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