Thursday, July 04, 2013
Childhood UTIs require precise assessments
By Dr. Anthony Policastro

There are many things that parents call physicians about after hours. One of those is related to their child having symptoms of urinary tract infection (UTI). The call often comes from a parent whose child has had a UTI in the past. There is often a request that an antibiotic be called in for the infection. Sometimes the request is for a specific antibiotic that worked in the past. When the parents are told that they need to come in for a urine sample, they sometimes object. They know that their child has a UTI. They know that their child needs an antibiotic. They know what antibiotic their child needs. They do not see the need for a urine sample. What they fail to realize is that there is more to UTI's than they really know. The first thing is that UTI's are more common in infants than they are in older children. However, the symptoms are different. Infants cannot complain about pain with urination. It is difficult to judge frequency of urination. Sometimes the only symptoms is a fever. That is especially true in infants under three months of age. Because of this, the evaluation of a young child for UTI is an entirely different topic. The first thing is that childhood UTI's are not very common. All children get colds. Most children get ear infections. Most children get strep throats. However, UTI is a rare childhood disease. In girls over age 3 years, about 1 to 2 out of every hundred gets a UTI. In boys the rate is much less than that. For this reason, we need to respect UTI when it occurs. It is not as simple as giving an antibiotic for an ear infection and then not worrying about it. The first thing that is necessary is making sure that UTI is the right diagnosis. It is not unusual for a young girl to develop UTI symptoms when there is no UTI present. This frequently occurs after a girl is potty trained. She learns to wipe herself when she goes to the bathroom. However, some of these young girls do it incorrectly. They wipe from back to front instead of from front to back. That results in bacteria being carried to the area outside the vaginal and urinary openings. The result is an inflammation in that area. When the child urinates, the salty urine on the irritated area causes pain. Thus the child has pain with urination. Because it hurts, they stop urinating. They hold the urine. That results in them having to go again very soon. Thus it looks like they are urinating frequently. Then because they are holding the urine in, they have the urgency to go again. They develop pain with urination. They develop urinary frequency. They develop urinary urgency. These are all signs of UTI. However, that is not the diagnosis. The treatment is not antibiotics. It is external care to clear the inflammation. Even in children who have a UTI, it is important to obtain a urine sample. The most important thing that does for us is confirm the diagnosis. However, there are other important pieces of information that it provides. It can sometimes tell us if there is something causing the infection. If that is true, the infection will come back once the antibiotics are stopped. It can also tell us what type of bacteria is causing the infection. We can then test to see if that bacteria is sensitive to the antibiotic we are using. If it is, we can continue that antibiotic. If it is not, we will need to change antibiotics. There is a high frequency of antibiotic resistance in children who have had previous antibiotics for their UTI. That is why it is even more important in those children to get a urine sample before treatment. If the child has bacteria resistant to the antibiotic, we may have to wait several days before knowing we used the wrong medication. At that point, if we do not have a culture, we will have to wait the 48 to 72 hours it takes to find out what antibiotic can be used for the infection. Another important consideration is related to the fact that UTI's are so unusual in children. When they do occur, they raise the question as to whether there is something in the urinary tract that caused them. Thus, a series of tests need to be done to evaluate that possibility. In boys, those tests are done with the first infection since they are so rare. In girls, it depends on multiple factors as to when the tests are done. However, that is not something that can be addressed with a prescription for an antibiotic called into the pharmacy. When a parent makes the diagnosis, they think that they have solved the problem. In actuality, all they have done is started a complicated process in motion.

Traumatic brain injury discussion The Delaware Commission of Veterans Affairs in cooperation with the Brain Injury Association of Delaware and the state Council of the Vietnam Veterans of America invite veterans, their families and veterans advocates to an informational meeting to discuss "Traumatic Brain Injury in America" on Wednesday, July 10 from 1 to 3 p.m. at the Easter Seals Building in Georgetown. For more information, call 302-739-2792.

Bill combats prescription drug abuse Legislation proposed by Attorney General Beau Biden and sponsored by two registered nurses serving in the General Assembly was unanimously approved by the House of Representatives and now heads to the Senate for consideration. House Bill 154, introduced by Rep. Rebecca Walker, D-Townsend, and Sen. Bethany Hall-Long, D-Middletown, is part of a two-bill package from the Attorney General and the two lawmakers to fight back against prescription drug abuse. HB 154 creates a new criminal offense of "Medication Diversion" that applies to anyone who intentionally diverts prescription narcotics from patients who are under the care of a healthcare program in medical or other 24-hour facilities. This felony-level charge subjects offenders to potential jail time. The bill also requires all medical professionals who are licensed to prescribe controlled substances, as well as licensed pharmacists, to take continuing medical education courses on risks associated with prescribing, administering, and diversion of controlled substances.

