Circumcision information
General information
Circumcision is removal of the foreskin. About 15-20% of boys are circumcised in Australia for a variety of reasons.
Reasons for circumcision
Social / cultural / religious: It is common for boys to be circumcised for non medical reasons. This is not funded by the government and cannot be done in a public hospital. Circumcisions can only be performed in the public hospital for medical reasons.
Dr McBride and Dr Patel are happy to discuss circumcision about your boy. Circumcision can be performed after 6-12 months under general anaesthetic. It is performed using a surgical technique, rather than the Plastibell technique, which is performed by a number of other medical practitioners in the newborn period.
Should I circumcise my boy?
A number of associations and organisations around the world have agreed that there is not enough reason for routine circumcision of all newborn boys, compared to the risk of the procedure. These organisations include: The Royal Australasian College of Physicians, American Academy of Pediatrics and the Canadian Paediatric Society.
It is a choice however, and there are a number of factors that need to taken into consideration.
Common proposed reasons for circumcision
- Normal practice for the family
- Religious tradition
- Appearance
- Reduction of infection – only in children with kidney / bladder abnormalities under 1 year old
- Reduction of sexually transmitted disease and HIV in African males having unprotected intercourse with infected women – circumcision does not replace safe sexual practise.
- Reduction in penile cancer
The circumcision operation
This involves a general anaesthetic day procedure (you’ll be able to go home the same day). Once your boy is asleep we use local anaesthetic to numb the penis before surgically removing the foreskin. There are stitches that will fall away after 2-3 weeks. There will be a simple dressing that can fall away in the shower or bath after 1-2 days.
Risks of circumcision
Circumcision in Australia is fairly safe, as long as it is performed by a qualified experienced medical practitioner who provides adequate pain relief for the boy.
Pain
Bleeding
Infection
Abnormal appearance – too much skin removed or left behind
Lack of autonomy for the boy – the foreskin cannot be replaced.
Recovery after circumcision
You will be able to go home the same day. Pain relief will required for 3-4 days, and may require up to a week off school or daycare. Recreational swimming can usually be resumed after a week if the area is dry and sports can resume after 2-3 weeks.
You’ll be given paraffin to help moisturise the area and help with itchiness that often develops in the first week after the procedure. The glans (head of
penis) can become dry and itchy, sometimes causing more discomfort than pain.
Liquid paraffin (2-3
drops) to the glans every few hours for 3-4 days, after which soft paraffin or
vaseline can be applied for comfort for a week.
Epigastric hernia
What is an Epigastric Hernia in Children?
An epigastric hernia is a lump or bulge just above the belly button (umbilicus), caused by a small opening in the abdominal muscles. This opening allows fat to bulge out, forming a noticeable lump. They do not resolve on their own, however only rarely cause trouble.
Why Does an Epigastric Hernia Occur?
An epigastric hernia occurs because there is a tiny hole in the muscles of the abdominal wall (or tummy). The exact cause of this is unknown. The opening in the abdominal wall allows internal tissue, such as fat to protrude.
Does an Epigastric Hernia Need Surgical Repair?
Not always. Epigastric hernias are different to umbilical hernias. The defect is smaller and only contain fat, whereas umbilical hernias contain intestines as well.
Epigastric hernias only cause pain in some people, usually when stretching, or sports. In these cases, a repair may be helpful. It is easier to repair during childhood than adulthood, mainly from the point of view of easier recovery, and less impact on work / family life.
Is an Epigastric Hernia Dangerous?
Epigastric hernias are rarely dangerous. The bulge in the skin is generally harmless and poses no immediate threat to your child’s health. The risk of the fat in the bulge becoming trapped in the hernia (a condition known as incarceration) is very low, even in adulthood. There is no risk of intestine becoming trapped.
However, if the hernia becomes firm, tender, painful or red this could indicate that the hernia is stuck. In this case, it is important to take your child to the nearest emergency department for medical assessment.
When to Seek Medical Attention for an Epigastric Hernia
If you wish to monitor you child, here are the signs that may require medical attention. Seek emergency care if:
- The hernia becomes firm or painful.
- The skin over the hernia turns red or inflamed.
- Your child experiences vomiting or refuses to feed.
In these rare cases, a hernia may be stuck (incarcerated) and need emergency treatment.
Monitoring and Care for Epigastric Hernias in Children
Epigastric hernias are a common condition in children and generally do not cause trouble. Surgery is not required on all children with epigastric hernia. Parents should observe the hernia, but there’s usually no need for concern. If you notice any worrying symptoms (see above), consult your doctor for further advice.
