A practical approach to evaluating urinary tract infection in children.

All children with urinary tract infections should be investigated by either excretory urography or abdominal X-ray, ultrasonography and technetium 99m - dimercaptosuccinic acid scintigraphy. Patients in the following categories should also have micturating (voiding) cystourethrography to diagnose or exclude vesico-ureteral reflux: infants aged less than 1 year, children with recurrent (second or subsequent) infections, children with clinically diagnosed acute pyelonephritis and those with a family history of reflux or chronic pyelonephritis. Cystography can safely be omitted in children over 1 year of age with unscarred kidneys and none of the additional risk factors listed. They should be followed for 1-2 years following the first infection for evidence of recurrence.