Assessing acute cystitis in children

For advice on the assessment and management of neonates and children younger than 3 months with a suspected UTI, see Urinary tract infection in neonates and children younger than 3 months.

It can be difficult to distinguish pyelonephritis and cystitis in young children. Choice of therapy is guided by the child’s symptoms:

treat as acute cystitis if the child has bacteriuria and localising symptoms (such as dysuria, frequency, urgency or lower abdominal discomfort), and does not have fever (38°C or higher) or loin pain or tenderness
treat as acute pyelonephritis if the child has bacteriuria and either fever (38°C or higher) or loin pain or tenderness.

If there is clinical uncertainty, treat as for acute pyelonephritis Schroeder, 2014.