Pyelonephritis or Kidney Infection (Child)
A type of infection of one or both kidneys is called pyelonephritis. A kidney infection is a type of urinary tract infection. It's usually caused when bacteria or a virus gets into the kidneys. The bacteria or virus can enter the kidney(s) from the bladder or from blood traveling from other parts of the body.
Common causes for UTIs in children include:
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Not keeping the genital area clean and dry. This promotes the growth of bacteria.
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Wiping from back to front (in young girls). This spreads bacteria from the rectum toward the urinary opening (urethra).
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Wearing tight pants or underwear. This allows moisture to build up in the genital area, which helps bacteria grow.
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Sensitivity to the chemicals in bubble baths. These can enter the urinary opening and can lead to a urinary infection.
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“Holding” the urine for long periods.
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Dehydration.
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Severe constipation or bowel dysfunction.
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Structural abnormalities of the urinary system. As many as 50% of newborns and infants with a UTI and 20% to 30% of school-aged children with a UTI have these abnormalities.
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Urine that flows back up the ureters (vesicoureteral reflux).
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Having a bladder catheter for a prolonged period.
During infancy, boys are more likely to develop UTIs. After infancy, girls are much more likely to develop UTIs because their short urethras make it easier for bacteria to move up the urinary tract. A first-time urinary tract infection isn't unusual in a female child. But repeated infections in a girl or a first-time infection in a boy will need more testing.
Kidney infections can cause symptoms similar to a bladder infection. The infection can cause symptoms such as:
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Pain (or burning) when peeing.
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Having to pee more often than usual.
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Bedwetting or peeing in underwear (by a child who is toilet-trained).
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Blood in pee (pink or red in color).
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Belly pain or discomfort, usually in the lower abdomen.
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Pain in the side or back.
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Pain above the pubic bone.
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Fever or chills.
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Vomiting.
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Crankiness, especially in infants.
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Refusing to eat.
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Poor weight gain.
Children younger than 2 years old may only have a high fever without other symptoms involving the urinary tract (such as blood in the pee or pain when peeing).
Children who are older than 2 months of age and not vomiting are treated with oral (liquid, pills) antibiotics. These are started right away with antibiotics. If a culture is done, you will be told if the treatment needs to be changed. If directed, you can call to find out the results.
Based on a child’s age (less than 2 months), overall health, or how severe the infection is, the child may need to be admitted to the hospital for I.V. (intravenous) antibiotics.
Some children with structural problems of the urinary tract need surgery to correct the problem.
Home care
Medicines
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The doctor will prescribe medicine to treat the infection. Follow all instructions for giving this medicine to your child. Use the medicine as instructed every day until it's gone. Don’t stop giving it to your child even if they feel better. Never give your child aspirin unless the doctor tells you to.
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For children ages 2 and up: You can give acetaminophen or ibuprofen for pain, fever, fussiness, or discomfort, if the doctor says it's okay.
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If your child has chronic liver or kidney disease, talk with the doctor before giving these medicines. Also talk with the doctor if your child has ever had a stomach ulcer or gastrointestinal bleeding or is taking blood thinners. Contact your child’s doctor before you start or stop any medicine (over-the-counter or prescription).
General care and prevention
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Your child should stay home from school and rest in bed until their fever breaks and your child feels better, or as advised by the doctor.
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Make sure your child drinks plenty of fluids. Or make sure your baby feeds often. This is to prevent dehydration. Ask the doctor how much water your child should try to drink daily.
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Keep track of how often your child pees. Note the color and amount.
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Do what you can to get your child to pee at least every 3 to 4 hours during the day. Make sure they do not delay. Holding urine and overstretching the bladder can make your child’s condition worse.
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Tell your child to completely empty the bladder each time. This will help flush out bacteria.
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Have your child wear loose clothes and cotton underwear.
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Give your child cranberry juice if advised by the doctor.
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Females should avoid taking bubble baths. Sensitivity to the chemicals in bubble baths can irritate the urethra.
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Make sure your child wipes from front to back after using the toilet. Wipe your baby from front to back during diaper changes.
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Make sure the penis is cleaned regularly. If not circumcised, have your child retract (pull back) the foreskin when cleaning.
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Change soiled diapers right away. Keep the genital region clean and dry.
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Constipation can make a urinary tract infection more likely. Talk to your child’s doctor if your child has trouble with bowel movements.
Follow-up care
Make a follow-up appointment as directed by your child’s doctor. Close follow-up and further testing are very important to find the cause and to prevent future infections.
If your child had a urine culture during this visit, you will be contacted if your child’s treatment needs to be changed. If directed, you can call to find out the results.
If your child had an X-ray, CT scan, or another diagnostic test, you will be notified of any new findings that may affect your child’s care.
Call 911
Call 911 if your child:
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Has trouble breathing.
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Is confused.
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Is very drowsy or has trouble waking up.
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Faints (loses consciousness).
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Has a rapid or very slow heart rate.
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Is weak or dizzy or feels faint.
When to seek medical advice
Contact your child's doctor right away if your child:
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Is not feeling better within 1 to 2 days after starting antibiotics.
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Is 2 years old or older and on antibiotics and has a fever of 102.2°F or higher (39°C) or has a fever that lasts for more than 2 days or as directed by the doctor.
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Has any symptoms that continue after 3 days of treatment.
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Has increasing pain in the stomach, back, side, or groin area.
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Has trouble peeing or is peeing less than normal.
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Has no urine for 8 hours, no tears when crying, "sunken" eyes, or a dry mouth.
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Is vomiting.
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Has bloody, dark-colored, or foul-smelling pee.
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Cannot take prescribed medicine due to nausea or any other reason.
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Is female and has vaginal discharge, pain, or swelling or redness in the outer vaginal area (labia).
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Is a baby and is more cranky or fussy than usual or won't calm down.