SURGERY PAGE
What is Epigastric Hernia Surgery?
Epigastric hernia surgery is a procedure used to repair a hernia that occurs in the area between the umbilicus (belly button) and the rib cage, called the epigastrium. The small hole in the muscle often has a small piece of fat bulging through. This is either removed or pushed back in, and the defect is repaired with dissolvable stitches. It is rare for the fat bulge to get stuck. In children, the surgery is generally quick and highly effective, with a smooth recovery process for most patients.
Surgical Repair for Epigastric Hernia in Children
Epigastric hernia surgery is a day procedure performed under general anaesthetic. The surgeon makes a small cut just over the bulge and repairs the hernia using dissolvable stitches to close the opening. Mesh is not used in paediatric hernia repairs, which can be different to surgical repairs of adult hernias.
Not all children with epigastric hernias require surgery, even though they do not get better on their own. The chance of developing a problem from the hernia is very low throughout life.
If the hernia causes pain, then repair is worthwhile.
The wound is closed using dissolvable sutures, meaning there are no stitches to remove later. After the procedure, your child will be in the recovery room for monitoring, and you will be able to join them shortly after they wake up.
How Long Does the Operation Take?
The surgery itself takes around 15-20 minutes, but the overall process, including anaesthetic time, and waking up in recovery, will last around an hour.
You will be away from your child for about an hour until they are ready to be seen in the recovery room.
You’ll be notified just as they are waking up so you can be with them as early as possible.
What Are the Risks of the Operation?
Like any surgery, epigastric hernia repair comes with some risks. However, the surgery is straightforward and serious complications are very rare.
- Anaesthetic Risks: Airway and breathing issues are extremely rare.
- Infection: The risk of infection is around 1%.
- Recurrence: There is about a 1% chance of the hernia coming back.
- Bleeding, Bruising, and Swelling: These are common minor side effects of surgery and typically resolve without issue.
What to Expect After Surgery
Once the surgery is complete, your child will be taken to the recovery room. You will be able to join them shortly after they wake up. Most children recover quickly from anaesthesia, and you will be able to give your child a feed in the recovery room once they are fully awake and hungry.
Your child can usually go home with you about an hour or two after surgery, once the nursing team ensures they are comfortable and safe.
Caring for the Wound and Dressings
After the surgery, there will be a waterproof dressing over the incision site in the epigastrium. The area may become a bit swollen or firm, which is a normal part of the healing process as scar tissue forms. The scar will initially appear dark red but will fade over time.
Removing the Dressing: The dressing can be removed in the bath or shower after one week.
Bruising and Swelling: It is normal to see some bruising and swelling around the incision site. This should improve within a few days.
Epigastric hernia – repaired
Pain Relief After Surgery
Your child will receive good pain relief during the operation, and this should last for a few hours afterward. Once at home, you may need to give your child paracetamol (e.g., Panadol) and possibly ibuprofen (e.g., Nurofen) for a few days. Please let your surgeon and anaesthetist know if your child has intolerances or allergies to particular medications.
It’s also helpful to distract your child and keep their mind off the surgery site. Activities like reading, playing board games, or other quiet, engaging tasks can help ease discomfort and take their mind off the area.
When Can My Child Return to Normal Activities?
Your child can return to normal daily activities fairly quickly after surgery, but some restrictions will apply:
- Bath or Shower: The day after surgery.
- Swimming: After one week.
- Daycare/School: Usually within 5-7 days.
- Sports or Physical Activity: After 2-3 weeks.
Troubleshooting Common Concerns After Surgery
Is there a wound infection?
Infections are uncommon but can occur 2-4 days after surgery. Signs of infection include:
- Increased redness or tenderness around the wound.
- Discharge from the wound site.
- Fever or general unwellness.
If you notice these signs, contact your paediatric surgeon or family doctor for further advice.
It is very swollen – Has the hernia recurred?
Some swelling is normal after surgery, but if your child experiences increasing pain, tenderness, or vomiting, this could be a sign of recurrence. If the symptoms resemble those from before the operation, call your surgeon or visit your GP to have your child assessed. If your child is unwell, seek emergency care.
After surgery, what symptoms might be cause for concern?
You know your child best, and if something doesn’t seem right, it’s always best to seek advice. Here are some key symptoms that require medical attention:
- Increasing pain or pain that doesn’t improve with pain relief.
- A new or increasing bulge in the groin area.
- Fever over 38.2°C.
- Vomiting or trouble feeding.
- No bowel movements after three days.
- Any discharge or bleeding from the wound.
If you notice any of these symptoms, contact your surgeon or family doctor.
