Understanding Childhood UTIs with Leading Specialist Dr Katerina Bambang

While it’s well known that women are more prone to urinary tract infections (UTIs), we also often hear from parents worried about their children experiencing them. To shed light on this important topic, we sat down with Dr Katerina Bambang – consultant gynaecologist with over 18 years’ experience in women’s health with the NHS and also founder of The Delphi Clinic – for a Q&A covering some of the most common questions parents ask.

1. Tell us a bit about yourself. What is your background, and what inspired you to start The Delphi Clinic? What does the clinic specialise in?

I am a consultant gynaecologist and subspecialist in reproductive medicine as well as a paediatric gynaecologist. I work both at a women’s hospital and Alder Hey Children’s hospital, a large tertiary level children’s hospital. I have been in women’s health for about 20 years and have looked after girls since 2019 having done a fellowship in Paediatric Gynaecology. My special interests lie in fertility & fertility preservation, integrative and functional approaches to women’s health and adolescent menstrual health.

The Delphi Clinic was born after the observation that our modern life is contributing to making us sick. There is a lot of evidence out there about the impacts of stress, nutrition, toxic exposures to name a few, are having on our health and I am passionate about educating and empowering women and mothers to take control of their own health in a preventative way. The Delphi Clinic combines the best of conventional medicine with integrative and functional medicine to address root causes of ill health.

Also, I want to point out that my views here are my own and not necessarily those of my NHS workplace.

2. Are UTIs in children common? Who is more prone—little boys or girls?

We generally quote that about 1 in 10 girls will have a UTI in childhood compared to about 3 in 100 boys.

3. How is this linked to the microbiome? And is missing oestrogen ever a factor in children?

Yes this is a really fascinating area of research at the moment. We know a lot about the microbiome in adult women but actually we don’t have huge amounts of data yet in children. Some studies have shown that the urinary microbiome also known as the urobiome is different in children than adults. We also know that a dysbiotic urobiome is linked to a higher risk of UTI and abnormal bladder function but the majority of the research has been in adults.

I think it is an area that is gathering a lot of interest as our mainstay of treatment for recurrent infection at the moment is prolonged courses of antibiotics which have been shown not to improve the outcome or reduce the risk of scarring and obviously significantly increase the risk of antibiotic resistant bacteria which is a really big problem.

Regarding oestrogen, again we have no specific data in children but we do know that menopausal women have a much higher risk of UTI and this is related to the lack of oestrogen which also leads to significant changes in both the urobiome and the vaginal microbiome. We speculate that it may be similar in girls due to the absence of oestrogen but I would like to see more data published around this before making any concrete judgments.

3. What can parents do to help prevent UTIs in children? Do you have any practical advice for parents?

This is a great question! Yes absolutely. 

• It is important children stay well hydrated throughout the day. I would always choose water rather than any sugary drinks including juice.
• Avoiding constipation and also encouraging girls to wipe from front to back is important. 
• Getting your child to pass urine every 3-4 hours is also important and encouraging children to do a ‘double void’ can also be helpful. A double void is when children pass urine and then count to 10 and try to pass urine again. This helps empty the bladder fully.
• Finally avoiding bubble baths and soaps in the bath as they can cause significant irritation resulting in girls avoiding passing urine.

4. Beyond your NHS work with UTIs in children, The Delphi Clinic also focuses on women’s health. What other key areas do you specialise in, and how do you support women?

That’s right – while my NHS work involves UTIs in children, I don’t see children at The Delphi Clinic. However, GPs are welcome to refer paediatric cases to my NHS clinic, and I can also connect families with trusted colleagues in private practice who specialise in children’s care.

At The Delphi Clinic my focus is primarily on women’s health – particularly fertility. I essentially see women with any gynaecological concern from about age 18-45 who are interested in a more root cause approach where we are looking to understand the biology of their body to identify the cause of their symptoms rather than just managing the symptom alone. So I will see women with a variety of conditions such as PCOS, menstrual disorders, endometriosis and recurrent vaginal discharge.

The important thing to say about this approach is that it is not a quick fix as it is a deep dive into what is causing the symptoms rather than quickly managing the symptoms alone so it does require commitment to making lifestyle changes. What I love about this approach is that it gives women control of their own health and a deeper understanding of their own body and also provides them with tools to maintain their health that are accessible to them throughout their lifetime.

5. Any final words you’d like to share? What professional goals are you working towards, and what excites you most about the future of women’s health?

It’s been great to chat and I am excited to see that more parents and women are learning how to keep themselves and their children healthy. Our healthcare system is brilliant when we are sick but it is not really designed to keep us in health and I am super passionate about empowering women to understand their cycles and how they influence their overall health and wellbeing.

I am currently working on a course to support women with evidence based information on optimising and also protecting their fertility.

This is a great time to be a woman! We are finally getting a spotlight on women’s health and there is so much innovation ongoing in areas such as femtech and finally we have publicity and research focusing on how to improve the way we diagnose and treat difficult conditions such as PCOS and endometriosis.

Dr Katerina Bambang, Consultant Gynaecologist & Subspecialist in Reproductive Medicine (NHS & Private Practice)

How to get in touch with Dr Katerina?

You can find me on Instagram @the.delphi.clinic or you can email me at contact@thedelphiclinic.com. I am always happy to share information so please get in touch if you have any questions.