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

January 6, 2018



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. 




  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?





  • Posterior urethral valves

  • Vesicoureteral reflux

  • Recent instrumentation

  • Constipation


2) KEEPS mnemonic:

  • K - Klebsiella

  • E - Enterococcus

  • E - E. Coli (80%) 

  • P - Proteus

  • S - Staph (15%)



  • 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:



  • 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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