urinary problems Flashcards
UTI presentation in kids
infants - poor feeding, irritability
younger kids - abdo pain, fever, dysuria
older kids - frequency, haematuria
NICE guidelines for checking urine sample in kid
- any sx suggestive of UTI
- unexplained dfever of 38C or higher
- with an alternative site of infection but who remain unwell
urine sample collection in kid
clean catch is preferable
- if not - urine collection pads
invasive methods only if others not poss - suprapubic aspiration
(not suitable - cotton wool balls, gauze, sanitary pads)
management of UTIs in infant <3months
referred immediatly to paeds
management of UTI in >3months kid
upper UTI
- consider admission
- if not - oral ABx -> cephalosporin or co-amoxiclav for 7-10days
lower UTI
- oral Abx for **3 days **
- bring back if still unwell after 24-48hrs
nocturnal enuresis
involuntary discharge of urine in child age 5 or older, in absence of congenital or acquired defects
most kids achieve day+nigh continence by 3 or 4
management of nocturnal enuresis
first line = enuresis alarm
reward systems - for using loo before bed (NOT for dry nights)
short term control (for a sleepover) = desmopressin
underlying cause of nocturnal enuresis
constipation
diabetes mellitus
UTI if recent onset
NICE guidance for imaging the uringary tract in kids
infants <6mnths who present with 1st UTI which rrespinds to tx = US within 6wks
kids >6mnths do not require imaging if responds to tx
- only if atypical infection or recurrent infection
investigations for URI in kids
urine for microscopy + culture
micturating cystourethrography -> identifies vesicoureteric reflux
- only for infants <6months with atypical sx or recurrent infections
features of atypical UTI
seriously ill
poor urine flow
raised creatinine
septicaemia
failure to respond to Abx within 48hrs
infection with non-Ecoli organism
predisposing factors for UTIs in kids
infrequent voiding
hurried micturition
obstruction due to constipation
neuropathic bladder
poor hygiene - girls wiping wrong way
vesicoureteric reflux - 35% of kids with UTIs
management of under 5 y/os with nocturnal enuresis
reassurance + lifestyle advice
