T

Consult your doctor if you are unable to find a cause for your child's problem from this chart.

possible cause Lack of bladder control at night is common in children under 5 and is rarely due to an underlying disorder.

action If you are still putting your child in nappies, continue to do so until he or she is often dry in the morning. when accidents do occur, try not to get cross. Change the bedclothes with as little fuss as possible, and reassure your child. A mattress protector and bedclothes that are easy to wash and dry will make coping easier. Your child will eventually achieve night-time control.

see your doctor within 24 hours possible causes Your child may have a urinary tract infection (see Urinary tract infections in childhood, p.126). Alternatively, an emotional problem may be the cause.

action Your doctor will test a sample of your child's urine. If the result indicates that an infection is likely, a urine sample will be sent to a laboratory for analysis to confirm the diagnosis. Meanwhile, your child will be started on antibiotics. Further tests, such as ultrasound scanning (see Investigating the urinary tract in children, p.127), may be needed to look for any associated problems. If no infection is found, your doctor will discuss the possibility of an emotional upset with you and your child.

possible causes Lack of bladder control during the day is unlikely to have a medical cause in a child under 5, but in an older child, it may indicate a physical or emotional problem. Consult your doctor, whatever your child's age.

action Your doctor will examine your child and may arrange for tests, including urine tests, to find an underlying cause. If no physical cause is found, follow advice on toilet training (see Toilet-training tips, opposite). Children over 5 years may need to be referred to a specialist.

possible cause Around 1 in 6 children wet their beds at age 5, and 1 in 20 still wet their beds at age 10. Regular bedwetting rarely has a physical cause, even in an older child, and is particularly common if one or both parents were late to acquire night-time bladder control.

action Follow measures for overcoming bedwetting (above). If these do not help, consult your doctor, who may prescribe a course of drug treatment or drugs that can be used for events such as an overnight school trip.

[45 Genital problems in boys

Consult this chart if your child develops a painful or swollen penis or a problem with his scrotum (the supportive bag that encloses the testes). Although most genital problems in boys are due to minor infections, you should always consult your doctor promptly if your child develops a problem in the genital area. In some cases, a delay in treatment can have serious consequences - for example, it may lead to problems with your child's fertility in the future.

Does your child have a pain in the penis only when passing urine?

Does your child have a painful scrotum?

YES Go to chart Urinary problems (p.126)

EMERGENCY!

call an ambulance

Possible cause Torsion of the testis, in which one of the testes is twisted within the scrotum, cutting off the blood supply, is a possibility (opposite). This condition can occur after an injury but often develops spontaneously during sleep.

action Urgent surgery to untwist the testis and restore its blood supply is essential. During surgery, both testes will be anchored within the scrotum to prevent the condition recurring.

Does the skin of the scrotum look red and inflamed?

Continued on next page

Does your child have a painless swelling in the scrotum?

possible causes The skin of the scrotum may be inflamed as the result of an allergic reaction to a detergent used to wash your child's nappies or underwear or because of a fungal infection. Consult your doctor.

action Your doctor will examine your son and prescribe a corticosteroid cream for an allergy or an antifungal cream for a fungal infection. If an allergy is diagnosed, use a non-biological detergent and rinse clothes thoroughly.

Circumcision

Circumcision is a surgical operation to remove the foreskin, which is the fold of skin that covers the tip of the penis. In the UK, most circumcisions are carried out for religious reasons. However, in some cases, circumcision may also be recommended if a child's foreskin is too tight or if a child has recurrent infections of the penis. In the past, circumcision was often performed routinely in childhood in the belief that it would improve hygiene, but this practice is no longer recommended.

In newborn boys, circumcision is most often carried out under local anaesthetic, whereas, in older boys or in men, it is usually performed under general anaesthetic.

During the operation, most of the foreskin is cut away. The remnant of the foreskin that remains is then stitched to the skin just behind the head of the penis, leaving the head uncovered. No dressing is needed while the wound heals. The stitches will either dissolve or fall out after a few days.

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