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A panel of multidisciplinary experts developed the guideline and expanded its recommendations to apply to a broader age range of children, now 8 days to 5 years of age 

September 28, 2026 - ITASCA--The American Academy of Pediatrics has published a comprehensive clinical practice sleeping baby bedroom 2563798 640guideline on diagnosing and managing urinary tract infections in young children, a common bacterial infection detected in up to 7% of infants with fever. 

The recommendations in “Clinical Practice Guideline for the Diagnosis and Treatment of Urinary Tract Infection in Children From 8 Days to 5 Years of Age” mark the first update of the literature and clinical recommendations since 2011. The guideline and three accompanying technical reports are published in the October 2026 Pediatrics (published online Sept. 28). 

“UTIs are one of the most common bacterial infections in infants and young children but reaching a diagnosis can be challenging,” said Brian K. Alverson, MD, FAAP, chairperson of the guideline panel.  “The updated guideline aims to give clinicians clearer, more up-to-date direction for care based on evidence.” 

The AAP retired the prior guideline in 2021 because it improperly used race as a biological factor to calculate disease risk. Race is not included as a risk factor in the updated clinical practice guideline, which also expands the age range for recommendations. The guideline addresses UTI in children from 8 days to 5 years of age, instead of the previous range of 2 months to 2 years of age. 

A panel of multidisciplinary experts developed the guideline, which underwent extensive peer review by individuals and organizations representing many different aspects of generalist and subspecialty pediatric care. The recommendations and supporting narrative highlight the important partnership between generalist and subspecialty care in the diagnosis and management of urinary tract infections. 

The clinical practice guideline was approved by the AAP Board of Directors before publication in Pediatrics.  

To diagnose urinary tract infections, clinicians must combine symptoms, urinalysis, culture thresholds, and clinical judgment, recognizing risk of both over- and under-treatment. The 2026 clinical practice guideline contains these updates:

  • Shorter antibiotic courses (seven days or fewer) are preferred for most children, with duration tailored by age and severity; longer courses are reserved for infants, high-risk cases, or poor clinical response;  
  • Greater attention to constipation and bladder-bowel dysfunction as contributors to recurrent infection;
  • Clear recommendations for primary care clinicians regarding when referral to a subspecialist might be indicated;  
  • Children 2 months to 5 years old with fever without a source or urinary symptoms are encouraged to be evaluated for UTI within 72 hours, with faster assessment for higher-risk patients to reduce risk of kidney injury and scarring. 

The guideline emphasizes individualized care with shared decision-making, acknowledging variability in evidence, patient risk, access to care, and the importance of reducing unnecessary antibiotics and improving health equity. 

“We recognize that physicians must make decisions on the unique needs and symptoms of each individual patient,” said David S. Hains, MD, FAAP, vice chairperson of the guideline panel. “This decision-making ideally occurs through a shared process that considers the patient’s and caregiver’s values and preferences.” 

Additional resources

Commentary, “Truth, Reconciliation, and Transformation: Another Step Forward,” published online Sept. 28 and in the December 2026 Pediatrics.

HealthyChildren.org articles

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.

Source: American Academy of Pediatrics