• Dr. Michelle Yee MD CCFP

To pee or not to pee: Pro pointers for pediatric pee problems


Jodi is a 2 year old girl with fever who presents to your rural emergency department. Jodi's mother reports that she has been recently fatigued and complaining of non-specific abdominal pain.

SNAP SAMP:

  1. List TWO risk factors that increase UTI in children.

  2. What are THREE common organisms in UTI?

  3. Name TWO potential complications of UTI.

  4. How do you obtain a urine sample from this 2 year old girl?

  5. What are THREE steps in your management of this child?

Answers:

1)

  • Posterior urethral valves

  • Vesicoureteral reflux

  • Recent instrumentation

  • Constipation

2) KEEPS mnemonic:

  • K - Klebsiella

  • E - Enterococcus

  • E - E. Coli (80%)

  • P - Proteus

  • S - Staph (15%)

3)

  • Pylenonephritis

  • Acute renal failure

  • Sepsis

  • Abscess

4) Discussion with parents about bag sample vs. clean catch catheterization. Catheterization is the preferred method as it can reliably diagnose a UTI. However, it may cause discomfort to the patient and parents. A bag sample may be attempted but it is only helpful if the bag sample is negative. A positive sample may reflect contaminate and a new sample should be obtained by catheterization.

Consider getting a midstream urine by Bladder Stimulation Technique - a novel approach at obtaining a non-invasive urine sample:

http://www.adhb.govt.nz/newborn/Guidelines/Infection/UrineCollectByBladderStimulation.htm

5)

  • Antibiotics - 7-10 day course in children, choices include:

  • Trimethroprim-sulfamethoxazole

  • Nitrofurantoin

  • Cephalexin

  • Amoxicillin

  • Tylenol or Advil for antipyretic and analgesia

  • Renal bladder ultrasound

  • In children, this is done for all UTI less than 2 years old

  • Additionally, this should be done for 1st UTI in boys, or recurrent UTI in girls, or children with poor growth

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