title: The struggle to diagnose UTI in children under two in primary care.
abstract: BACKGROUND
  The incidence of urinary tract infection (UTI) in childhood is highest in infancy and accounts for 5% of febrile infants. Reflux nephropathy following UTI in early childhood is the commonest preventable cause of chronic renal failure. Recent guidelines aim to improve the diagnosis and management of UTI in small children.
  
  
  OBJECTIVE
  To assess management of febrile children and UTI in children under 2 years amongst GPs, and to identify some reasons for the difficulties in diagnosing UTI.
  
  
  METHODS
  Questionnaire distributed by periodical journal.
  
  
  RESULTS
  Eighty-two GPs responded, of whom 61 (74%) were unaware of the recent Royal College of Physicians guidelines on childhood UTI. Seventy-seven GPs (94%) would find guidelines helpful on when to send a urine sample for culture from a child under 2 years. Only 11 GPs (14%) regularly sent urine from febrile infants and toddlers; 48 GPs (63%) sent urine from only 0-10% of patients; 21 (26%) were unable to collect urine at all from these children. Several difficulties were identified by GPs regarding investigation for UTI in children. These related to practical difficulties in urine collection and culturing, lack of professional awareness of the importance of UTI and concerns about the costs of investigation.
  
  
  CONCLUSIONS
  GPs frequently do not investigate for UTI in febrile children due to practical difficulties, lack of awareness and financial costs. National guidelines need to be disseminated and implemented effectively to reach target groups. Further scope for research into a simple, cheap method to collect and test urine has been highlighted as a priority to improve early diagnosis of UTI. Management of UTI in primary care can be improved with carefully evaluated strategies and this could lead to a reduction in the prevalence of renal scarring.
authors.affiliation: Department of Child Health, University of Wales College of Medicine, Cardiff Royal Infirmary, UK.
authors.forename: J
authors.initials: J
authors.lastname: van der Voort
authors.forename: A
authors.initials: A
authors.lastname: Edwards
authors.forename: R
authors.initials: R
authors.lastname: Roberts
authors.forename: K
authors.initials: K
authors.lastname: Verrier Jones
mesh_terms: D005194:Family Practice; D005334:Fever / Q000175:diagnosis / Q000652:urine; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007494:Ireland; D010818:Practice Patterns, Physicians'; D006113:United Kingdom; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000652:urine