3 The incidence of UTIs falls below 1% in school-aged boys and increases to 1–3% in school-aged girls. In the first year of life, UTIs are more common in boys than girls and 10 times higher in uncircumcised boys, compared with circumcised boys. UTI susceptibility is determined by bacterial virulence, anatomical variances (gender, vesicoureteral reflux, circumcision), bowel or bladder dysfunction resulting in urinary stasis (constipation and neurogenic bladder), and host defences (genetics and flora of periurethral and gastrointestinal tracts). Urine is sterile, but uropathogens may gain entry during catheterisation, turbulent voiding patterns, sexual intercourse or genital manipulation. UTIs resulting from haematogenous and direct invasion seldom occur. From the bladder, uropathogens may ascend the urinary tract (pyelonephritis) or invade the bloodstream (urosepsis). Often, UTIs develop when uropathogens ascend from periurethral colonisations to the bladder (cystitis). The aim of this article is to provide clinicians with an overview of the assessment and management of children with UTIs. Delaying diagnosis and management of UTIs may potentially result in renal damage and loss of renal function. An estimated 2% of boys and 8% of girls will experience a UTI by seven years of age, and 7% of febrile infants will have a UTI.1,2 Paediatric UTIs, especially in young children, have varied and non-specific presentations that can be undetected or misdiagnosed. Urinary tract infections (UTIs) are common in childhood.
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