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Urine collection in children

Last edited 30 Jul 2022

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Urine collection in children (1)

take urine samples from children and young people before they are given antibiotics
babies and children with a high risk of serious illness should have a urine sample taken, but treatment should not be delayed if a urine sample cannot be obtained
use a clean catch method for urine collection wherever possible
if a clean catch urine sample is not possible, use other non-invasive methods such as urine collection pads. It is important to follow the manufacturer's instructions when using urine collection pad
do not use cotton wool balls, gauze or sanitary towels to collect urine from babies and children
use catheter samples or suprapubic aspiration (SPA) when it is not possible or practical to collect urine by non-invasive methods. Use ultrasound guidance to confirm that there is urine in the bladder before SPA

Urine testing

Use dipstick testing for babies and children between 3 months and 3 years with suspected UTI, and:

if both leukocyte esterase and nitrite are negative:
- do not give antibiotics
- do not send a urine sample for microscopy and culture unless at least 1 of the criteria below apply:
  - Send urine samples for culture if a baby or child:
    - is thought to have acute upper UTI (pyelonephritis)
    - has a high to intermediate risk of serious illness
    - is under 3 months old
    - has a positive result for leukocyte esterase or nitrite
    - has recurrent UTI
    - has an infection that does not respond to treatment within 24 to 48 hours, if no sample has already been sent
    - has clinical symptoms and signs but dipstick tests do not correlate
if leukocyte esterase or nitrite, or both are positive:
- send the urine sample for culture
- give antibiotics

Use the urine-testing strategy for children aged 3 years or older shown in table below:

Urine dipstick test result	Strategy
Leukocyte esterase and nitrite are both positive	Assume the child has a urinary tract infection (UTI) and give them antibiotics. If the child has a high or intermediate risk of serious illness or a history of previous UTI, send a urine sample for culture.
Leukocyte esterase is negative and nitrite is positive	Give the child antibiotics if the urine test was carried out on a fresh urine sample. Send a urine sample for culture. Subsequent management will depend on the result of urine culture.
Leukocyte esterase is positive and nitrite is negative	Send a urine sample for microscopy and culture. Do not give the child antibiotics unless there is good clinical evidence of a UTI (for example, obvious urinary symptoms). A positive leukocyte esterase result may indicate an infection outside the urinary tract that may need to be managed differently.
Leukocyte esterase and nitrite are both negative	Assume the child does not have a UTI. Do not give the child antibiotics for a UTI or send a urine sample for culture. Explore other possible causes of the child's illness.

For detailed guidance then see NICE (July 2022). Urinary tract infection in under 16s: diagnosis and management

Reference:

NICE (July 2022). Urinary tract infection in under 16s: diagnosis and management

Urinary tract infection (UTI) in children

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Urine collection in children

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