Bayhealth welcomes hospitalist group Patients at Bayhealth will see a new set of faces in the hospital halls. Thanks to a recent partnership with Apogee Physicians, a hospitalist group with more than 750 physicians, nurse practitioners, and physician assistants nationwide, Bayhealth patients will receive personalized expert care while they are hospitalized in Dover or Milford. Hospitalists are physicians who care for acutely-ill, hospitalized patients. While a patient's care team usually includes a primary care physician and specialists related to the particular cause of illness, the hospitalist is the patient's attending physician during the hospital stay. The Apogee hospitalists work on a seven-day schedule. Because the vast majority of hospital stays are less than seven days, patients will have the same doctor for the duration of their stay. The hospitalists also follow up with patients after discharge. To learn more about the services Bayhealth offers its patients, visit

Diabetes education program Nanticoke Memorial Hospital will hold a four-session diabetes educational program on July 17, 24, 31 and Aug. 7 from 5 to 7 p.m., at the hospital. Registration is required. The cost of the four-session program may be reimbursable by insurance. This program includes weekly education sessions and individualized meal planning for diabetes self-management. The goal is to give you the self-management skills to control your diabetes. Family members/significant others are welcome to attend. To register and to obtain more information, contact Nanticoke Memorial Hospital's Diabetes Education department at 629-6611, ext. 2446.

First aid classes offered Nanticoke Memorial Hospital will offer community First Aid classes to anyone interested in learning first aid from 6:30 to 9:30 p.m. on Tuesday, July 16, at the Nanticoke Training Center located on Water Street in Seaford. Participants will learn basic first aid that will enable them to administer help during the first few moments until emergency responders arrive. Classes are open to participants ages 13 up. The course covers cognitive learning, role-playing, and skill practice. Cost is $35. Payment and registration is required no later than five business days prior to the class. To register, or for more information, contact the Nanticoke Memorial Hospital's Training Center office at 629-6611, ext. 8919.

Medical practices recognized at expo Over 100 physicians and staff members from Delaware's leading health information technology medical practices joined key national and local speakers for an evening of celebration at the RECognition & Health IT 2.0 Expo at the Sheraton Dover Hotel in Dover.

Quality Insights of Delaware - Regional Extension Center (QIDE REC) and the Delaware Valley HIMSS Chapter recognized the progress these practices have made in "meaningfully using" health IT to elevate the quality of patient care to those in the First State. "The physicians in Delaware have worked very hard over the past two years to make The First State one of the leaders in our nation for health information technology adoption, and I'm honored to have been a part of the process," said Beth Schindele, QIDE REC director. QIDE REC is assisting over 1,000 physicians with the adoption of electronic health records and the achievement of Meaningful Use. To learn more about QIDE REC, visit

End-of-life planning Q&A sessions In collaboration with Procino Wells LLC, Attorneys at Law, Delaware Hospice is offering "Off the Clock" complimentary Elder Law Q&A Sessions from 3 to 4:30 p.m. on Friday, July 12, at the Delaware Hospice Center, 100 Patriots Way, Milford. Patients and family members face many challenges at the end-of-life, including legal questions. What is a power of attorney? What is a guardianship? What responsibility does a durable medical power of attorney have? What steps can one take to safely protect assets? "Off the Clock" presenters will be Michele Procino-Wells, Esq., and Amber B. Woodland, Esq., from Procino Wells LLC. Participants will hear a brief presentation and are then encouraged to ask questions about the legalities of end-of-life planning. Learn more by contacting Katie Berna, MHA, BSN, CHPN, associate director of education for Delaware Hospice, at or 302-530-2388.

Bayhealth plans Runway of Hope Bayhealth invites the community to the 3rd Annual Runway of Hope in August at the Rehoboth Beach Country Club. A festive summer afternoon filled with a luncheon, fashion show, and silent auction, the event raises money to support the Bayhealth Cancer Institute's Survivorship Program, which helps cancer survivors live full and productive lives. Local Rehoboth favorites Cleo's Boutique, Sole Boutique, Jane & Georgie, and Rock Creek, along with Aquamarine of Lewes and Dover's own Bel Boutique, are partners in the event. Come feast your eyes on fine apparel and accessories exclusively found at these stores. Stuart Kingston will be on hand with a display of fine jewelry for sale. Last year, the sold-out Runway of Hope event raised more than $37,000 to help bridge the gap between active cancer treatment and follow-up care. To learn more about Runway of Hope or to purchase tickets, visit or call 302-744-7015.

