Our Doctors Answer

While babies are in the womb, their testes are located inside the abdomen, and some time before birth they descend through the inguinal canal into the scrotum. When a testis fails to complete its descent and remains in the inguinal canal, the condition is called an undescended testis. Babies with an undescended testis are followed until 18 months of age, because the testis may descend into the scrotum on its own. If the testis has not descended during this follow-up period, day surgery is planned. Children with an undescended testis are checked in the outpatient clinic the day after surgery and 15 days later for dressing changes.

A retractile testis is commonly known as a shy testis. A retractile testis is not an undescended testis and in most cases does not require surgery. However, some of these testes may remain in the groin during follow-up and become a true undescended testis, or the development of the retractile testis may be affected. In such cases, the child is evaluated for surgical treatment.

Muscular torticollis means a crooked neck. It can occur for many reasons. It develops because of hardening of the sternocleidomastoid muscle, which holds the neck steady and contributes to its movements. The baby's neck tilts toward the side of the thickened muscle, while the baby's face turns toward the opposite side. Babies younger than one year are followed with stretching exercises. Surgical treatment is planned for babies who are older than one year and do not benefit from stretching exercises. In surgical treatment, part of the hardened neck muscle is removed to correct the tilt. After this procedure, patients are kept in hospital for 1 night and followed with a neck collar for one month.

In children, an umbilical hernia may close on its own until the age of 3. Large umbilical hernias that do not close on their own after this age are treated surgically. After umbilical hernia surgery, patients are kept in hospital for one night for observation.

A yellow discharge from the navel after the umbilical cord has fallen off is due to an umbilical granuloma. An umbilical granuloma is treated in the outpatient clinic by cauterization with silver nitrate. In some cases, silver nitrate may need to be applied several times. A bloody discharge from the navel may be due to infection or may be a sign of a bleeding disorder, and it must be investigated by specialist physicians. In newborns, a purulent discharge from the navel and redness around it suggest a possible umbilical infection and always require treatment. Rarely, urine or intestinal contents may also leak from the navel. In such cases, a pediatric surgeon should be consulted.

In girls, adhesion of the labia may occur because of the withdrawal of maternal hormones or problems related to hygiene of the genital area. Parents sometimes mistake this for fusion or absence of the vaginal area. Labial adhesion can be managed with warm sitz baths and estrogen creams, or it can be treated in the outpatient clinic by simply separating the adhesion and applying estrogen cream. Warm sitz baths are continued for some time after the procedure. Very rarely, labial adhesion requires separation under operating room conditions.

An anal fissure is a crack that forms in the anal area due to hard stool, especially in children with constipation. It may cause streaks of bleeding in the anal area after a bowel movement. Passing stool is painful in children with an anal fissure, and children often avoid going to the toilet. In children with an anal fissure, both the constipation and the fissures must be prevented. For constipation, age-appropriate dietary recommendations are given. In children who have been constipated for a long time, medication to soften the stool and, rarely, enemas may be used. An anal fissure can be healed with warm sitz baths and by applying healing ointments with a local anesthetic effect to the anal area. In some children, the treatment of constipation and anal fissure may take a long time.

Bedwetting is a condition that may improve over time as the child develops bladder control. However, bedwetting in children older than 5 years must always be investigated and treated. In some children, bedwetting runs in the family. Some cases resolve on their own. Simple supportive measures are preferred first, such as limiting fluids at night, going to the toilet before bed, and waking the child to go to the toilet some time after falling asleep. In patients who do not benefit from these measures, an alarm or medication may be needed, depending on the child's night-time voiding pattern.

Flu-like infections and infections with rashes are common in childhood. In non-urgent cases, it is recommended that surgery under anesthesia be performed at least 15 days after the infection has been treated.

A hydrocele is a collection of fluid around the testis and may resolve on its own over time. Hydroceles that do not resolve on their own need to be operated on when the baby is 18 months old. Hydrocele repair is a day surgery procedure, and these children are usually monitored without being admitted to hospital.

