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Questions to the pediatric surgeon

Questions to the pediatric surgeon

Son 11.5 months. When it is strained, the navel slightly bulges out. Is this a sign of an umbilical hernia?

How to treat it to avoid surgery?

Marina, Cheboksary

The protrusion of the bottom of the umbilical fossa at tension of the abdominal muscles is a reliable symptom of the umbilical hernia. But all the same the surgeon should examine the child to determine the size of the defect.

For small defects (up to 1 cm), the baby is observed up to 4–5 years old; if the symptoms do not disappear, it is operated on. Conservative treatment is effective during the first year of life, but it is prescribed by a surgeon. These are massage, physical therapy, mechanical fixation and covering of the defect with a special plaster.

Results are usually seen 1–2 months after the start of treatment.

The son (he is 2 years old) has small spikes on the foreskin. The clinic said that, most likely, they are physiological and will pass themselves. But maybe it’s not too late, is it still to be treated?

How are spikes on the foreskin treated and at what age? How can spikes in this place affect the further development of the child?

Svetlana, Pushkin

The adhesions between the foreskin and the head of the penis are called synechia. This physiological condition does not require treatment: it does not deliver discomfort to the child and does not affect its sexual development. The synechia themselves “dissolve” under the influence of hormones in the puberty period of the boy (from 9–11 years old).

Some doctors, arguing that smegma accumulates under them and there is a risk of inflammation, insist on breeding synechias. But the manipulation can lead to trauma to the head, in addition, it is painful.

Operational separation of synechiae is appointed only if they persist even after the start of puberty.

A 3-year-old daughter has a fracture of the lower leg (slipped on a rug) without moving the bones. She put a cast.

I’m worried: will gypsum prevent bone growth? I heard that little gypsum is not always imposed on babies.

Is it so? When can you do without it?

Irina, Kostroma

If the sprouting zones are not affected, then nothing will hinder the growth of bones, even a plaster splint, because gypsum with uncomplicated fractures is worn for no more than 2-4 weeks. Babies younger than a year, gypsum, sometimes, do not impose due to physiological features: they have a periosteum (film, surrounding the outside of the bone) thicker than the bone – and reliably fixes it. At 3 years old, when the bone thickens, the periosteum can no longer fix it at the turn.

Therefore, it is possible to do without plaster if the child is immobile for the entire period of bone healing (2–4 weeks), which is basically impossible. The timing of wearing gypsum is determined by a traumatologist.

After removing the gypsum, rehabilitation of the broken limb (massage, physical therapy) will be needed, because with a prolonged absence of stress, the muscle tissue of the limb decreases (visually, you can see the difference in the volume of the healthy and broken leg).

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