Introduction

This guideline outlines which children with urinary tract infections (UTIs) should be referred for specialist assessment. For diagnosis, investigation, imaging and treatment of UTIs, refer to the Clinical Practice Guideline: Urinary Tract Infection.  

Most children with a first, uncomplicated UTI who recover as expected can be managed in primary care and do not require specialist referral.

Refer to General Paediatrics if:

• ≥2 culture-confirmed febrile UTIs, or ≥3 culture-confirmed UTIs within 12 months
• Recurrent culture-confirmed UTIs associated with bladder or bowel dysfunction despite appropriate management.

Refer to Renal/ Nephrology if:

• Abnormal renal ultrasound suggestive of renal parenchymal disease or renal scarring
• High blood pressure for age confirmed on two or more occasions – see Hypertension CPG. Please see the pre referral guideline for Hypertension
• Renal impairment or persistent proteinuria (early morning urine protein:creatinine ratio >30mg/mmol on 2 or more occasions). Please see the pre referral guideline for Proteinuria

Refer to Urology if:

• Structural urinary tract abnormality requiring surgical review (e.g. significant hydronephrosis, obstructive uropathy, thick walled or trabeculated bladder, ectopic ureter/ureterocoele).

Do NOT routinely refer

• Single uncomplicated UTI with appropriate clinical recovery and no concerning features
• Asymptomatic bacteriuria

Red flags –send to the Emergency Department

• Infant <3 months with suspected UTI
• Suspected sepsis
• Clinically unwell child with suspected pyelonephritis
• Unable to tolerate oral fluids or antibiotics
• Significant dehydration
• Acute kidney injury
• Persistent fever or clinical deterioration despite 48 hours of appropriate antibiotic treatment

Wait time for appointments 

Specialist Clinics wait times 

Services available closer to home

Most children with uncomplicated UTIs can be managed by their GP or local paediatric service and do not require referral to The Royal Children's Hospital. Where specialist review is required, referral to a local paediatric service is preferred whenever appropriate.

Pre-referral work up/management

• Confirm the diagnosis with a urine culture and treat according to Clinical Practice Guidelines.
• Optimise bladder and bowel health (including management of constipation), hydration and toileting habits.
• Review urine culture results and tailor antibiotics as required.
• Arrange investigations as per the Clinical Practice Guideline.
• Do not routinely arrange VCUG/MCUG or commence antibiotic prophylaxis before specialist review unless specifically advised.

Referral criteria / required information

• Urine MCS results
• Relevant blood results (if performed)
• Renal ultrasound report (if performed)
• Number of previous UTIs
• Blood pressure (if available, particularly important for renal referrals)
• History of constipation or voiding dysfunction

How to refer

Specialist Clinics referral

Please complete the above and submit via:

• Facsimile (03) 9345 5034 or
• Email screferrals@rch.org.au
• Urgent referral or clinical query call ED admitting officer or Registrar on-call (03) 9345 5522

Information for families

•  RCH Kids Health Information: Urinary Tract Infection (UTI)

Resources and links

• RCH CPG: Urinary Tract Infection
• HealthPathways: Urinary Tract Infection (UTI) in Children

Acknowledgements

The development of this guideline was coordinated by General Medicine. Guideline reviewed in July 2026.