Other than fever, few symptoms are consistently found in infants and children diagnosed with UTI. Neonates may present with jaundice, poor feeding, irritability, and lethargy. Older infants and young children commonly present with gastrointestinal complaints, such as abdominal pain, vomiting, and change in appetite. The classic signs of dysuria, urinary frequency, urgency, or hesitancy are more likely to be present in older children and adolescents. The clinical signs and symptoms of UTI also vary with the primary site of infection along the urinary tract. The symptoms of dysuria, frequency, and urgency are more often associated with lower tract (uncomplicated) infections, such as cystitis, and urethritis. More systemic symptoms, such as fever, chills, vomiting, and dehydration, suggest upper tract (complicated) infection. However, recent studies clearly indicate that pyelonephritis often occurs in the absence of such symptoms. -I0 Unfortunately, the signs and symptoms of infection anywhere along the urinary tract may be nonspecific and overlapping. For these reasons, UTI should be considered in all febrile children, regardless of symptoms or lack thereof. Furthermore, upper tract infection should be considered as well, particularly in febrile children. The utility to distinguish between lower and upper tract disease is relevant when considering treatment options, long-term sequelae, and recommendations for follow-up.
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