Urinary tract infection risk in girls can be up to four times higher

By Ahmet Taş | Wise News Press
ANKARA, TURKEY — Urinary tract infections are among the most common childhood infections, and experts warn that girls may face a risk up to four times higher than boys.

Associate Professor Neşe Karaaslan Bıyıklı, a pediatric nephrology and child health specialist at Anadolu Medical Center Hospital, said early diagnosis and proper treatment are critical because untreated infections may lead to permanent kidney damage, high blood pressure and kidney failure later in life.

Girls face a higher risk of infection

Bıyıklı said the frequency of urinary tract infections in children varies according to age, sex and circumcision status in boys.

According to the specialist, urinary tract infection is detected in 1% to 16% of children under the age of 2 who are brought to health facilities with fever. In older children, the rate reaches about 8%.

Girls are at a higher risk than boys, with the likelihood of infection reported to be 2 to 4 times greater. The shorter urinary tract in girls can make it easier for microorganisms to reach the bladder and upper urinary system.

This higher risk makes hygiene, regular toilet habits, adequate fluid intake and early medical evaluation especially important in girls.

Symptoms may not always be clear

Urinary tract infections in babies and young children do not always appear with obvious symptoms. In some cases, fever may be the only noticeable sign.

Bıyıklı said burning during urination, frequent urination and changes in urine color may point to infection. However, vomiting, loss of appetite, abdominal pain and unexplained discomfort can also be warning signs.

For this reason, families should not ignore unexplained fever, feeding problems, abdominal pain or persistent restlessness in young children.

The specialist emphasized that urine analysis and urine culture are important in cases where the cause of symptoms cannot be clearly explained. A urine test alone may suggest infection, but a culture is needed to identify the microorganism and guide the correct treatment.

Kidney involvement can cause permanent damage

Urinary tract infections should not be seen only as a temporary fever or urinary complaint. If the infection spreads from the bladder to the kidneys, it may cause lasting damage.

Bıyıklı warned that kidney infections in childhood can increase the risk of hypertension and kidney failure in later years.

This risk becomes more important in children with recurrent infections, structural abnormalities in the urinary system, stones, narrowing, reflux or bladder and bowel function disorders.

If a child has repeated urinary tract infections, doctors usually investigate whether there is an underlying cause. According to Bıyıklı, nearly half of these children may have structural problems related to the urinary tract.

Urinary reflux is seen in about three in 10 cases

Bıyıklı explained that urinary tract infections develop when microorganisms enter the urinary system and multiply. Germs usually enter through the urinary opening and may progress to the bladder and kidneys.

Poor genital hygiene, delayed diaper changes in newborns, diaper rash, diarrhea and parasites can increase the risk of infection.

In boys, foreskin-related problems or narrowing at the tip of the penis may make urination more difficult. Anatomical or neurological disorders of the urinary system, stone formation and vesicoureteral reflux are also important risk factors.

Vesicoureteral reflux is a condition in which urine flows backward from the bladder toward the kidneys. Bıyıklı said this condition is seen in about 30% of children who have urinary tract infections.

This makes further evaluation important, especially in children with fever, kidney involvement or repeated infections.

Recurrent infections require further evaluation

Urinary tract infections tend to recur in children. Bıyıklı said that after a first infection, recurrence may occur in 20% to 30% of boys and 40% to 60% of girls.

Because of this, children who have had a urinary tract infection should be evaluated for underlying causes.

Leakage, narrowing, stones or other structural problems may lead to repeated infections. Bladder and bowel dysfunction can also reduce treatment success.

Constipation, holding urine for long periods, delaying toilet visits and irregular urination habits may increase infection risk. Managing these issues is often an important part of preventing recurrence.

Bıyıklı also noted that urinary tract infections experienced in childhood may recur in girls later in life, especially during menstrual periods and pregnancy. In some cases, past infections may also increase the risk of pregnancy-related complications.

Urine testing may not be enough alone

Bıyıklı said children who experience urinary tract infections should not be evaluated only with urine analysis and urine culture if there are signs of possible underlying problems.

Kidney and bladder ultrasound is among the main evaluation tools. In some children, kidney scintigraphy may be needed to assess possible kidney damage.

Depending on kidney damage risk, family history and clinical findings, further tests such as voiding cystography may also be used. In selected cases, MR urography, computed tomography, MAG3 scans and urodynamic studies may be required.

Treatment depends on the child’s age, symptoms, infection severity and risk factors. Correct antibiotic selection, proper dose and full treatment duration are essential. Some children can be treated with oral medication, while others may need injectable treatment.

Families should avoid stopping antibiotics early without medical advice, even if the child appears to improve.

Daily habits can lower infection risk

Daily habits play a major role in preventing urinary tract infections in children.

Bıyıklı said adequate water intake and control of constipation can help reduce the risk. Children should be encouraged not to hold urine for long periods and to use the toilet regularly.

For children who use diapers, diapers should be changed frequently. Prolonged diaper use should be avoided when possible.

In girls, the genital area should be cleaned from front to back. In boys, the area around the penis should be washed carefully. Bıyıklı said water alone is generally sufficient for cleaning the genital area.

Special care products and wet wipes may disrupt the natural structure of the genital region. Long bubble baths should also be avoided.

Choosing cotton underwear, changing underwear daily and maintaining regular hygiene are among the practical steps families can take.

Parents should seek medical advice if a child develops fever, burning during urination, frequent urination, foul-smelling urine, abdominal pain, vomiting, loss of appetite or unexplained discomfort.

This article is for informational purposes only and does not replace medical diagnosis or treatment. Families should consult a pediatrician or pediatric nephrology specialist for evaluation and care.

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