Stroke support group Nanticoke Memorial Hospital's next Stroke Support Group meeting is at 1:30 p.m. on Tuesday, July 16, at the Seaford Library. The support group is designed for individuals who have survived a stroke as well as their families and caregivers. The two-hour support group meetings will consist of guest speakers and breakaway sessions in which caregivers and stroke survivors will meet in two groups to discuss concerns, provide support, and allow for networking. Refreshments will be provided. Pre-registration is not required for this free support group. For more information, contact Nanticoke Memorial Hospital at 629-6611, ext. 8626.

Aquacare offers diabetes program Aquacare Physical Therapy, with offices located in Lewes, Millville, Milsboro and Seaford, are pleased to offer a specialized Diabetes Therapy Program. This program emphasizes a comprehensive treatment strategy to assist patients in the development of an exercise program to prevent and manage diabetes. After an initial evaluation by a physical therapist, patients will be seen for a series of visits addressing various topics. Managing your diabetes can lower your risk of resulting health issues. Management includes controlling your blood sugar (glucose), lowering your blood pressure and cholesterol, maintaining a healthy weight, and exercising. Physical therapists are experts in restoring and improving human motion, and can play an integral role in the management of diabetes by establishing and, as needed, supervising exercise programs and providing treatment of complications. This program is covered by most insurances. Exercise is an important part of managing diabetes. The American Diabetes Association recommends 30 minutes of moderate exercise at least five days per week. You should see a physical therapist to help you with physical activity if you have:
  • Pain in your joints or muscles
  • Numbness or tingling in your feet
  • Calluses or sores on your feet
  • Pain or limping with walking
  • Used an assistive device such as a cane or crutches
  • Desire to develop an exercise program
For more information on the specialized services offered for diabetes management at Aquacare Physical Therapy or to schedule a consultation or free screening, call the Seaford office at 536-1774.

Hospice offers Camp New Hope Delaware Hospice has spaces available at its Camp New Hope, which will be held from Aug. 6-9, at Killens Pond State Park, for children and teens who have suffered the recent loss of a loved one. Since 1990, Delaware Hospice's New Hope program has offered individual and family grief counseling to more than 1,500 children and adolescents aged 6-17. The New Hope program, including Camp New Hope, is a free, community outreach program. New Hope supports children referred from the community as well as members of Delaware Hospice families. Camp New Hope is the annual highlight of the New Hope Program. This inspirational day camp takes place over four days, connecting children in similar age groups in order to help them process their feelings of loss and grief. Many of the children in New Hope have lost a parent, sibling, or grandparent due to illness or sudden death. Learn more about Camp New Hope by contacting New Hope Coordinator for Kent and Sussex Counties, Robin Murphy at 302-678-4444 or

Law targets prescription drug abuse Delaware's prescription monitoring efforts will be strengthened by legislation that received final approval in the General Assembly and makes its way to Governor Markell for his signature. Senate Bill 119, which passed the House unanimously, responds to the recognition that increasing numbers of prescription drug addicts are turning to emergency rooms and urgent care clinics to obtain narcotics as enhanced enforcement has limited previous sources of drugs. SB 119 builds on Delaware's prescription drug monitoring program by:
  • Limiting all medical facilities except licensed pharmacies from dispensing more than a 72-hour supply of a controlled substance to patients
  • Requiring all "dispensers" to enter any prescription of a controlled substance into the PMP, just as pharmacies are currently required to do, and
  • Requiring the Department of Health and Social Services to establish a uniform protocol to guide caregivers regarding the proper disposal of controlled substances upon a patient's death.
Hospice care providers would also assist family members and caregivers to inventory and dispose of a patient's remaining supply of controlled substances upon that patient's death.

Hospice 5K Run & Fun Walk Delaware Hospice will celebrate the 5th anniversary of the opening of the Delaware Hospice Center in Milford at its popular 5K Run & Family Fun Walk on Wednesday, July 10. Registration opens at 5:30 p.m., the race begins at 6:30, and the post-event cookout and party will go on until evening. Early registrants will pay $18 for individual entries until July 8. After July 18, individual entries are $20. Team rate for a group of four or family rate for a group of four or more from the same household is $50. Sponsorships are welcome. There will be medals for winners and door prizes for everyone. For more information, contact Peggy Dolby, assistant director of development, at 856-7717 or