Urinary Tract Infections in Children – Part II: Analyze & Treat

In my last post (Urinary Tract Infections in Children – Part I) I discussed the importance of urinary tract infections, how they might present in children of various ages, and testing to verify the presence of these infections. This post will pick up with further diagnostic measures and treatment.

UTI's can be difficult to diagnose with babiesOnce an appropriate sample of urine is obtained, it will then be analyzed in two different ways. A chemical analysis and microscopic exam is done to see whether those elements that might suggest urinary tract infection are present; white cells, protein, blood, etc. The second thing that is done with the urine is to take a culture specimen of the urine and attempt to grow bacteria out of it. This is the true litmus test for urinary infections, as chemical analysis might suggest infection but if there is no bacteria in the urine no true infection is present. The culture can take up to 3 days for a result and therefore in a child who has typical symptoms, the use of an antibiotic may be decided temporarily on the urinalysis alone until the results of the culture are available. A simple bladder infection, which is much more common than a kidney infection can be easily treated with a short course of antibiotics, during which time the symptoms usually resolve completely. Kidney infections, if severe, may take a lot longer and may require intravenous antibiotics.

If a child gets a significant number of infections over a relatively short period of time, or an individual infection appears to be very severe, or a significant infection occurs in an infant or very young child, then it is necessary to explore the problem much deeper in terms of further testing the child. This can be done in one or more ways to be determined by your doctor and the radiology department;

One method is a simple non invasive sonogram wherein a sound waves “picture” is taken of the entire urinary tract. Another method is called a VCUG, voiding cysto-urethrogram in which a small catheter is placed into the bladder through the urethra (the exit from the bladder to the outside), a small amount of dye is placed in the bladder in order to outline the anatomy of the lower urinary tract( bladder and ureters -tubes that go from the kidney to the bladder). A functional picture of the lower tract can be obtained by radiologocally “watching” during and after urinating. Two further tests can be done to more clearly evaluate the anatomy and function of the kidneys. Both involve the injection into the blood stream of a substance that will be taken up by the kidney, delineating structure and function.

A history of repeated urinary tract infections is not an uncommon problem. If something has been found that can be surgically corrected to prevent further infections, this choice may be made. This situation is less common than finding nothing abnormal on the testing in a child who still gets repeated infections. Certainly this situation, as in anyone with repeated infections, will need to be monitored very carefully by your Doctor.

The bottom line in handling urinary infections is to prevent them from ascending up the urinary tract and potentially injuring the kidneys, for this will ultimately lead to a certain amount of loss of function of the kidneys; something better prevented than treated.

Checklist for a SAFE Back to School and Sports. Everyone Ready?

Little girl with inhalerIs it August already?  Yes it is! Or soon will be and that means that soon it will be back to school and organized sports and all the things that make the school year so hectic.   As a parent returning one child to school and sending one to his first year of school this is a pretty busy time of year in our house.  Mixed in with all the fun of summer reading lists and back to school shopping, I would like to give you another list of things to make sure are right before the kids return to school and sports.

First and foremost on my list is always making sure that the school is up to date on its CPR and First Aid training.  If you are a parent leaving your child at a school, daycare, or organized sports league you need to inquire and make sure that the staff or at least the staff that will be on hand ALL the time knows what to do in case of an emergency situation, such as an injury or an allergic reaction involving your child.  Does your child have any emergency medicine that they need such as an EpiPen or an asthma inhaler, or any other medication that might be needed in a moment’s notice? , and if so, are they expired, does the school need a new one or even know about them and how to use them should the need arise?   I have seen people forget their own name when confronted with these situations and the right training and preparation can make all the difference in the world.

