Urinary tract infection in the infant: The unsuspected diagnosis

Urinary tract infection (UTI) in childhood is surpassed only by the usual fevers and upper respiratory tract infections in its frequency of occurrence, yet a high index of suspicion, aggressive treatment, and conscientious follow-up is not common. Although most infants with UTI have few residua, others require urinary tract diversion and still others develop end-stage renal disease. Perhaps the reason that UTIs are often overlooked in children is because of the emphasis that is put on flank pain, dysuria, or frequency as signs of UTI, with little regard to the age variables associated with these symptoms. However, nonspecific symptoms such as jaundice, anorexia, vomiting, failure to thrive, enuresis, and abdominal pain may signal UTI in a young child. Children in whom such symptoms exist but in whom the significance goes unnoticed may be those who fail to thrive as infants, develop obvious infection as adolescents, and develop end-stage renal disease as adults. Children at particular risk who deserve close monitoring are those whose first UTI occurs before age 2 years, boys with structural anomalies, and those with recurrent infections, as illustrated by 2 case reports.