How to get toddler to release urine for urine sample

Urine collection is an awkward task when your patient is still in nappies, but it’s essential for getting the diagnosis right

The only way to know for sure that a small child has a urinary tract infection is to test for bacteria in the urine. But that’s a lot easier said than done.

Most children aren’t able to urinate at will until the age of two or three years, so GPs and parents have to wait for spontaneous voiding, says general paediatrician Dr Jonathan Kaufman.

Traditionally, urine samples have been collected using a nappy pad or bag.

But around half of these samples will be contaminated with incidental skin bacteria, rendering them useless for UTI detection, he said. 

Parents can standby with a collection jar and hope to catch the midstream urine. But it takes about an hour for a baby to pass urine after drinking fluid, so this is impractical for parents with other responsibilities.

The absence of a good, practical method of urine sample collection has meant that GPs often just used guesswork to diagnose UTIs in babies, Dr Kaufman, writing in BMJ Paediatrics Open, said.

“And that leads to both misdiagnosis of other conditions, but also, if you keep waiting and waiting and you can’t get a sample, potentially delayed therapy for children with UTI,” Dr Kaufman told The Medical Republic.

Direct urine extraction was possible with urethral catheterisation or suprapubic needle aspiration, but these procedures were invasive and painful, he said.

Image courtesy of Jonathan Kaufman and Bill Reid

While GPs generally started infants who were suspected of having a UTI on antibiotics before receiving the lab results back, the global rise in antibiotic resistance made it important that a urine sample was tested, he said.

As part of his PhD project with The University of Melbourne, Dr Kaufman has developed a quick and easy method for urine sample collection in babies and toddlers that can be used by GPs or parents at home.

The Quick-Wee Method involves removing the child’s nappy, wiping the area clean, lying the infant down on its back and rubbing its abdomen in a circular motion using cold, wet gauze.

“And that can trigger children to pee so you can collect a sample more quickly,”  Dr Kaufman said.

The Quick-Wee Method was tested un a randomised controlled trial of around 350 infants in 2017 and was shown to produce a urine sample within five minutes in 30% of children.

By comparison, only 12% of children produced a urine sample in five minutes using the standard clean-catch method, the study found.

“It’s something that GPs can do in the clinic room to try to improve the likelihood that they catch a sample,” Dr Kaufman said.

“It’s also something that if parents are trying to collect a sample at home, that parents can do as well because it is so quick and simple.”

BMJ Paediatrics Open, 24 September

If you’ve ever had to needed to get a urine sample from a sick baby, you’ll know what a time-consuming (and messy) process it can be. Now doctors in Melbourne claim they’ve found a way to speed up the process – and make it more pleasant for everyone.

“They call infant urine samples ‘liquid gold’ for good reason,” says Dr Jonathan Kaufman, a doctor at the Royal Children’s Hospital in Melbourne. “Baby wee can be elusive.”

This trickiness can make collecting a urine sample from an infant difficult. But Dr Kaufman, who is also a researcher at the University of Melbourne and the Murdoch Children’s Research Institute, has developed a simple method that encourages babies to urinate, greatly increasing the chances of collection.

Known as Quick-Wee, and recently published in The BMJ, the method involves gently rubbing the lower abdomen in circular motions with a piece of gauze soaked in cold liquid, to trigger urination.

Current methods for collecting a urine sample from an infant can be at best, time consuming and at worst, distressing.

When doctors suspect a baby may have a urinary tract infection (UTI) they often use a method known as Clean Catch, where they wait for the infant to go to the toilet spontaneously, and use a cup to ‘catch’ the urine. This can take a long time and has a high failure rate, as well as a risk of sample contamination.

If Clean Catch fails or time is of the essence, clinicians may need to use a catheter or a needle (extracting the urine directly from the bladder) to collect the sample, which is invasive and painful.

Dr Kaufman first conceived Quick-Wee (which works by triggering a baby’s involuntary reflexes) when he was working night shifts as a paediatric trainee. He noticed that cleaning the skin in preparation for inserting a catheter often triggered babies to urinate.

“I wondered if this could form the basis for a more formal method of collecting urine samples,” he says.

“Then one night there was a baby in the emergency department who really needed a urine sample, but the junior doctor wasn’t able to do a catheter.

“I couldn’t get down there straight away, so I asked the doctor to get everything ready for a catheter, and to keep cleaning the skin while they waited with a cup ready in case they could catch some wee.

“It worked, they had collected a urine sample by the time I got there.”

Dr Kaufman and his team trialled the method with 354 babies under 12 months who needed a urine sample in the Royal Children’s Hospital emergency department.

“Our trial showed that Quick-Wee can speed up urine collection for many babies,” says Dr Kaufman.

“Collecting the sample quickly means the clinician can test for a UTI in a timely fashion, and either treat with appropriate antibiotics, or move on and look for other diagnoses,” he says. “It also decreases the chances of needing an invasive collection method, like a catheter or a needle, for some children.”

But perhaps the most satisfying result for Dr Kaufman was when he used Quick-Wee for his own infant daughter.

“We were away visiting family in the country, and she had a fever and was vomiting all night,” he recalls.

“The doctor in the emergency department there wanted to check a urine sample, so we used Quick-Wee. We collected a sample within a few minutes, which meant she didn’t need a needle or catheter procedure, and there was no delay in starting her antibiotic treatment.”

For Dr Kaufman, Quick-Wee’s simplicity is key to its success. And, as an added bonus, he now has a good line of wee jokes for medical conferences.

“I do like to share my wee-search,” he laughs.