Problem:
A 5-month-old infant presents with increasing fussiness over the past three days and has been vomiting since last night. The infant developed a fever of 102.2 this morning. The infant has been healthy since birth and their immunizations are up-to-date. Review of systems is positive only for loose stools for the past 24 hours. Physical exam reveals normal vitals except a temperature of 39.0. A thorough HEENT, respiratory, and abdominal exam are normal. Genitourinary exam reveals an uncircumcised penis with normal testicles. How does the presentation of urinary tract infection (UTI) vary at different ages through childhood? What are the risk factors for UTIs in the pediatric population? Would you consider a UTI in this infant? What would you do next in the office to further evaluate him?