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

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

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 .

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 .

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

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