Introduction: Urinary tract infections (UTIs) are common in children, often leading to renal damage if not promptly treated. Understanding the changing epidemiology, causative agents, and antibiotic resistance patterns is crucial for effective management. Methods: A cross-sectional study was conducted at a tertiary care hospital. 100 children aged 1 month to 18 years diagnosed with UTI based on symptoms, pyuria, and bacteriuria were enrolled. Data on demographics, clinical features, and antibiotic use were collected. Urine samples were cultured, and antimicrobial susceptibility testing was performed. Results: Infants (<1 year) showed a higher male prevalence (69.6%) compared to females (30.4%). Fever was the most common symptom (92%). Escherichia coli (E. coli) was the predominant pathogen (69%), followed by Klebsiella pneumoniae (10%) and Enterobacter spp. (6%). Antibiotic resistance was observed, with 20% sensitive to 4 or fewer antibiotics and 27% sensitive to 9-12 antibiotics. Prior urinary instrumentation, past UTI history, and recent antibiotic use were identified as risk factors for resistance. ESBL-producing organisms showed significant resistance to cephalosporins and ciprofloxacin compared to non-ESBL organisms. Conclusions: UTIs in children show age-specific gender variations and evolving bacterial profiles. E. coli remains the dominant pathogen, but resistance is rising. Prior interventions, past UTIs, and recent antibiotic use are associated with resistance. ESBL-producing organisms pose a particular challenge. These findings highlight the need for judicious antibiotic use and tailored management strategies based on age, bacterial profile, and resistance patterns.