What’s a hydrocele?

hydrocele in chrildrenWhen I see boys for routine physicals, I always check their testicles for lumps or swelling. The most common problem I find in the first year of life is something called a hydrocele. A hydrocele is a collection of fluid around the testicle.

Hydroceles have an interesting history. Although a baby’s gender is decided at the moment of conception, both sexes develop along the same path until the third month of pregnancy. At that point, a group of cells in the lower abdomen develop into ovaries in females or testicles in males. If the baby is a girl, the ovaries are in the correct anatomic position. If the baby is a boy, the testicles need to descend into the scrotum. This process takes about six months. As the testicles move downward, they pass through the inguinal canal before reaching their proper position in the scrotum.

After the testicle enters the scrotum, the inguinal canal is supposed to fuse thereby separating the abdominal cavity from the scrotum. In some cases, this doesn’t happen and a small amount of fluid travels into the scrotum. Most of the time, this occurs before birth and the hydrocele will be detected at the baby’s first examination. In some cases, fluid moves into the scrotum after birth, in which case the hydrocele won’t be found until the baby is older. Most turn up between 1 and 4 months of age.

Hydroceles are not dangerous and usually resolve before a child’s first birthday. If they persist beyond a year, there’s a possibility the child also has an inguinal hernia. In this case, he should see a pediatric urologist or a general pediatric surgeon.

Caring for umbilical stumps

umbilical stump careAt the time of birth, a baby’s umbilical cord has a shiny, off-white color. Over the next few days, the cord will dry out and turn a dark brown or black color. As this happens, the cord will shrink and often looks like a scab on the baby’s abdomen. In the past, the umbilical stump was coated with a blue dye after birth and parents were told to clean the area with rubbing alcohol at every diaper change. These recommendations were discontinued because they were found to increase the time it took for the cord to fall off. Nowadays, parents don’t need to do anything special other than keeping the stump from becoming irritated by the baby’s diaper and avoiding baths until the cord falls off.

A few things may happen that worry parents during the 7 to 10 days that it takes for the cord to fall off.

  • The base of the cord may develop a gooey, greenish-yellow appearance. This is normal and not a cause for concern.
  • The cord may smell bad. The reason the cord falls off is because it no longer has a blood supply, and the baby’s immune system is rejecting the dead tissue. If the stump became infected, the skin around the belly button would become red and swollen. If you think your baby’s umbilical stump is infected, you should see the doctor promptly.
  • The cord may bleed a little before or after it falls off. If this happens, you can gently clean the excess blood with a cotton swab.
  • A red, fleshy lump may appear after the cord falls off. This is called an umbilical granuloma. It’s not serious, but doctors treat the area with silver nitrate to make the lump fall off.

What is pediatric oral allergy syndrome?

Pediatric Oral Allergy SyndromeMost food allergies manifest themselves with non life-threatening reactions such as facial swelling or hives. That being said, it’s important to let the doctor know if your child has had an allergic reaction to a food. This will not only reduce the possibility of a serious reaction in the future, but you will be taught how to deal with such reactions.

Oral allergy syndrome is not a serious food allergy. Instead, it’s a mild reaction to foods that many people have not heard about. It occurs when someone experiences an itchy or tingling sensation in his mouth or throat after eating certain foods. The person does not get hives, facial swelling or other symptoms associated with a potentially serious food allergy.

Oral allergy syndrome is seen in people with spring and summer pollen allergies. It turns out that certain food have an allergen (something a person can be allergic to) that cross reacts in people who are allergic to certain types of pollen. Here are some examples.

If you’re allergic to birch pollen, you may react to apples, pears, cherries, plums, peaches, kiwi, celery, carrots, parsley, hazelnuts and almonds. If you’re allergic to grass, you may react to tomatoes, melons, celery, peaches and oranges.

The most interesting thing about oral allergy syndrome is that the person will not have symptoms if he eats the same food after it’s been cooked. In other words, apples cause symptoms, but applesauce does not. The reason you don’t react to the cooked food is because the allergen is destroyed when the food is processed.

Is it OK to give kids fever (or other) medicine before a doctor’s visit?

kid's tylonol before doctor visitLots of parents think that giving a child acetaminophen or ibuprofen prior to seeing the doctor will compromise the visit. This is not true. Fever reducing medicine won’t make it harder for the doctor to figure out what’s wrong. In fact, reducing a child’s fever usually makes it easier for the doctor because the child is more likely to cooperate if her temperature is lower during the visit.

