For a child with suspected urinary tract infection, which investigations are indicated?

• A. Imaging tests such as ultrasound and voiding cystourethrogram for all children.
• B. Urinalysis and urine culture; imaging if indicated by age or recurrence pattern.
• C. Blood culture and lumbar puncture routinely.
• D. No tests unless fever persists.

Answer: (B)

When a child is suspected of having a urinary tract infection, the first priority is to confirm that an infection is present and identify the organism to guide treatment. This is done with urinalysis to look for signs of infection and with a urine culture to identify the causative organism and its antibiotic sensitivities. Imaging is not required for every child; it’s used selectively based on the child’s age and the pattern of infection. In younger children, especially those under two years old, or in kids with recurrent UTIs, imaging helps detect any underlying anatomic issues that could predispose to infection. A renal ultrasound is typically the first imaging step, and a voiding cystourethrogram may be added if there are abnormalities or repeated infections to evaluate for reflux or obstruction. Routine blood cultures or lumbar punctures are not part of a standard UTI workup unless there are signs of a systemic infection or meningitis. So the best approach is urinalysis and urine culture, with imaging only if indicated by age or recurrence.