Pediatric patients represent a significant portion of patients in the emergency department, and they often present with nonspecific complaints (such as fussiness, decreased oral intake, crying, or fever), which can pose a diagnostic dilemma. One serious cause for these complaints that should be considered is a urinary tract infection. Approximately 7% of fevers in pediatric patients presenting to the ED are caused by a bacterial infection of the normally sterile urinary system, and there is a litany of ways in which a young patient can manifest a urinary tract infection. This review will discuss the epidemiology, natural history, and pathophysiology of urinary tract infections in children. Pertinent history and physical examination findings as well as the diagnostic and treatment modalities will be examined, with the goal of providing updated evidence on the varied options in managing a patient once diagnosed. Controversies in the exact diagnosis of a urinary tract infection as well as a review of novel concepts in the management of this condition will also be presented.