UTI in Children: Model Clinical Case and Viva Q&A

Clinical Case of UTI in Children

Clinical Case: Urinary Tract Infection in a 3-year-old Girl

Patient Information:

  • Name: Sarah Johnson
  • Age: 3 years
  • Sex: Female

Chief Complaint:

Fever, frequent urination, and abdominal pain for the past 2 days.

History of Present Illness:

Sarah's mother reports that her daughter has been experiencing a high fever (up to 39.5°C) for the past 48 hours. The child has been urinating more frequently than usual, often complaining of pain or discomfort while doing so. Sarah has also been holding her lower abdomen and crying intermittently. The mother noticed that Sarah's urine has a strong, unpleasant odor.

Past Medical History:

  • No previous UTIs
  • Up-to-date on vaccinations
  • No known allergies

Physical Examination:

  • Temperature: 39.2°C
  • Heart Rate: 110 bpm
  • Respiratory Rate: 24 breaths/min
  • Blood Pressure: 95/60 mmHg
  • Abdominal examination: Mild suprapubic tenderness
  • No costovertebral angle tenderness

Laboratory Tests:

  • Urinalysis:
    • Leukocyte esterase: Positive
    • Nitrites: Positive
    • WBC: >20 per high-power field
    • RBC: 5-10 per high-power field
  • Complete Blood Count:
    • WBC: 14,500/μL with left shift
    • Hemoglobin: 12.5 g/dL
    • Platelets: 280,000/μL
  • C-reactive protein: 3.5 mg/dL (elevated)

Diagnosis:

Acute urinary tract infection (likely pyelonephritis)

Treatment Plan:

  1. Initiate empiric antibiotic therapy with oral cefixime 8 mg/kg/day divided into two doses for 10 days.
  2. Encourage increased fluid intake.
  3. Administer acetaminophen for fever and discomfort.
  4. Obtain urine culture and adjust antibiotics based on sensitivity results if necessary.
  5. Schedule follow-up in 48-72 hours to assess clinical improvement.
  6. Consider renal ultrasound to evaluate for anatomical abnormalities or complications.

Follow-up:

Sarah's symptoms improved significantly after 48 hours of antibiotic therapy. Urine culture grew Escherichia coli, sensitive to cefixime. She completed the 10-day course of antibiotics without complications. A follow-up urinalysis 2 weeks after completion of treatment was normal.



Clinical Presentations of UTI in Children

Clinical Presentations of UTI in Children

  1. Classic Symptomatic UTI in Older Children:

    • Dysuria (painful urination)
    • Frequency and urgency
    • Lower abdominal or suprapubic pain
    • Low-grade fever
    • Cloudy or strong-smelling urine

  2. Febrile UTI / Pyelonephritis in Infants and Young Children:

    • High fever (>39°C / 102.2°F)
    • Irritability or lethargy
    • Poor feeding
    • Vomiting
    • Abdominal pain or flank pain
    • Failure to thrive

  3. Asymptomatic Bacteriuria:

    • No clinical symptoms
    • Positive urine culture (discovered incidentally)
    • More common in girls

  4. UTI in Neonates:

    • Nonspecific symptoms: poor feeding, vomiting, jaundice
    • Temperature instability (hypothermia or hyperthermia)
    • Lethargy or irritability
    • Failure to thrive
    • Sepsis-like presentation

  5. Recurrent UTI with Underlying Abnormalities:

    • History of multiple UTI episodes
    • Enuresis or daytime incontinence
    • Weak urine stream
    • Incomplete bladder emptying
    • Urinary retention
    • Possible signs of vesicoureteral reflux or other anatomical abnormalities

  6. UTI in Children with Neurogenic Bladder:

    • Change in usual bladder or bowel habits
    • Increased urinary incontinence
    • Increased spasticity in children with spinal cord issues
    • Autonomic dysreflexia in susceptible individuals
    • Fever may or may not be present

  7. UTI Associated with Dysfunctional Elimination Syndrome:

    • History of constipation
    • Daytime wetting or enuresis
    • Frequent urge to urinate
    • Holding maneuvers (e.g., squatting, crossing legs)
    • Recurrent UTIs


Knowledge Check: Question and Answers for Medical Students & Professionals

This interactive quiz component covers essential viva questions and answers. It includes 30 high-yield viva questions with detailed answers.

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Disclaimer

The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.



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