Urinary Tract Infection – Female

Is this your child’s symptom?

• Your child was diagnosed with a urinary tract infection (UTI)
• The most common UTI is a bacterial infection of the bladder. The medical name is cystitis.
• Your child is taking an antibiotic for the UTI
• You are worried that the fever or pain is not getting better fast enough

Symptoms of UTI

• Pain, burning or stinging when passing urine
• Suspect pain if a young child starts to cry while passing urine
• The feeling of “can’t wait” to pass urine may occur. This is called urgency.
• Passing small amounts of urine at a time often. This is called frequency.
• New onset of day or night -time wetting
• Pain in the lower tummy may also occur. If the kidney is infected, the pain is in the flank. The flank is the side right below the ribs.
• UTIs are a common cause of fevers without other symptoms in young children.
• The urine may be cloudy and have a bad odor. Sometimes, there is some blood in the urine.

Causes of UTI

• UTIs are caused by bacteria that travel up the urethra into the bladder. The opening of the urethra is just above the vagina.
• The vulva is the area outside the vagina. Soaps can cause this area to be red, sore and itchy. This can lead to UTIs. Stool that gets on the vulva is another big factor. This can happen with careless wiping. It can also happen with constipation.
• A rare cause is if the bladder isn’t emptied all the way. Reason: Urine that stays in the bladder too long can become infected.
• Cystitis is more common in girls than boys. This is due to the much shorter length of the urethra in girls.

Diagnosis of UTI

• A clean catch urine sample needs to be tested. A UTI is confirmed by finding white blood cells in the urine. A positive culture for bacteria is also needed.

When to Call for Urinary Tract Infection – Female

Call 911 Now

• Not moving or too weak to stand
• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Side (flank) or lower back pain and new onset since starting antibiotic
• Stomach, side or back pain and worse since starting antibiotic
• Vomited 2 or more times and interferes with taking antibiotic
• Fever over 104° F (40° C)
• Shaking chills
• Age less than 1 year and any symptoms worse
• Taking antibiotic more than 24 hours and you think your child is worse
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Blood in urine and new onset since starting antibiotic
• Taking antibiotic more than 24 hours, and pain with passing urine is severe. (Plus the pain is not better 2 hours after taking pain medicine)
• Taking antibiotic more than 48 hours and fever still there or comes back
• Taking antibiotic more than 3 days and pain not better
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• You have other questions or concerns

Self Care at Home

• Bladder infection on antibiotic with no other problems
• Questions about prevention of bladder infections

Care Advice

Treatment for a Bladder Infection

1. What You Should Know about Bladder Infections:
   • Bladder infections are common in girls.
   • Most infections do not respond to the first dose of an antibiotic.
   • Often the bladder symptoms do not improve the first day.
   • Here is some care advice that should help.
2. Keep Giving the Antibiotic by Mouth:
   • UTIs need a prescription antibiotic. It will kill the bacteria that are causing the bladder infection.
   • Give it as directed.
   • Try not to forget any of the doses.
   • Give the antibiotic until it is gone. Reason: To keep the bladder infection from flaring up again.
3. Pain Medicine:
   • For pain when passing urine, give a pain medicine.
   • You can use an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Use as needed.
4. Fever Medicine:
   • For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Note: Fevers less than 102° F (39° C) are important for fighting infections.
   • For all fevers: Keep your child well hydrated. Give lots of cold fluids.
5. Give More Fluids:
   • Give extra fluids to drink. Cranberry juice may be helpful.
   • Reason: Fluids dilute the urine so that it does not sting.
6. Baking Soda Baths – For Young Girls:
   • Soak for 10 minutes to remove germs and to help with healing.
   • Add 2 ounces (60 mL) baking soda per tub of warm water.
   • Reason: Baking soda is better than vinegar for young girls.
   • During soaks, be sure she spreads her legs. This allows the water to cleanse the genitals.
   • Repeat baking soda soaks 2 times per day for 2 days.
7. Vinegar Warm Water Soaks – For Older Girls After Puberty:
   • Soak the genital area for 10 minutes to remove irritants and decrease pain.
   • Add 2 ounces (60 mL) vinegar per tub of warm water. Reason: After puberty, vinegar water matches the normal acid level of the vagina.
   • During soaks, be sure she spreads her legs. This allows the water to clean the genital area.
   • Repeat vinegar water soaks once per day until is better.
8. Young Girls – Avoid Soaps:
   • Avoid bubble bath, soap, and shampoo to the vulva. Reason: They are irritants and can lead to a UTI.
   • Only use warm water to clean the vulva area.
9. What to Expect:
   • Fever is usually gone in 48 hours.
   • Pain and burning are often much better in 48 hours.
   • Frequency (passing small amounts of urine often) is also usually better in 48 hours.
   • Bladder infections occur more than once in 10% of girls.
   • For any future fever without other symptoms, call your doctor’s office. Your child should be seen for a urine check.
10. Return to School:
    • Bladder infections cannot be spread to others.
    • Your child does not need to miss any school or child care.
11. Call Your Doctor If:
    • Pain when passing urine becomes severe
    • Fever lasts over 48 hours after starting the antibiotic
    • Vomiting and can’t keep down the antibiotic
    • You think your child needs to be seen
    • Your child becomes worse

Prevention of Bladder Infections in Girls

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1. Tips for How to Prevent UTIs in Girls:
   • When your child bathes, clean the genital area with warm water. Soap is not needed for young girls.
   • Don’t use bubble bath, shampoo or other soaps in the bath water. Reason: They are irritants.
   • Keep bath time less than 10 minutes. Your child also should pass urine right after baths.
   • Teach your daughter to wipe herself correctly from front to back after a stool.
   • Drink enough fluids each day to keep the urine light-colored.
   • Pass urine at least every 4 hours during the day and avoid “holding back.”
   • Wear cotton panties. Reason: To allow the skin to breathe. Your child doesn’t need to wear panties during the night.
   • Avoid constipation.
2. Call Your Doctor If:
   • You have other questions or concerns

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

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Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 10/11/2023

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Last Revised: 12/30/2022

Copyright 2000-2023. Schmitt Pediatric Guidelines LLC.

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