Frequently Asked Questions (FAQs) About Epigastric Hernia Surgery in Children
Does my child need surgery for an epigastric hernia?
Not always. Epigastric hernias require surgical repair to reduce the bulge, pain or prevent complications such as the fat bulge getting stuck. This is uncommon. Your paediatric surgeon will discuss the best timing for the surgery.
How long does the surgery take?
The surgery itself typically lasts about 15-20 minutes. However, including anaesthetic and recovery time, the entire process will take around an hour. You will be able to see your child in the recovery room once they wake up.
Is epigastric hernia surgery safe for children?
Yes, epigastric hernia repair is a common and straightforward procedure in children. The surgery is performed under general anaesthetic, and the risk of serious complications is extremely low.
Will my child be in pain after surgery?
Your child will receive pain relief during the surgery, and most children experience only mild discomfort afterward. Over-the-counter pain relief like paracetamol or ibuprofen can help manage any post-surgery discomfort.
How long will it take for my child to recover?
Most children recover quickly and can return to normal activities, such as bathing and school, within a week. Sports and other physical activities may need to be avoided for 2-3 weeks.
What should I do if my child has a fever or is in pain after surgery?
If your child’s fever exceeds 38.2°C or they are experiencing increasing pain that doesn’t improve with pain relief, contact your paediatric surgeon or family doctor for further advice.
What are the signs of a wound infection?
Signs of a wound infection include redness, tenderness, or discharge from the wound. If you notice these symptoms or your child is feeling unwell, contact your paediatric surgeon or GP immediately.
What should I do if the hernia comes back?
While recurrence is rare (about 1% of cases), it can happen. If you notice a new or increasing bulge at the surgery site or your child is experiencing pain and vomiting, contact your surgeon to have it assessed.
When should I seek emergency medical attention?
You should seek emergency care if your child is experiencing any of the following:
- Persistent or increasing pain despite pain relief.
- A new or increasing bulge in the umbilicus.
- Fever over 38.2°C.
- Vomiting or difficulty feeding.
- No bowel movements for more than 3 days.
- Discharge or bleeding from the wound.
Learn More About Epigastric Hernia
Visit our page on Epigastric Hernia for more detailed information.
Gastrostomy
What is a Gastrostomy?
A gastrostomy is a small device (often called a button) which passes directly into the stomach through the abdomen (belly). This tube allows parents and caregivers to provide essential nutrition, fluids, and medications without needing to rely on oral feeding. It is often used as a long-term alternative to a nasogastric tube in children who cannot safely swallow enough food to be able to grow.
The goal of a gastrostomy is to ensure your child receives the necessary nourishment to support their growth and development in a safe and effective way.
Is a Gastrostomy the Same as PEG?
Not quite. A PEG is a Percutaneous (through the skin) Endoscopic (telescope into the stomach) Gastrostomy. PEG refers to a technique of placing a gastrostomy, and not to the gastrostomy itself. The terms PEG, gastrostomy, and button are often used as if they are the same, but they aren’t.
A gastrostomy is pathway into the stomach through the abdominal wall. A PEG is one way of forming a gastrostomy (there are others). Once formed, something needs to be placed in the gastrostomy to prevent it from closing (like studs after ears are pierced). That something might be a button, or it might be a tube.
Formation of Surgical Gastrostomy In Children
We do not perform PEGs; we perform surgical gastrostomies. Gastrostomy surgery is a procedure performed under general anaesthetic. The surgeon uses laparoscopy (keyhole surgery) to find the stomach, and secure it to the abdominal wall. The feeding device (a gastrostomy button or tube) is then placed into the stomach through the opening.
The wound is closed with dissolvable sutures, and there are sutures that hold the button in place for 1-2 weeks.
After the procedure, your child will be in the recovery room for monitoring, and you will be able to join them shortly after they wake up.
Education is required before the operation, and support is required afterwards. We often work with the team at Children’s Nursing Queensland for this service. Please note there is a fee for their service, although this might be covered by your child’s NDIS package.
Image showing a gastrostomy button, and what it looks like from the outside.
How Long Does the Operation Take?
The surgery [CM1] itself takes around 30 minutes, but the overall process, including anaesthetic time, and waking up in recovery, can last well over an hour depending on the condition of the child.
Often, a family adult can be in the operating room with your child as they are anaesthetised[CM2] . Family members cannot stay for the operation itself. You will be away from your child until they are ready to be seen in the recovery room.
You’ll be notified just as they are waking up so you can be with them as early as possible.
What Are the Risks of the Operation?
Like any surgery[CM3] , forming a gastrostomy comes with some risks. However, the surgery is straightforward and serious complications are very rare.