The same thing is true for asthma medicine or any other drug your child is taking. Unless the doctor or nurse specifically tells you not to give a medicine before a visit, you should do what you can to control your child’s symptoms.

What’s better, sippy cups or straw cups?

Sippy-cups-vs-straw-cupsNewborns have a sucking reflex that enables them to nurse or bottle feed. This reflex involves opening their mouths and moving their tongues in and out to “milk” the nipple. When babies start solid foods around 6 months of age, they usually push food out of their mouths because that’s what their tongues are used to doing. It takes a week or more for babies to learn how to use their tongues effectively with spoon-feeding, but they continue with the milking action when taking breast milk or formula.

Sippy cups have been around for as long as I can remember. Straw cups are relatively new on the scene. When babies drink from sippy cups, some of them continue to push out their tongues, which could lead to lisps and other speech problems later on. However, with straw cups, they are more likely to keep their tongues in their mouths, which is theoretically better for speech development.

So which type of cup is better for infants and young children? Here’s what Maia Magder, a speech pathologist at NIH, has to say about the matter: “There is no hard evidence that sippy cups cause speech delays, but it’s important to provide infants with opportunities to move their mouths in more advanced patterns to foster feeding and speech advancement.”

Regular “open” cups are the best for speech development, but babies are pretty messy, so many parents aren’t ready for this step until the toddler years. Here is Maia’s take on getting rid of spouts and straws: “Offering an open cup as early as 8 or 9 months helps with jaw stabilization, which is another important factor in speech development. As for the messiness, like other aspects of parenting, think of it as balancing the new with the old. It’s always important to read a baby’s signs and signals when using cups so that your baby doesn’t choke.”

Which bug repellants are best for kids?

Bug-Repellants-for-KidsIf you spend time outdoors with children, you’ll need to keep them safe from mosquitos, biting flies and ticks. For young infants, the best approach is to protect them with clothing or nets that cover their strollers. For older children, you’ll need an insect repellent to get the job done. DEET can be used with infants as young as 2 months, but the American Academy of Pediatrics (AAP) recommends not using products with more than 30% DEET: http://www.healthychildren.org/English/safety-prevention/at-play/Pages/Insect-Repellents.aspx. Lower concentrations of DEET work well, but last for shorter periods of time. A 10% concentration lasts for about two hours. I prefer an ingredient called picaridin because it works almost as well as DEET, but feels nicer on the skin. If you want a natural product, the soy-based repellent in Bite Blocker lasts about 90 minutes.

If you use a product containing DEET or picaridin, a lotion or pump spray is safer than an aerosol. Don’t apply it to your child’s hands and be careful to avoid the eyes, nose and mouth. It’s also a good idea to wash it off when you come inside.

You should not use products containing insect repellent and sunscreen. Instead, apply the sunscreen first, wait until it’s absorbed, and then apply the insect repellent. Keep in mind that sunscreen should be used liberally and reapplied every two hours. Bug sprays are applied sparingly and many should not be reapplied. Always read the instructions that come with the product you’re using.

How to reduce itching from bug bites

BugBiteItchOne of the frustrations that comes with itchy rashes is something doctors call the “itch scratch cycle.” The process goes like this: A rash itches so we scratch it. Although the scratching makes the itch go away, it can irritate the skin causing the itch to recur. This can lead to itch-scratch-itch-scratch, etc. Eventually, the skin can become so irritated that scratching the area actually hurts. The best way to deal with this is to put something cold on the itchy/painful area for 5 to 10 minutes. Of course, not getting into this bind is even better.

If your child starts to scratch a bug bite, you can use 1% hydrocortisone ointment (not cream) and a “dot” Band-Aid to stop the itch. First, put a small amount of the ointment on the bite. Second, open the Band-Aid and briefly stick it to your shirt or pants. (This takes some of the adhesive off the bandage so your child is less likely to complain when you remove it.) Third, place the Band-Aid on the bite and leave it in place for about 15 minutes. You can repeat this up to three times a day for four or five days if necessary. Facial skin is thinner than skin on the rest of the body, so don’t use Band-Aids for facial bug bites. The hydrocortisone can still help, but you shouldn’t use it for more than three days.

If the bite gets very red or develops discharge, call your doctor to make sure it hasn’t become infected.