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News from Baby Medical Q&A, Issue #014 - Nov 2007
November 01, 2007
New Questions and Answers
Question: My 5 year old's penis foreskin is very tight, even more so since he forced it back tearing the skin on both sides. This has healed leaving scars and has made the opening of his penis even tighter than before, which causes soreness and infections often. I have also noticed that when he is urinating the urine balloons up under the skin before forcing its way out. I took him to our GP who referred him to Hospital for a second opinion. The specialist said that he would need a circumcision as the scar tissue has healed causes the skin to become even tighter. This decision was given within minutes of examining him.
We are very anxious about the operation in itself but also have the added worry of our child being put under general anaesthetic. Is there another procedure that is not as intrusive as we are worried about the after effects of the operation and the added worry of general anaesthetic being given? Is there any chance of the skin loosening on its own later on, or something that we can do ourselves to help it along?
My son hasn’t had an infection for a few months now, so we are hoping that in time it will loosen on its own.
I know that the infections are caused by not being able to properly clean under the skin, so was thinking about how I could clean him better and came up with this idea. Yesterday I brought one of those baby medicine syringe, fill it with warm water and gently flushed under the skin, it worked. The water gets right underneath washing it out. My son was a little bit nervous at first because he thought it would hurt, but after I done it the first time, he realised it wasn’t painful at all, and he lets me do it without any fuss. So as long as I can clean it thoroughly each day, this should help keeping infection at bay, is it ok to do this?
I was reading on the net that for scar tissue you could use a steroid cream that would soften the skin, is this used on children and what do you think about it?
Answer: I can understand your worry. It does sound as if the foreskin is tight and your doctor is right - when the skin is forced back it can tear and when the tear heals it contracts the skin making the foreskin tighter. The ballooning with peeing is because of the tight foreskin.
This is called phimosis and is a reason for circumcision.
If your son isn't getting infections underneath the tight foreskin (called balanitis) and it isn't worrying him too much at the moment, you could wait and see if the skin relaxes a bit over time before having surgery.
If you are going to wait and see, gently pull the foreskin back as far as it will go comfortably in the bath - don't force it. Over time, this may just relax the skin enough so a circumcision wouldn't be necessary. I think your plan to keep the foreskin clean is a very good idea. It's worth a try anyway if you don't want to rush into surgery. Just beware that you don't force the foreskin back and cause a tear as that will only make matters worse.
I wouldn't use steroid cream to weaken the skin - that is usually an undesirable side effect of steroid creams. In time, if there is not continued scarring the skin will loosen by itself.
As for the general anaesthetic, there is always a small risk and I wouldn't advise unnecessary operations but this may become a necessary one. The operation is relatively short and so the risk is small, but you are right to be concerned.
Question: My baby girl has just turned 5 months old, she was 5 weeks premature and had a small heart murmur that has not posed a problem. She has been getting a large lump (the size of a golf ball) in her groin on her right hand side which I assume is colic as I can usually massage it out with no worries and her crying will stop. She has had this since about 2 and a half months old, it seems to be getting worse. Tonight I massaged her and bounced her on my shoulder for over an hour, everytime I put her down on her back the lump would return. Would this just be colic?
Answer: I don't think this is colic. It sounds like your daughter has an inguinal (or maybe a femoral) hernia. See the inguinal hernia page.
Although hernias are usual in boys, they can occur in little girls as well.
As long as it goes back in that's good but you need to get your doctor to refer you to a paediatric surgeon.
Question: How can a infected mother with HIV reduce the risk of it being passed on to her fetus?
Answer: With good health care, most babies born to HIV positive mothers will not get the infection.
Things you can do:
Question: My grandson is 7 months old and is testes have not come down. Is that something to worry about?
Answer: Sometimes it takes some time for the testes to descend but if they're not down by 12 months of age, they need to be surgically pulled down into the scrotum. If they are left high, there is an increased risk of cancer later in life.
See your doctor soon to make an appointment to see a pediatric surgeon before your grandson is a year old.
News and Updates
A new study has shown that a quick "in and out" approach to childhood immunisations (vaccinations) is less painful that the slow approach - so that is slow insertion, pull back on the needle (aspirate) and then a slow injection and slow removal of the needle.
Check your health care provider has seen that study before your child's next immunisations and just quickly inserts the needle, injects and then withdraws the needle.
Moshe et al. Vaccine related pain: Randomized controlled trial of two injection techniques Arch Dis Child. Published Online First: 8 August 2007. doi:10.1136/adc.2007.118695
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