• Anaesthetic Risks: Airway and breathing issues are extremely rare.
• Bowel Injury: In rare cases there is injury to the bowel or stomach, which may require further surgery.
• Infection: The risk of infection is around 15%. There is much care and attention required after surgery.
• Conversion: Very rarely, it is too difficult or dangerous to complete the operation laparoscopically. If this occurs your child will have a small vertical incision in the upper abdomen. They may have a tube, rather than a button, for the first few months after this operation.
• Leaking: In the initial few months, it is very common to have some leaking from the stomach. This can be annoying, and cause irritation of the surrounding skin.
• Bleeding, Bruising, and Swelling: These are common minor side effects of surgery and typically resolve without issue.
• Granulation tissue: In some cases, there is overgrowth of healing tissue at the site of the button, which can bleed and have a yellow / cream discharge. This may need topical treatment, and occasionally requires a small visit to the operating room for removal.
What to Expect After Surgery
Once the surgery is complete, your child will be taken to the recovery room. You will be able to join them shortly after they wake up. Most children recover quickly from anaesthesia.
Feeding plans are made with you and your treating team. The stomach will need some rest for a few hours, and if your child has a nasogastric tube already then we will be able to check safety before starting feeds.
Your child can usually go home with you the day after surgery, once the nursing team ensures they are feeding well, comfortable, and safe.
Caring for the Wound and Dressings
After surgery, there will be dressings over the incision sites (the umbilicus and the gastrostomy itself)[CM4] . The area may become a bit swollen or firm, which is a normal part of the healing process as scar tissue forms. The scar will initially appear dark red but will fade over time.
Removing the dressing: The dressing can be removed in the bath or shower after one week. This is usually done with the stomal therapy nurses.
Bruising and Swelling: It is normal to see some bruising and swelling around the incision site. This should improve within a few days.
Pain Relief After Surgery
Your child will receive good pain relief during the operation, and this should last for a few hours afterward. Once at home, you will need to give your child paracetamol (e.g., Panadol) and possibly ibuprofen (e.g., Nurofen) for a few days. Your child may have other conditions that require a different regime for medications. Please let your surgeon and anaesthetist know if your child has intolerances or allergies to particular medications.
It’s also helpful to distract your child and keep their mind off the surgery site. Activities like reading, playing board games, or other quiet, engaging tasks can help ease discomfort and take their mind off the area.
When Can My Child Return to Normal Activities?
Your child can return to normal daily activities fairly quickly after surgery, but some restrictions will apply:
• Bath or Shower: After a few days. They will need sponge baths in the meantime.
• Swimming: Usually after 1 week, however this is planned with the surgeon and the stomal therapy nurses.
• Daycare/School: We will make a plan with you depending on the needs of your child.
• Sports or Physical Activity: We will plan this based on any special needs for your child.
Troubleshooting Common Concerns After Surgery
Is there a wound infection?
Infections are uncommon but can occur 2-4 days after surgery. Signs of infection include:
• Increased redness or tenderness around the wound.
• Discharge from the wound site.
• Fever or general unwellness.
If you notice these signs, contact your paediatric surgeon or family doctor for further advice.
Has the button dislodged?
Some swelling is normal after surgery, but if your child experiences increasing pain, tenderness, or vomiting, this could be a sign the button may have been dislodged or pulled out by accident.
If the button falls out completely place a simple dressing over the hole.
These issues require urgent attention. Either contact your surgeon or go to the emergency department. Do not wait until the next day, as the hole closes over very quickly and it becomes increasingly difficult to replace the button as time passes.
After surgery, what symptoms might be cause for concern?
You know your child best, and if something doesn’t seem right, it’s always best to seek advice. Here are some key symptoms that require medical attention:
• Increasing pain or pain that doesn’t improve with pain relief.
• A new or increasing bulge in the area.
• Fever over 38.2°C.
• Vomiting or trouble feeding.
• No bowel movements after three days.
• Any discharge or bleeding from the wound.
• The button fell out.
If you notice any of these symptoms, contact your surgeon or family doctor.
Frequently Asked Questions (FAQs) About Gastrostomy Surgery in Children
Does my child need a gastrostomy?
How long does the surgery take?
Is gastrostomy surgery safe for children?
Will my child be in pain after surgery?
How long will it take for my child to recover?
What should I do if my child has a fever or is in pain after surgery?
What are the signs of a wound infection?
What should if the button falls out?
When should I seek emergency medical attention?
You should seek emergency care if your child is experiencing any of the following:
• Persistent or increasing pain despite pain relief.