Organized sports are another area where things need to be checked off before the new season starts. These activities can be at any age and be anything from baseball and football to cheerleading and gymnastics.  Injuries happen in these sports all the time and once again, the coaches, staff, volunteers, and anyone else involved need to be properly trained or refreshed on what to do in case of an emergency.  Most of the centers or parks hosting these activities have automated external defibrillators (AED’s) on site for both participants and parents and need to be trained or refreshed on the use of these devices as well.    When playing organized sports like baseball and football, there are pieces of safety equipment built into the helmets and pads and other parts of the uniforms. If your children have  grown over the summer like mine have then you need to make sure that the equipment they are using fits properly and securely and delivers the maximum amount of safety it was designed for.  Whether its helmets, groin protectors or even shoes, these should all be the proper size for best results.

As always, a little preparation makes all the difference and I wish you all the safest and best school/sports year.

Finally – A Step Towards Safe Transport for Kids in Ambulances!

Last updated on August 8th, 2019 at 07:02 pm

In 2008 the National Highway Traffic Safety Administration (NHTSA) convened a working group of representatives from the American Academy of Pediatrics, Emergency Medical Services for Children, the American Ambulance Association, and other key organizations and started a project called “Solutions to Safely Transport Children in Emergency Vehicles”. Finally a long-standing problem was being recognized and addressed: “there are no Federal standards or standard protocols among EMS and child safety professionals in the U.S. for how best to transport children safely in ground ambulances from the scene of a traffic crash or a medical emergency to a hospital or other facility. The absence of consistent national standards and protocols … complicates the work of EMS professionals and may result in the improper and unsafe restraint of highly vulnerable child passengers.”(1)

In fact a 1998 study regarding the use of child restraints in ambulances revealed that 35 States did not require patients of ANY AGE to be restrained in a ground ambulance. Of those States that did require some sort of child restraint system, requirements for an “acceptable restraint” varied significantly.(2)

It is illegal in the US to travel with an unrestrained child in an automobile. However, when a child is already sick or injured, we have been willing to transport them in a vehicle where the passenger compartment is exempt from most safety requirements, they cannot be properly restrained and they have a higher probability of an accident than an automobile. We might not if we knew the following:

  • It is estimated that up to 1,000 ambulance crashes involve pediatric patients each year.(3)
  • In a collision at 35mph, an unrestrained 15kg child is exposed to the same forces as in falling from a 4th story window.(4)

Wednesday September 19, 2012, after an intense 2 year research effort, a public meeting in August 2010 to review the findings and gather input (see Pediatric Safety Post by Sandy Schnee “A Public Meeting on Safe Transport for Kids on Ambulances“), and 2 additional years refining the results, NHTSA has released the official:

BEST PRACTICE RECOMMENDATIONS FOR THE SAFE TRANSPORT OF CHILDREN IN EMERGENCY GROUND AMBULANCES”          Thank you NHTSA!!

 The working group outlined 5 potential child transport “Situations” (see chart below) and for each described their “Ideal” solution – the best practice recommendation for safe a safe transport for each situation. They also presented an “If the Ideal is not Practical or Achievable” alternative – basically an “acceptable” backup plan.

They also came up with guidelines to assist EMS providers in selecting a child restraint system – particularly important because due to the lack of regulation and testing requirements specific to ground ambulances, many of the available child restraint devices were not designed for use in ambulances, some were tested to automotive standards and others were not tested at all.

In the end, the ultimate goal of ALL the recommendations: Prevent forward motion/ejection, secure the torso, and protect the head, neck, and spine of all children transported in emergency ground ambulances.

In short – transport these children safely.

We know that since the adoption of “mandatory use laws” in the U.S. for child safety restraints in automobiles, that thousands of children’s lives have been saved. Yet for years we have continued to allow children to be transported unrestrained on ambulances. With this report, we have finally taken a step in the right direction

It is hoped that the recommendations provided in this report will address the lack of consistent standards or protocols among EMS and child passenger safety professionals in the United States regarding how to most safely transport children in ground ambulances from the scene of a traffic crash or medical emergency to a hospital or other facility. It should be noted that the expectation is that States, localities, associations, and EMS providers will implement these recommendations to improve the safe transportation of children in emergency ground ambulances when responding to calls encountered in the course of day-to-day operations of EMS providers. In addition, it is hoped that EMS providers will be better prepared to safely transport children in emergency ground ambulances when faced with disaster and mass casualty situations”.

