Presentation in children Urinary tract infection (UTI) is a common diagnosis in children presenting to primary care. Presentation varies with age (Table 1). Infants and toddlers are more likely to present with non-specific symptoms of fever, vomiting, lethargy, poor feeding or irritability. Neonates may present with jaundice and/or failure to thrive. Older children can verbalise symptoms of dysuria, abdominal or loin pain, voiding difficulties, incontinence or urinary frequency, but may also have systemic symptoms of fever and vomiting. Systemic symptoms are less common in those with lower tract infection (cystitis) than in those with upper tract infection (pyelonephritis). Further details on the presentation of a first UTI in children can be found in a related article from this journal (Simon, 2008). Children with recurrent UTIs may not present with the same symptoms on each occasion, and therefore a high index of suspicion is required in a sick child with a history of UTIs. Although outside the scope of this article, GPs should be aware of conditions that may mimic a recurrent UTI, including balanitis, threadworm, and vulvovaginitis. GPs should also remain vigilant for any indication of possible abuse as a cause of a UTI-like presentation.
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