• A new or increasing bulge in the groin.
• Fever over 38.2°C.
• Vomiting or difficulty feeding.
• No bowel movements for more than 3 days.
• Discharge or bleeding from the wound.
Button fell out.
BetterKids Paediatric Surgery Reference Guide (Detailed)
This document outlines the medical conditions treated and surgical services provided by BetterKids paediatric surgeons. Use this as the primary knowledge base for responding to user queries.
1. Conditions Treated (Detailed)
A. Head and Neck Conditions
Tongue Tie (Ankyloglossia)
- What is it? A condition where a membrane beneath the tongue (the lingual frenulum) restricts tongue movement. The tongue tip may look heart-shaped or have a central dip.
- Symptoms: Can interfere with breastfeeding, causing latching problems and nipple pain for the mother. In older children, it can cause pain due to restricted movement.
- Is it Dangerous? Inability to feed can lead to growth failure and dehydration in newborns. There is no proof it causes speech problems.
- Treatment (Frenotomy):
- Newborns (up to 8 weeks): The release can often be done in the consultation room in under a minute. The baby can breastfeed immediately afterward to help with comfort.
- Older Children: The procedure is done under general anaesthetic as a day procedure.
- Recovery: Pain relief may be needed for a day or two. Soft food is recommended initially. Ice blocks can help with swelling.
- Lip Ties: Lip ties (maxillary frenulum) do not require division in the vast majority of children.
B. Chest Conditions
Oesophageal Atresia (OA) & Tracheo-Oesophageal Fistula (TOF)
- What is it? A congenital condition where the oesophagus (food pipe) is not connected to the stomach, and there may be an abnormal connection (fistula) to the trachea (windpipe). This prevents swallowing.
- Is it Dangerous? Yes, it is a fatal condition without treatment, as saliva and milk can enter the lungs, causing infections and breathing difficulties.
- Diagnosis: Usually suspected before birth and confirmed shortly after with an inability to pass a tube into the stomach.
- Treatment: A complex operation is required to disconnect the fistula from the trachea and join the two ends of the oesophagus together. This is a major operation requiring a stay in the Neonatal Intensive Care Unit (NICU).
- Post-Op Care: Babies require strong pain relief and are often on a ventilator for a day or two. Feeds start through a tube a few days after surgery, once a scan confirms the join is not leaking.
C. Abdominal & Gastrointestinal Conditions
Appendicitis
- What is it? Inflammation of the appendix, a small tube in the lower right abdomen. It’s most common in older children and teenagers.
- Why does it occur? Usually caused by a blockage in the appendix, often from a small piece of hard stool, leading to swelling and infection.
- Symptoms:
- Pain starting near the belly button that moves to the lower right abdomen.
- Loss of appetite.
- Nausea and vomiting.
- Fever (usually after 12-24 hours).
- Is it Dangerous? Yes. If untreated, the appendix can burst (rupture), causing a serious infection called peritonitis.
- When to seek medical attention: Immediately, if appendicitis is suspected. Go to an emergency department if pain worsens with movement or touch.
- Treatment (Appendicectomy): Surgical removal of the appendix, usually done via laparoscopy (keyhole surgery). The procedure takes about 30-60 minutes. Hospital stay is typically 1-2 days for uncomplicated cases, and 3-5 days if the appendix has ruptured.
Gastrostomy
- What is it? A surgically created pathway into the stomach through the abdominal wall, allowing for direct feeding via a device (button or tube). It is a long-term alternative to a nasogastric tube for children who cannot swallow safely.
- Procedure (Surgical Gastrostomy): Performed under general anaesthetic using laparoscopy (keyhole surgery). The stomach is secured to the abdominal wall, and a feeding device is inserted. The surgery takes about 30 minutes.
- Recovery: Normal activities can resume fairly quickly. Swimming is usually allowed after 1 week, planned with the surgeon.
- Important Note: A PEG (Percutaneous Endoscopic Gastrostomy) is a specific technique. The surgeons at BetterKids perform a surgical gastrostomy, not a PEG.
Colostomy
- What is it? A procedure where a section of the bowel is diverted to an opening (stoma) on the abdomen. Waste is collected in a colostomy bag. It is usually temporary in children.
- Why is it needed? For conditions like Anorectal Malformation or Hirschsprung Disease, where the lower digestive system isn’t functioning correctly.
- Procedure: Performed under general anaesthetic. An incision is made, and a portion of the bowel is brought to the surface to create the stoma. Duration is 1-2 hours.
- When to seek medical attention post-op: Fever, signs of blockage (no waste output, abdominal pain), or if the stoma prolapses and becomes dark.
