catheterization, or bag specimen as opposed to catheterized specimen in children older than months of age If the bag specimen UA is positive, a catheterized urine specimen must be obtained for culture In children who are not toilet trained, aseptic urethral catheterization or suprapubic aspiration is the appropriate method to obtain urine for the diagnostic urine cultures An additional noninvasive method of urine collection in infants is suprapubic cutaneous stimulation, where cold saline-soaked gauze is rubbed in the suprapubic region to stimulate urination allowing for a clean-catch specimen to be obtained TABLE 31.4 FEVER WITHOUT LOCALIZING SIGNS IN CHILDREN 56 DAYS TO 24 MONTHS Consider UTI Consider occult pneumonia - If >3–4 days of fever in setting of respiratory symptoms, hypoxia, tachypnea, abdominal pain, chest pain Consider occult bacteremia - If unimmunized or not fully immunized, especially those under mo of age Consider sinusitis - If ≥1 year of age, fever ≥39°C for at least days and purulent nasal discharge Consider Kawasaki, including incomplete - If fever >3–4 days with signs of Kawasaki or if 8 days of fever without a source Consider seasonal or locally endemic infection - For example, influenza If the child between and 24 months of age with a temperature of 39°C (102°F) or higher does not have localizing symptoms or laboratory/radiograph results (when performed) indicative of definitive focal infection, the child should be assessed for the risk of occult bacteremia especially if younger than months of age or not fully immunized for Hib and Streptococcus pneumoniae A “well” clinical appearance does not decrease the risk for occult bacteremia (otherwise the bacteremia would not be “occult”) Children with occult bacteremia are at risk