…. Amen to that !!

 

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Editorial Update:  Quite a bit has happened since the original publication of this article.  Suffice it to say that while this was a terrific step in the right direction – it was not enough to cause the system-wide level of change hoped for.  According to ems.gov… unanswered questions remain, primarily due to the lack of ambulance crash testing research specific to children.”  To address this,  in 2017 the National Association of State EMS Officials (NASEMSO) established the Safe Transport of Children Ad Hoc Committee, with the goal of improving the safety of children transported by ambulance through the creation of evidence-based standards.  Pediatric Safety will continue to follow their efforts in future articles as they work to improve the national standard of care and establish consistent guidelines for the safe transport of all our children on ambulances. Every ride, every time.   

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References:

1. Notice published by NHTSA of Public Meeting on August 5th, 2010 to discuss draft version Recommendations for Safe Transport of Children on Ground Ambulance Vehicles: Federal Register, July 19, 2010,

 2 & 3. Working Group Best-Practice Recommendations for the Safe Transportation of Children in Emergency Ground Ambulances: NHTSA / USDOT, September 2012

4. “EMS to Your Rescue?” Int’l Forum on Traffic Records & Hwy Safety Info. Systems – Levick N, July, 2008

Helping Your Child Deal with the Loss of a Pet

vet kid and sick dogUnlike many years ago, when most pets lived outside, today many of our pets become members of the family. When most of us have ‘had enough’ with the world, it is our pets that give us solace. And for many kids, their pets are their best friends in the world….always there to ‘lick their wounds’… both emotionally and physically.  So how do you handle it when that ‘best friend’ passes away? There are many answers to this question…. And of course, how it gets explained varies greatly on many things…. From the family’s religious beliefs, to the age and maturity level of the child and how much they can comprehend. Let’s face it… no one really completely understands death, except that it happens to all of us.

I.  Age Appropriateness I want to emphasize caution here –  be careful how you phrase things to very young children. For example, many people do not realize when you tell a young child that ‘the dog got sick and then he died’ that many young children suddenly become very fearful every time they or someone they love gets sick… often they become afraid that they will die too… like the dog.

II.  Prepare them in advance Barring sudden unexpected deaths like from an accident, many times with illness or advanced age, you can tell when your beloved pet is nearing the end of their life.  This is probably the best time to sit down and talk with your children about it. Here are some key steps that may help:

  • To begin – Talk to each child individually. Many times, when you bring all the children together to talk about it, the younger ones look to the older ones to judge how they ‘should’ be feeling or reacting. By taking each one individually, you allow them to each have their own feelings.
  • Next you can discuss how dog years are different than human years…. That each human year is about 7 years to a dog. To make sure they understand this, you can say something like, “So if Max is 10 years old in human years…. How old is he in dog years?” Once they come up with the number 70, then you can say, “That’s pretty old right?” Now you can go into how he may not run around as much as he used to, he isn’t as active as he used to be, many dogs get very white in the face as they get older, etc. Now you can go on to talk about what a great life he has had with them, remember activities you all did together like a camping trip or a hike, or fun tricks they may have down, remembering when he was a puppy, how easy or difficult he was to train….. etc.
  • This is the point where you bring up that although they had a great life together, it is nearing the time where he may die.. You can ask your child what they understand about death, and really listen to what they say. You might be amazed at their answers.

I once saw a post where a family pet had passed away, and while the family sat around crying about why it is so unfair that pets should die so early, and questioning why this is, it was a young child who answered, “I know why….. it is because we are all put here to learn how to live a good life, and to be kind and loving…. Dogs already know that, so they don’t have to stay here as long.” 

