Parenthood can be challenging when you are concerned about the health of your child. We aim to inform parents so that you feel empowered and well equipped to make the best choices for your child’s care and treatment.
If you have further questions, please don’t hesitate to contact us or call 02-9540 4409.
What is a Paediatric Surgeon?
Paediatric surgeons specialise in diagnosing, treating, and managing children’s surgical needs. At Sydney Children’s Surgery we aim to provide a complete surgical service for the care of your child, from initial consultation, any operative procedures, through to long term health management.
Paediatric surgeons treat children from newborn babies through to late adolescence. We work closely with your GP and paediatrician who will usually make the initial recommendation for your child to see a surgeon. Children’s surgical care is the core of our medical practice. We are fully qualified medical practitioners with additional training and qualifications in pediatric surgery.
Problems seen by paediatric surgeons are often different from those seen by general surgeons. Children cannot always express what is the problem – Dr Dilley and Dr Russell specialise in examining and treating children in a way that makes them feel relaxed and cooperative.
Is there an out of pocket expense for operations performed in a private hospital?
In the vast majority of cases there are no additional out of pocket surgical expenses, with the exception of elective circumcision. Many health insurance companies waive the policy excess for children having surgery, however, you will need to speak with your insurer to determine these costs.
There is usually an out of pocket fee from the anaesthetist, you will be given the details of the anaesthetist at the time of booking your child’s procedure. Please feel free to contact the anaesthetist to discuss your child’s health and learn the fee associated with the procedure.
Where a specimen is sent to a pathologist for assessment, you will receive an invoice for this as well.
How do I know if my baby is tongue tied?
When a newborn baby has a tongue tie it can cause a functional problem. Usually, in this age group, the most common concerns are issues with breast or bottle feeding.
For a breast-fed baby, the mother may experience nipple pain or damage or have latching problems. The baby may be inefficient with their feeds, they may tire easily, or they may have slow weight gain.
A bottle-fed baby may take a long time to feed or having difficulty latching to the teat.
Both breast and bottle-fed babies with tongue tie may experience choking or coughing during the feed, some may make a clicking sound.
The tongue itself may be heart-shaped or have a notch in the tip, or the tongue can be square looking. The baby may have difficulty bringing the tongue forward, lifting it up, or moving it side to side.
Do all babies need to have their tongue tie divided?
No. Not all tongue ties cause a functional problem. Once the tongue tie has been assessed you will be advised if release is recommended for your baby.
How will I know if my baby would benefit from division of the tongue tie?
If you are having problems establishing breastfeeding, especially after lactation advice, it is best to get an assessment done by someone who specialises in this area.
Some babies require suck training exercises to improve tongue function and therefore improve feeding, others require division of their tongue tie.
This can be done with local anaesthetic in our rooms for babies under 4 months. Between 4-6 months it will be determined by the surgeon whether local or general anaesthetic is required. Over 6 months the procedure is generally done in hospital under general anaesthetic.
How much pain will my baby have after the tongue tie procedure?
Depending on the age of the baby, some will require paracetamol in the first 24 hours.
Why is my baby crying with feeds after the tongue tie release?
Some babies will require some paracetamol for pain relief after the procedure.
Some babies are uncoordinated with their sucking and this can be frustrating for the baby and results in increased crying with feeds. Some suck exercises can help in this situation, these exercises will be explained during your consultation.
If you have any concerns you can call the surgeon or the rooms to talk to the nurse.
Is ultrasound harmful to my baby during the tongue tie assessment?
Ultrasound uses sound waves to create the image, there is no radiation used and ultrasound is not harmful to your baby.
Why is the head of the penis purple?
The head of the penis can be pink, deep red, purple, bluish, or greyish in colour. All of these colours are normal and can change depending on the blood flow to the head of the penis at the time. As the baby gets older and the skin over the head thickens the colour change is less obvious.
What is the difference between the surgical cut technique and the Plastibell technique for newborn circumcision?
Both techniques are performed following the administration of paracetamol by our nurses and ultrasound guided injection of local anaesthetic. Both techniques use and element of skin crushing to prevent bleeding. The surgical cut technique involves using a clamp to crush the skin edges of the skin to be removed and cutting off the excess skin. A bandage is then applied. This bandage is removed the following day. This technique takes 2-3 minutes after the injection of anaesthetic.
The Plastibell technique involves placing a plastic ring between the head of the penis and the foreskin. A string is tied tightly around the foreskin crushing the skin against the ring. The excess skin is removed. The ring stays comfortably in place for 7-10 days before spontaneously falling off. There is no bandage to remove. This technique takes 8-9 minutes after the injection of anaesthetic.
From the parents point of view, the main downside of the surgical cut technique is that the bandage needs to be removed the following day and this can be uncomfortable for the babies. The main downside of the plastibell is that the procedure takes longer and the babies may not like being held still for the additional time.
Both techniques require liberal application of Vaseline. Babies often need two further doses of Panadol in the first 24 hours, but rarely anything after that.
Why does my baby need an injection for his circumcision, can’t he just a EMLA (numbing) cream?
EMLA numbs the skin very well, however, the head of the penis and deeper layers of the foreskin are not numbed by the cream.
We use an ultrasound machine to guide the injection of local anaesthetic to ensure that the local anaesthetic is injected in exactly the right place – we are confident that the entire penis in completely numb for the duration of the procedure and for approximately 40 minutes thereafter.
My baby had a circumcision as a newborn. Now his penis is buried and looks like there is too much skin left?
The appearance of the penis will change with your son’s body shape.
Newborns are often thin and have little fat over the pubic bone. They quickly become good at eating and develop substantial fat deposits, often over the pubic bone, in which case the fat pushes the skin forward along the penis giving it a buried appearance. This buried appearance usually goes when the rest of the puppy fat does, at around four years of age.
If the penis becomes buried, ensure the penis is ‘popped out’ with each nappy change for cleaning.
Why has my baby got adhesions after the circumcision?
In the few months following the circumcision the layers of skin are trying to heal themselves and often the remaining inner layer of the foreskin will reattach to the head of the penis.
This can be very easily separated with minor discomfort. Equally, the adhesions will undergo spontaneous separation at some stage in the future.
How much pain will my baby be in after circumcision?
Most babies (under 12 weeks) will require paracetamol in the first 24 hours after the circumcision, occasionally up to 48 hours.
If the baby has been a little unsettled, they are usually back to their normal behaviour within 48 hours or so.
If you have any concerns you should contact the surgeon or contact the rooms and speak to one of our nurses.
What is hypospadias repair?
Hypospadias repair is a surgery to fix the location of the opening in the penis when it is not in the right place at the end of the penis.
Hypospadias is a relatively common condition affecting around one in 250 males in Australia. It presents with varying degrees of severity, and a number of different procedures have been described to correct it – for these reasons it can be difficult for parents to find information relevant to their child on the internet.
Boys born with hypospadias should not be circumcised at birth. During surgery tissue from the foreskin may be required to repair the hypospadias. Hypospadias surgery is performed after six months of age.
Most boys under 18 months of age are unaware that their penis is ‘different’ to other parts of their body, it is recommended therefore that correction be complete by then while they are relatively unaware.
While most hypospadias repairs are intended to be successful in the first procedure, up to 15-25% of boys may require a further procedure to achieve the desired outcome.
Further review is undertaken six weeks later, and if progress is satisfactory then a final review is performed 3-4 months postoperatively, by which time most swelling has resolved.