Urinary tract infections (UTIs) are one of the commonest bacterial infections in children and are caused by E. coli in 75% of the cases. They encompass upper (pyelonephritis) and lower urinary (cystitis) infections. Recurrent UTIs can be persistent or re-infection depending on whether the causative organism is the same or a new pathogen, respectively. A thorough history and examination are recommended while assessing the patient and urine analysis must be performed prior to starting antibiotic therapy. Ultrasound within 24–48 h must be performed in infants with febrile infections and to rule out mechanical or functional obstruction of the urinary tract. Oral or parenteral antibiotics are required for treatment depending on clinical situation and response. Duration of treatment ranges from 7 to 14 days, and choice of antimicrobial treatment depends on local sensitivities followed by adjustment in accordance to sensitivities of the isolated pathogen. Complicated UTIs may require hospitalisation for parenteral antibiotics and temporary drainage if they fail to respond to conservative treatment or have obstructive uropathy. The chapter contains a flow chart detailing approach to assessment and management of UTIs in the paediatric population. Continuous long-term antibiotic prophylaxis may be useful in some patients with recurrent UTIs with a high risk of renal damage.