  • It is important that you do not hide your feelings from your children. Let them know how you are honestly feeling… using specific feeling words like ‘sad’ or ‘angry’ is much more helpful to a child than generalized words like ‘upset’. This allows them to relate to your feelings, and also to help them identify their own.
  • It is also very important to remember that all children grieve differently. My friend’s dog had recently passed away, and when I was talking to my friend about it, and how her 7 year old was doing, she told me, “I’ll tell you… it was the weirdest thing! For three days after the dog died…. Nothing. Not a tear. We buried her in the yard, and did a little service, and both of her friends cried… but from her, NOTHING! I started to worry! Then all of a sudden, when my husband came to pick her up from school three days later, she saw him, and started crying hysterically!!”

III. If you are considering Euthanasia for a dog that is nearing the end, again, be careful of the words you use   You want to avoid telling younger children that ‘the vet will give him a shot to put him to sleep” or ‘He went to sleep.’ Kids take things very literally, and you don’t want them afraid when they have to get a shot at the doctor’s office, or create future fears of going to sleep and not waking up again. Instead, you can tell them the that doctor thinks their pet is in a lot of pain, and since they love him so much, they don’t want him to suffer anymore. So the vet is going to give him some medicine that will stop all of his pain, and let him slip into death peacefully. With older children, it is okay to let them decide if they want to be there to say goodbye while the injection is given… but I would not just depend on age, I would also assess maturity level and their basic understanding of the process before giving them that choice. I also want to stress here that if your child does want to be there, and you feel this is okay, make sure you and your child are fully prepared for what to expect. Talk to your vet about it, and explain that your child will be with you, and you want to walk them through each step of the process in advance.

IV. I think it is also very important to ask if they have any questions When I mentioned earlier that religious beliefs may come into play; it is because children often ask what happens after they die. Be honest and open with your child, and share with them what YOU believe happens…. Whether it be that you believe they all go to Heaven with GOD, or if a relative passed not too long ago, you can say that they will be together, but make sure you are not making up answers to appease them. If you are not religious, and you personally are not sure what your beliefs are on the subject… it is OK to tell them that… that you just don’t know. They will appreciate and respect your honest answers.

V.  After the fact After your pet has died, or been put to sleep, let children be involved in the ‘saying good-bye’ process. If you are burying them, let them be part of the service. If you are planning on cremating your pet, let them be involved in choosing the urn, or the spot to place the ashes. And most importantly, don’t avoid the subject of their pet afterwards. You don’t want to make the pet’s name a taboo subject because you are afraid bringing it up may bring up unpleasant feelings for you or them. Let them know it is okay to talk about their feelings and memories by doing so yourself.

It is never an easy or a pleasant subject to discuss death, but how you handle this may determine how your children deal with loss in their future. Death is a part of life… so the more honest and open we discuss it with our children, the more prepared they will be when it actually happens.

The Rainbow Bridge

The Rainbow BridgeJust this side of heaven is a place called Rainbow Bridge. When an animal dies that has been especially close to someone here, that pet goes to Rainbow Bridge.

There are meadows and hills for all of our special friends so they can run and play together. There is plenty of food, water and sunshine, and our friends are warm and comfortable. All the animals who had been ill and old are restored to health and vigour; those who were hurt or maimed are made whole and strong again, just as we remember them in our dreams of days and times gone by. 

The animals are happy and content, except for one small thing; they each miss someone very special to them, who had to be left behind.

They all run and play together, but the day comes when one suddenly stops and looks into the distance. His bright eyes are intent; His eager body quivers. Suddenly he begins to run from the group, flying over the green grass, his legs
carrying him faster and faster. You have been spotted, and when you and your special friend finally meet, you cling together in joyous reunion, never to be parted again.

The happy kisses rain upon your face; your hands again caress the beloved head, and you look once more into the trusting eyes of your pet, so long gone from your life but never absent from your heart.

Then you cross Rainbow Bridge together

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