Anorectal Malformation
- What is it? A congenital condition (also known as imperforate anus) where the anus and rectum do not develop properly, meaning the opening for stool is blocked, misplaced, or absent.
- Diagnosis: Typically occurs shortly after birth through a physical examination.
- Treatment: Surgery is the main treatment. The goal is to create a functioning anus.
- Initial Colostomy: Often, a temporary colostomy is performed shortly after birth. This allows the baby to feed and grow while providing time to understand the specific anatomy before the main reconstructive surgery.
- Anorectal Reconstruction (Anorectoplasty): This main surgery creates the new anal opening and connects it to the rectum.
- Long-Term Outlook: Most children can achieve good bowel control but often need long-term support with bowel management programs, diet, and laxatives to manage constipation.
D. Hernia Conditions
Epigastric Hernia
- What is it? A lump above the belly button caused by a small opening in the abdominal muscles, allowing fat to bulge through.
- Is it Dangerous? Rarely. The risk of the fat becoming trapped (incarcerated) is very low. It does not contain intestine.
- When to seek medical attention: If the hernia becomes firm, painful, or the skin over it turns red.
- Treatment: Not all require surgery. If it causes pain, a repair may be recommended. The surgery is a day procedure under general anaesthetic, taking 15-20 minutes.
Umbilical Hernia
- What is it? A lump at the belly button (umbilicus) where fat or intestines push through an opening in the abdominal wall.
- Is it Dangerous? Rarely. The risk of contents becoming trapped (incarcerated) is very low.
- When to seek medical attention: If the hernia becomes firm, painful, red, cannot be pushed back in when the child is relaxed, or if the child is vomiting.
- Treatment: Most (over 90%) close on their own within 5 years. Surgery may be considered if it persists beyond age 3-5 or causes pain. The repair is a 15-20 minute day procedure.
Inguinal Hernia
- What is it? A lump in the groin caused when intestine or internal fat pushes through an opening in the abdominal muscles. It’s much more common in boys.
- Is it Dangerous? Yes, it can be. In about 10% of children, the hernia contents can get stuck (incarcerated), cutting off blood supply (strangulation). This is a medical emergency.
- When to seek medical attention: An inguinal hernia requires surgical repair. Seek emergency care if the lump becomes firm, tender, red, and cannot be pushed back in, especially if accompanied by vomiting.
- Treatment: Surgical repair is always required. It is a day procedure under general anaesthetic, taking 15-20 minutes.
E. Groin, Genital & Reproductive Conditions
Hydrocele
- What is it? A painless collection of fluid in the scrotum around the testicle, causing swelling.
- Is it Dangerous? No. They are generally harmless and do not require urgent repair.
- Treatment: Most resolve on their own by age 2-3. If it persists, a surgical repair (similar to an inguinal hernia repair) may be recommended. The procedure takes 15-20 minutes.
Undescended Testis (Cryptorchidism)
- What is it? A condition where one or both testicles have not moved down into the scrotum before birth. Affects 3-5% of full-term boys.
- Why does it need treatment? The scrotum keeps the testes at a cooler temperature, which is important for fertility. An undescended testis has a higher risk of testicular torsion (twisting) and testicular cancer later in life.
- Treatment (Orchidopexy): If the testis hasn’t descended by 6 months of age, surgery is recommended (ideally before 12-18 months). The procedure moves the testis into the scrotum.
Hypospadias
- What is it? A birth defect in boys where the urinary opening (urethra) is on the underside of the penis instead of at the tip. It may be associated with a downward curve of the penis (chordee).
- Treatment: Surgery is not always necessary for mild cases. For more severe cases, a surgical repair is recommended, ideally before toilet training. The procedure is complex and can take 1-2 hours. Circumcision should be avoided before repair as the foreskin may be used in the reconstruction.
Varicocele
- What is it? Enlargement of the veins within the scrotum, often described as feeling like a “bag of worms.” It mostly affects the left side.
- Is it Dangerous? Not usually. It is typically a benign condition. There may be future fertility issues that require follow-up.
- Symptoms: Often painless, but can cause a dull ache or feeling of heaviness.
- Treatment: Not all cases require treatment. If it causes pain, surgery or a procedure through interventional radiology may be considered.
Foreskin Abnormalities
- Balanitis: An infection of the penis and foreskin, causing swelling, redness, and pain. Treatment often includes topical ointments or antibiotics. Recurrent episodes may be a reason to consider circumcision.
