Primary care approach to urinary tract infection in children

Jane, a seven-month old Chinese girl, was taken to your clinic for a high fever (39.6 degrees C) of two days' duration for no apparent reason. Jane was born full-term with a birth weight of 2,800 g. Her mother had reported during her postnatal visits that she was coping well. Jane was her first child. However, her mother said that Jane had been refusing her cereals for the past two days and was now taking only half her usual milk portions. On direct questioning, she reported that Jane's diapers were not as heavy as usual, and her urine had a stronger smell. No blood was noted. Jane seemed more tired but was still interested in playing with her toys about an hour after taking syrup paracetamol self-administered by her mother. On examination, Jane was febrile at 38.9 degrees C. Her vital signs were stable, her tongue was moist and she had good skin turgor. She was fretful but consolable when carried by her mother. A head-to-toe examination did not reveal any localising signs of infection.