertal girls may become sexually active or even pregnant, all of which may increase the chance of urinary tract infections (STDs should be considered as well). The prenatal ultrasound should be carefully checked for hydronephrosis (and other urinary anomalies) and spina bifida (leading to neurogenic bladder). Physical examination Many children have no specific signs. Some just have a high fever. However, the abdomen should be systematically examined for hydronephrosis, bladder (neurogenic bladder), tumors, or feces in the sigmoid colon (constipation is one of the causes of the elimination syndrome). The sacrum (spina bifida) should also be examined for hairs, sinuses, and lipomas. Lower extremities, anus for normal nerve development. Boys should be checked for paronychia. Urine collection How to collect urine? This is a learning curve. It depends on the level of suspicion you have for the diagnosis of urinary tract infection. There are four methods of urine collection listed below. My personal recommendation is to use the first two if you just want to expel a urinary tract infection (which is unlikely), and the last two if you have a high suspicion of a urinary tract infection and want to know for sure the nature of the bacteria and their resistance to drugs. Urine bag Bring a small plastic bag on the penis or the girl’s vagina and take some urine. A simple routine urine test and microscopic examination (urinalysis) can be done. A urinalysis can usually be done in a few minutes with reagent strips. The most important indicators are the white cell count and nitrite. White blood cells are a reflection of all inflammation in the body. Nitrate in food can be converted to nitrite by bacteria in the bladder. If both white blood cells and nitrite are positive, 96% are urinary tract infections and antibiotics can be prescribed. If both are negative, then it should not be an infection. What if the white blood cells are positive and the nitrites are negative? If the child is asymptomatic, I would wait for the urine culture results and not prescribe antibiotics. If the white blood cells are negative and the nitrites are positive, it is usually recommended to give antibiotics first.