Satisfactory results are obtained when most of the diseases that require surgical treatment in infants are diagnosed early and treated at the appropriate time and by the team. Signs and symptoms of a significant portion of these surgical diseases are located under the baby’s diaper. Diagnosis of many diseases that require surgical treatment is delayed as a result of the examination done without opening the baby’s diaper in order to save time or if the diaper is dirty while the baby is in diapers. The fact that the child does not want to show the diaper to the doctor because of embarrassment at an older age leads to a further delay in the diagnosis.
In the first two or three years when babies are in diapers, careful observation during diaper changes can help diagnose many diseases without delay. Mothers who clean their baby’s diapers many times a day can immediately reach their doctor and ask for help in case of suspicion, so that the surgical diseases in their babies can be diagnosed in a timely manner and appropriate treatment can be done without delay. Surgical treatment should also be performed by a Pediatric Surgeon and/or Pediatric Urology specialist.
Among the points to be considered during diaper change in the first days of the baby: the presence of an abnormal lesion, the presence of male or female suspicions in the appearance of the external genital organs, the first time and place of urine and poop can be counted. A baby who does not pee or poop in the first 24 hours, has poop from the urinary tract or has a suspicious appearance should be shown to the physician without delay.
Boys’ eggs (testicle) are in the bag at birth. If both are not in place, immediately, if one is not in place, within the first six months, the testicle that is not placed in the bag should be shown to the doctor and surgically placed in the bag until the age of one year in order to avoid permanent damage.
Boys with very small pips, congenital half-circumcision or no urinary opening should be shown to the physician without delay and the diagnosed disease should be corrected within the first year. Traditional circumcision should not be performed for half-circumcised children without a diagnosis. Correction of sloping or facing pipi is done in advanced ages.
The foreskin of boys should not be forced to retract. The foreskin cannot be retracted normally in 90% of newborns and 50% of one-year-olds. There is very little need for medical opening of the foreskin. Half should be taken from the specialist to avoid unnecessary processing.
It is okay to circumcise children with diapers in surgical principles. On the contrary, the ideal circumcision time is between 3 and 24 months. Children with buried penis should be circumcised at school age with specific surgical correction.
It is beneficial to leave the external genital organs of children who have to undergo gender reassignment to be corrected until the first two years of age, and uterine correction operations to be left to the adolescence period.
The presence and disappearance of swelling in the groin suggests an inguinal hernia. If the resulting swelling does not go inside, there is a risk of strangulated hernia. Strangulated hernia requires urgent surgical treatment, while other inguinal hernias require urgent surgical treatment. It is more common in premature babies. It is less common in girls, but the risk of being bilateral is higher in girls. Hernias that show symptoms in the early period have a higher risk of strangulation. Surgical treatment of strangulated hernia is more difficult and the risk of complications is higher.
Most of the swellings seen in the bags are due to water hernia (hydrocele). Most of these heal spontaneously in the first year and do not disturb the baby in this period. If it is too tight and large after six months, continues after the age of two, has symptoms after the age of three, or is located in the groin (cord cyst), day surgery is required. Communican hydroceles, which are small in the morning and grow towards the evening, do not have a chance to resolve spontaneously. It is necessary to distinguish hydrocele from large inguinal hernia and testicular tumors.
Early surgical treatment may be required for some tumors that also cause babies with excessive genital hair growth.
In girls, swelling or a piece of flesh coming out of the reservoir, bloody or smelly discharge requires surgical assistance. The opening of the chamber should be observed with the places where the girls poop and pee. If an abnormality is thought in the three hole structure, the decision should be made by the physician. Conjoined small lips are common in girls and require a simple treatment.
Newborn babies urinate very often. As it grows, the frequency decreases and the diaper is dry in between. If the diaper is constantly wet or if there is swelling under the navel with very rare forced peeing, the possibility of functional or structural disorders in the urinary tract is higher. In case of bloody urine, investigation is required without delay.
In the first six months, it is normal for babies to have a soft consistency and poop 3-4 times a week. Babies who do not poop within the first 24-48 hours after birth, if they have difficulty in pooping with aids such as degrees or wicks, if they produce hard and voluminous or hard small poop in the form of goat droppings, or babies who have troublesome poop, should seek help from the physician without delay.
Babies whose diapers are contaminated with blood after poop, blood on their poop, black or cherry bruise poop should be investigated for diseases that will cause bleeding in their stomach and intestines.
Babies who have swelling, cracks or discharge on their bottoms and babies whose rectum protrudes after pooping or a piece of flesh comes out of the anus may also require surgical treatment.