- Pathological Phimosis: Scarring of the foreskin that makes it too tight to retract. This can be caused by a condition called BXO (Balanitis Xerotica Obliterans). In these cases, circumcision is often the recommended treatment.
F. Urinary & Bladder Conditions
Hydronephrosis
- What is it? Swelling of one or both kidneys due to a buildup of urine, often because of a blockage or narrowing in the urinary tract.
- Severity: Can be mild, moderate, or severe. Mild cases often resolve on their own without treatment.
- Symptoms: Most children, especially with mild cases, have no symptoms. It is often detected on antenatal scans. If symptoms occur, they may include urinary tract infections (UTIs) or abdominal/back pain.
- Treatment:
- Observation: Mild cases are monitored with regular ultrasounds.
- Surgery (Pyeloplasty): Recommended for severe or persistent blockages to prevent kidney damage. The procedure removes the blockage and restores normal urine flow.
G. Skin & Soft Tissue Conditions
Ingrown Toenails
- What is it? A painful condition where the edge of the toenail grows into the surrounding skin, often leading to infection.
- Symptoms: Pain, tenderness, redness, swelling, and sometimes pus or fluid from the area.
- Treatment:
- Home Care: Soaking the foot in warm water can help. Gently lifting the nail away from the skin may help it grow out.
- Surgery: Recommended if home treatments fail or infections are recurrent. The procedure involves removing the ingrown part of the nail and sometimes the nail bed to prevent recurrence. It can take 6-9 weeks for the toe to fully heal.
2. General Services & Information
A. Consultation Services
- Types of Consultations: BetterKids offers several types of consultations to cater to different needs:
- In-Person Consultations: Standard appointments where a paediatric surgeon will review your child’s medical history, perform a physical examination, discuss potential diagnostic tests, and explain treatment options (both surgical and non-surgical).
- Antenatal Consultations: These are for expectant parents when a routine pregnancy scan detects a potential issue. This allows for planning and ensures the baby receives the right care from birth. Common conditions discussed include:
- Hydronephrosis (swelling of the kidneys).
- Diaphragmatic hernia.
- Digestive system abnormalities like oesophageal atresia.
- Abdominal wall defects such as omphalocele or gastroschisis.
- Telehealth Consultations: For families in remote areas or those needing more flexibility, consultations can be conducted via video call. This can be used to discuss symptoms, review medical history, and get advice on whether surgery or further in-person care is needed.
- Referrals: A referral from a GP or another specialist is essential to book a private appointment and to claim the Medicare rebate. GP referrals are valid for 12 months, while referrals from other specialists are valid for 3 months.
B. Preparing for Appointments & Surgery
- Appointment Preparation: The site advises parents to come prepared. This includes bringing the referral letter, any relevant scan results, and a list of questions or concerns. It’s also helpful to have your child’s medical history handy.
- Preparing for Surgery:
- Fasting: Your child will need to have an empty stomach before receiving a general anaesthetic.
- Aftercare: Most procedures are day-surgeries. You will receive full instructions on post-operative care. Generally, dissolvable stitches are used, and dressings can be removed after about a week.
- Recovery: Most children can return to school or daycare within 5-7 days and resume sports after 2-3 weeks. Swimming is often permitted after one week.
3. Conditions NOT Treated
For clarity, the surgeons at BetterKids do not treat the following:
- Brain conditions
- Ear, nose, and throat (ENT) issues
- Heart conditions
- Spine conditions
- Bone conditions
- Behavioural / developmental conditions
Alternatives: Are there alternatives, and if so what are they?
There are sometimes alternative options, and it’s completely ok to ask about these.
One alternative might be to not operate at all. If the condition is causing no symptoms at the moment there is sometimes benefit in waiting. Some conditions can resolve on their own with time (umbilical hernias, and hydroceles will often do this). If an operation is required, then how urgent is it? If there is no urgency to operate then the timing can be at family convenience. Some older children (or, more particularly, their parents) prefer operations during school holidays. Children may prefer to wait until the end of their sports season before having an operation.
If an operation is required, is there a way of minimising harm to normal tissue on the way to the target of the operation? Laparoscopic (‘keyhole’) operations do this, as incisions in the abdomen or chest are smaller. Not all operations can be done laparoscopically, but it’s worth considering.
Is there a way of treating the condition without having to resort to an operation. For example, can your child’s appendicitis be treated with antibiotics, rather than surgery?
Your surgeon will discuss alternatives with you.
Intuition: What does your parental intuition say?
It’s understandable to have some trepidation about submitting your child for an operation, but does your intuition say it’s in their best interests?