Hydronephrosis is dilation of the kidney, and hydroureteronephrosis is dilation of the kidney and urinary tract; they may be caused by congenital narrowing of the urinary tract or by reflux. Post-natal follow-up of hydronephrosis and hydroureteronephrosis seen on ultrasonography during pregnancy is important. Hydronephrosis is the more commonly detected condition, and these babies should be evaluated by ultrasonography a few days after birth, if possible before leaving the hospital. When the baby is one month old, a number of tests should be performed to investigate the causes of the hydronephrosis. Most cases of hydronephrosis can be followed safely with periodic kidney ultrasonography. Hydronephrosis that causes deterioration in kidney function during follow-up is evaluated for surgery.

Circumcision performed for medical reasons (recurrent urinary tract infections, narrowing of the foreskin, etc.) can be done at any age. However, when circumcision is performed without a medical reason, it is recommended to do it between 9 months and 3 years of age or after 6 years of age, when children are least likely to be psychologically traumatized.

Hypospadias is a congenital anomaly in which the urethral opening is not located at the tip of the penis. There are mild and severe forms, depending on where the urethral opening is located. In children with hypospadias, the foreskin cannot surround the penis and is absent on the front side of the penis. Some patients are thought to be born circumcised. At birth, attention is paid to whether the urethral opening is wide enough. If the opening is narrow, it needs to be widened with a limited procedure. Because the foreskin may be used in hypospadias repair, these children should not be circumcised until the repairs are completed. Many hypospadias repair techniques have been described in which the urethral opening is moved to the tip of the penis. Depending on the repair technique, patients are kept in hospital with a catheter for 3 days to 1 week after surgery. It should be kept in mind that complications such as retraction of the urethral opening, fistula and stricture may occur after hypospadias repair.

Accidental ingestion of cleaning products is very common in children. These substances can cause burns of the esophagus and resulting strictures. For this reason, they should be stored out of children's reach, in containers that cannot be opened easily. If these substances are swallowed by mistake, the child must be taken to the emergency department. Interventions such as inducing vomiting, gastric lavage or giving food are not recommended, because the caustic substance passes through the esophagus once again and increases the damage. They must in fact be strictly avoided. After first aid in the emergency department, these children should be examined with an endoscope to assess the damage to the esophagus.

In children who have aspirated a foreign body, the airways need to be examined with a bronchoscope immediately if there is respiratory distress, and as soon as possible if there is not. All cases with suspected foreign body aspiration should be examined with a bronchoscope and the foreign body should be removed.

After the age of one, trauma is one of the major health problems of childhood. In physical trauma, the head, chest cage, abdominal organs, pelvis, urinary tract and musculoskeletal system may be damaged, and injuries that may be very serious at first may not be noticeable from the outside. After trauma, the emergency department should be reached as soon as possible, and the necessary interventions and examinations should be performed in time.

A significant proportion of vomiting seen in newborns may be due to gastroesophageal reflux. In newborns, reflux can usually be relieved by feeding in a suitable position and with thickened foods. Newborns who vomit everything they are fed and have fluid loss need to be investigated for pyloric stenosis. In babies with pyloric stenosis, after appropriate fluid treatment the pyloric stenosis can be relieved by cutting the pyloric muscle. A newborn who vomits bile may have a congenital intestinal obstruction and must therefore be evaluated in the Department of Pediatric Surgery.

Abdominal pain is a common complaint in children. Age, the character, location and radiation of the pain, and other accompanying complaints may vary depending on the cause of the pain. Through the history and physical examination, some diseases that require urgent surgical intervention can be recognized, and other necessary examinations are then planned. If it is not recognized early, abdominal pain may be a sign of some life-threatening diseases. For this reason, painkillers should not be given before the cause is known when there is abdominal pain, and a doctor must always be consulted.

Depending on the child's age and the nature of the bleeding, rectal bleeding may be due to different causes. Since it may be caused by many different conditions such as anal fissure, intussusception, polyps, inflammatory bowel diseases and systemic diseases that cause bleeding disorders, a doctor should be consulted when this complaint is encountered and the necessary examinations should be planned.