BLOOD IN THE URINE (HAEMATURIA)

Blood in the urine (haematuria) can be due to many causes, including trauma and infection. If you suspect that your child has blood in his urine (if it is pink, red or brown in colour), see your doctor as soon as possible. Take a specimen of urine with you so that it can be tested for the presence of blood.

ERECTIONS

Erections occur quite often in the newborn and older child and may be the result of a full bladder, or of self-stimulation. In any event it is completely normal for children to have erections. It is important not to tease your child when he has an erection, nor to punish him. Simply pay no special attention to it, and answer any questions from your young son in an honest and matter-of-fact manner.

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FORESKIN, HYGIENIC CARE OF THE

In young boys the foreskin covering the glans of the penis is usually not fully retractable until around the age of 4-5 years. Hygiene of the foreskin is very important and should be taught to your son from an early age. A white secretion (smegma) collects between the foreskin and the glans, and should be cleaned away carefully. In babies, gently pull the skin on the shaft of the penis away from the tip — do not do this more than once or twice a week initially, and never use force. Cleanse the area with water only, so that soap does not collect under the foreskin. If you cannot retract the foreskin at all, do not force it; it will gradually loosen up. Teach the older toddler to retract his own foreskin and wash here carefully once a week.

FORESKIN, PROBLEMS WITH THE

The normal penis Four per cent of boys have a retractable foreskin at birth; 50% at 1 year; 80% at 2 years; 90% at 4 years. The cleaning of the penis should be facilitated by gently retracting the foreskin as far as it goes, but never try to pull it back beyond the point where resistance is met.

Phimosis This is when the foreskin opening is very small, often as a result of inflammation, so that retraction of the foreskin is impossible. Sometimes the phimosis is so severe that there is no stream of urine, and it comes out in a dribble. Usually circumcision is necessary.

Paraphimosis This is when the foreskin is retracted and is unable to be returned to its normal position. This condition is often treated by circumcision too. Balanitis This is an inflammation of the foreskin. If it recurs, circumcision is often necessary.

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Circumcision is a simple surgical procedure in which the foreskin, which covers the tip of the penis, is removed. Whether a boy should be circumcised continues to be a subject of debate among parents and health professionals. While exact figures are not available, probably about one third of boys in Australia are circumcised, mostly in the newborn period, although the tendency for this procedure to be done is gradually decreasing.

Arguments for circumcision

1. Cultural or religious practice, for example in the Jewish or Muslim faiths.

2. Hygiene — a penis without a foreskin is easy to clean.

3. Medical reasons (see Foreskin, problems with the, opposite).

4. Prevention of certain conditions. Circumcision is said to decrease the risk of cancer of the penis, urinary tract infection, and perhaps sexually transmitted disease and cancer of the cervix in females although there is no hard evidence for these claims.

5.To be the same as father or peer group. The argument becomes less persuassiveas the number of circumcised boys decreases, and is probably not as important as once thought.

Arguments against circumcision

1. The procedure as performed in the newborn causes significant pain and behavioural changes, such as irritability, which can persist for some time (often days).

2. It is contraindicated if there is a medical condition such as a bleeding disorder or hypospadias, which is an anatomical abnormality of the tip of the penis.

3. There is a small but definite risk of complications, such as bleeding, infection, taking off too much or too little skin.

Ultimately, whether or not to circumcise their child is a decision for parents to make after considering the advantages and disadvantages. While circumcision for religious and cultural reasons continues, routine circumcision is performed less and less. If you are uncertain, you may want to discuss your doubts with the doctor.

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Many children suffer from pinworms (Enterobius vermicularis). These are thin, white parasites about 1 cm in length, which live in the digestive tract.

These worms can be seen wriggling on the surface of the skin surrounding the child’s anus, especially at night when the female worms emerge from the anal passage to lay their eggs. Children with pinworms complain of a very itchy anus (see p. 258) which may cause them to wake from sleep. Scratching often leads to reinfection because the child may put his fingers, which are contaminated with eggs, to his mouth.

Treatment

If you suspect that your child has worms, see your doctor who will prescribe anti-worm medicine or tablets. It is wise for the whole family to take these even if others do not have symptoms. Careful washing of hands after going to the toilet and before eating is important to prevent re-infection. Keep fingernails short. Wash all clothing and linen in hot water to destroy eggs, and vacuum or mop the bedroom floor to pick up any eggs that have dropped. Pets do not carry pinworms.

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