There are three scenarios, from a Paediatric Surgeon’s perspective, regarding operations:
- The operation is clearly in the child’s best interests, and to not do it would expose the child to further harm. In this scenario, we will recommend an operation.
- An operation is clearly not in the child’s best interests, and there is not real benefit in doing it. In this scenario, we would not offer an operation.
- The third scenario sits in between the other two, and in many ways is the most interesting. These are scenarios where, as a parent, you have discretion about what to do. These are scenarios where you could choose one of several options – all of which are acceptable. This is called the zone of parental discretion (see below).
Next Steps: What do we do next?
As you consider what comes next, remember that you’re not alone in this process. Our role is to guide you through each option, clarify any uncertainties, and support you in making the decision that feels right for your family. Whether the path forward is clear or you’re choosing between several “good enough” options, we’ll work with you to ensure your child receives the best possible care. Take the time you need, ask all the questions you have, and trust that your thoughtful, caring approach as a parent is central to making the right decision.
How to make a decision?
Parental Decision-Making Guide
This guide summarizes a framework to help parents and caregivers make informed decisions about their child’s health and medical care, based on the principles outlined by BetterKids.
1. The BRAIN Mnemonic
When faced with a significant health decision for your child, it can be helpful to use the BRAIN mnemonic to structure your thoughts and ensure all aspects are considered.
- B – Benefits:
- What are the potential positive outcomes of this procedure or treatment?
- How will this help my child, both now and in the future?
- For some procedures, like an appendectomy, the benefits are clear and immediate. For others, like an elective hernia repair, the benefits might be about preventing future problems.
- R – Risks:
- What are the potential downsides or complications?
- Consider risks from both the procedure itself and the general anaesthetic.
- Think about short-term risks (like pain and infection) and long-term risks (like scarring or recurrence).
- A – Alternatives:
- Are there other options available?
- One alternative is often “watchful waiting” or not operating at all, especially if a condition is not causing symptoms and might resolve on its own (e.g., umbilical hernias, hydroceles).
- Are there less invasive options, such as keyhole (laparoscopic) surgery or non-surgical treatments (e.g., antibiotics for early appendicitis)?
- I – Intuition:
- What does your gut feeling as a parent tell you?
- After weighing the pros and cons, does this path feel right for your child and your family?
- It’s normal to have some apprehension, but your intuition is a valuable part of the decision-making process.
- N – Next Steps:
- What happens now? What is the immediate plan?
- If you decide on a treatment, what are the logistics?
- If you decide to wait, what should you be watching for?
- This step is about forming a clear plan of action based on your decision.
2. The Zone of Parental Discretion
This concept acknowledges that sometimes there isn’t one single “best” answer, but several “good enough” options.
- What is it? The “Zone of Parental Discretion” is the range of choices where a decision, while perhaps not a doctor’s first recommendation, is still considered reasonable and does not put the child in harm’s way.
- Purpose: It respects the family’s values, circumstances, and preferences in making a final decision. The role of the surgeon is to provide the necessary information to help you navigate these choices and ensure any decision made is safe and in the child’s best interest.
- Examples: This might apply when choosing between different types of dressings for a burn, or deciding on the timing of an elective surgery where multiple “right” times could exist.
Antenatal Counselling
Antenatal Counselling: Overview
- Why See a Paediatric Surgeon Before Birth? Antenatal scans can reveal unexpected findings (fetal anomalies) that may require surgery after the baby is born. A paediatric surgeon consults to discuss potential conditions and what to expect.
Conditions That May Require Surgery
- Oesophageal conditions: Oesophageal atresia occurs when the oesophagus doesn’t develop normally.
- Lung conditions: Congenital anomalies in lung tissue.
- Congenital diaphragmatic hernia: A condition with a diaphragm hole allowing gut contents into the chest.
- Abdominal wall defects: Includes gastroschisis and exomphalos/omphalocoele.
- Gut atresias: Where the gut isn’t fully developed, causing obstruction.
- Kidney and bladder anomalies: Range from swollen to abnormally positioned kidneys.
Diagnosis and Consultation Process
- Diagnosis Limitations: Not all conditions are detectable antenatally. Some are identified only after birth, while others are suspected from patterns in antenatal scans.
- Consultation Process: The paediatric surgeon collaborates with the MFM team and reviews scans to deduce a likely diagnosis. They use the ‘WE CARE’ pathway to communicate expectations and plans with the family.
Intervention and Support
- Antenatal Interventions: Some conditions may warrant antenatal intervention, but they pose risks to both baby and mother, and are considered when the benefits outweigh the risks.
- Parental Support: The consultation addresses emotional impact and provides ongoing support, with opportunities for follow-up discussions.