Clinical Tip: Urine samples from toddlers: Into the trees

It is not unusual to have to obtain a urine sample from a child who is not completely toilet trained. When we strongly suspect a urinary tract infection, we collect a sample by catheterization, the gold standard. For children with a low suspicion of UTI, however, catheterization seems too invasive, and bagged specimens are too unreliable. Young children who have not completed toilet training are usually reluctant to give a clean-catch sample and wind up spending a lot of time in the office or emergency department while we wait for them to void.

The father of one of our patients suggested a solution to this dilemma that worked beautifully and gave us a good chuckle. His partially toilet trained 3-year-old son, who had a fever and no obvious site of infection, was reluctant to give us a urine sample but didn't seem ill enough to warrant catheterization. The father told us that the child had camped out several times and always enjoyed peeing on trees. We gave the boy a sterile cup and sent him and his mother outside to the tree-lined parking lot, where he proudly filled the cup within minutes. This method, which obviously works better for boys than girls, beats the discomfort of a catheter or a long wait for a traditional clean-catch sample.

Sanford Glikin, MDTampa, Fla.