Vesicoureteral Reflux (VUR) in Children
Content reviewed against published AAP, NIH, AAP guidelines
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Vesicoureteral reflux (VUR) is a condition where urine flows backward from the bladder into the ureters and potentially into the kidneys. It is the most common urological abnormality in children, affecting approximately 1-2% of all children and found in 30-40% of children who present with a UTI. VUR is graded I through V based on severity. The primary concern is that reflux of infected urine into the kidneys can cause renal scarring and long-term kidney damage. Many children with low-grade VUR outgrow it as the bladder matures.
Key takeaways
- Vesicoureteral reflux (VUR) is a condition where urine flows backward from the bladder into the ureters and potentially into the kidneys.
- Duration: VUR is a chronic condition that often resolves over years. Grade I-II: 80-90% resolve by age 5-6. Grade III: 50% resolve. Grade IV-V: 10-20% resolve spontaneously. Resolution depends on grade, bilateral vs. unilateral, and presence of bladder dysfunction. Monitoring continues until resolution confirmed on imaging.
- Go to ER if: High fever (103°F+) with vomiting in a child with known VUR
- No vaccine currently available
Symptoms
How It Presents by Age
0-12 months
Often detected after investigation of febrile UTI or prenatally detected hydronephrosis. More common in boys in this age group. High-grade VUR (IV-V) may present with recurrent pyelonephritis. Often discovered when investigating first febrile UTI.
Risk level: Moderate to high — depends on grade
1-3 years
Febrile UTIs prompt investigation. Girls begin to predominate. Low-grade VUR (I-III) has high spontaneous resolution rate. Potty training issues may unmask bladder dysfunction contributing to VUR.
Risk level: Low to moderate
3-7 years
May present with recurrent UTIs, voiding dysfunction, or as incidental finding. Constipation and bladder-bowel dysfunction are important contributing factors. Many low-grade cases resolve by this age.
Risk level: Low to moderate
7-12 years
Most low-grade VUR has resolved by this age. Persistent VUR is usually higher grade. May present with breakthrough UTIs on prophylaxis or with established renal scarring and its consequences.
Risk level: Low (if resolved) to moderate (if persistent high-grade)
Treatment
Observation (low-grade)
Grades I-III have high spontaneous resolution rates (80%+ for grade I-II). Watchful waiting with prompt UTI treatment is appropriate. Annual reassessment with ultrasound.
Antibiotic prophylaxis
Continuous low-dose antibiotics (trimethoprim or nitrofurantoin) to prevent UTIs while waiting for VUR to resolve. RIVUR trial showed 50% reduction in recurrent UTI but did not prevent scarring. Controversial — used selectively.
Endoscopic injection (Deflux)
Office-based procedure injecting a bulking agent (dextranomer/hyaluronic acid) at the ureteral orifice. Success rate 70-85% for grades II-IV. Can be repeated if needed. Less invasive than surgery.
Surgical reimplantation
Ureteral reimplantation surgery for high-grade VUR (IV-V), breakthrough infections on prophylaxis, or worsening scarring. Success rate 95-98%. Open or robotic-assisted approaches.
Home Care
- Ensure regular voiding every 2-3 hours (timed voiding)
- Treat and prevent constipation aggressively (fiber, fluids, stool softeners)
- Adequate daily fluid intake
- Double voiding technique for older children (void, wait, void again)
- Do not hold urine — encourage prompt bathroom visits
- Complete all prescribed antibiotic courses for UTIs
- Give prophylactic antibiotics consistently if prescribed
- Front-to-back wiping for girls
- Monitor for signs of UTI (fever, pain, smelly urine)
When to Worry
Go to the ER if:
- High fever (103°F+) with vomiting in a child with known VUR
- Infant with VUR who develops fever and appears ill
- Severe flank pain with fever (possible pyelonephritis)
- Unable to keep fluids or antibiotics down
- Child appearing very ill or septic
- No urine output for 8+ hours with fever
Call your doctor if:
- Any fever over 100.4°F in a child with known VUR (possible UTI)
- Signs of UTI (painful urination, frequency, smelly urine)
- Questions about prophylactic antibiotic regimen
- New-onset bedwetting or urinary incontinence
- Constipation not responding to home measures
- Follow-up imaging or reassessment due
Keep an eye on:
- Breakthrough febrile UTI while on prophylactic antibiotics
- High blood pressure detected
- Growth delay or poor weight gain
- Persistent or worsening hydronephrosis on ultrasound
- Elevated creatinine on blood work
- Recurrent kidney infections despite treatment
Prevention
- Screen siblings of children with VUR (30-50% have VUR)
- Prompt evaluation and treatment of febrile UTIs in infants
- Treat bladder-bowel dysfunction (constipation, holding behaviors)
- Prophylactic antibiotics as prescribed for high-risk children
- Regular follow-up imaging to monitor resolution or progression
- Good voiding habits and adequate hydration
- Consider prenatal ultrasound follow-up for hydronephrosis
Contagion & Incubation
Incubation
Not applicable. VUR is a congenital or acquired structural condition, not an infection.
Contagious for
Not contagious.
Duration
VUR is a chronic condition that often resolves over years. Grade I-II: 80-90% resolve by age 5-6. Grade III: 50% resolve. Grade IV-V: 10-20% resolve spontaneously. Resolution depends on grade, bilateral vs. unilateral, and presence of bladder dysfunction. Monitoring continues until resolution confirmed on imaging.
Frequently asked questions
How long does vesicoureteral reflux (vur) in children last?
How does vesicoureteral reflux (vur) spread?
When should I take my baby to the ER?
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When can my child return to daycare?
Sources
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources
Related Illnesses
Bottom line
Vesicoureteral Reflux (VUR) in Children is treatable with appropriate medical care. Seek emergency care if high fever (103°f+) with vomiting in a child with known vur.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.