Mucocele – Swelling On Inner Side Of The Lip

Mucocele is a fairly common condition seen in children.

How does it form?

The minor salivary glands, and, there are over 600 of them, are small glands that produce saliva. They are too small to be seen by the naked eye and consist of a small globular gland. The saliva that forms in the gland drains out through a narrow tube (the duct) into the mouth. This saliva helps us chew our food and also starts the process of digesting food.

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The dangers of pillion riding

Dangerous Pillion riding
Dangerous and careless pillion riding

Children should never travel on two wheelers, as it is very, very unsafe. Most people, do not pay any heed to safety, or are not even thinking how dangerous it is to ferry children around on two wheelers, and this gentleman, nicely protected by his helmet (I suspect more out of fear of the law, than concerns about safety!), ferrying not one, but two kids in the rear.

There is absolutely, no protection and no restraint. Any accident (whomsoever is at fault, whether it be the rider himself, other drivers, the road or pedestrians), will result in the children being flung with great force out of the vehicle and crashing into anything that is close by. Please do yourself and your children (whom you profess to love so much!) a favor and only travel with them, properly restrained in car seats in the back of four-wheelers! Please!

Another example of dangerous pillion riding by children and their parents can be found here!

Care of the uncircumcised penis in the child

First the don’t! – Do not pull back the foreskin forcibly under any circumstances.

At birth, the foreskin, sometimes called the prepuce, is attached to the end of the penis, an area known as the glans. Over time, the foreskin separates from the glans, forming a space between the skin and the glans. Separation is completed in 50 percent of boys by age 3 years, 95 percent by age 5 years, and 99 percent by adolescence. So just wait it out, and it is very likely that the skin will retract back up to the junction between the head and the body of the penis, on its own.
In fact, there is a risk of injury to either the foreskin or the glans, if the foreskin is retracted forcibly. Many of these children who have had injury need to be circumcised at a later date.

Now for the actual care:

  • Change diapers frequently – This is not the place to save money. Don’t wait to get what you consider a “full load”! Apart from possible infections of the skin of penis in boys, you can get vaginitis in girls, or diaper rashes or increased risk of urinary tract infections.
  • Always clean poop from front to back – that way you are unlikely to get poop on to the genitals.
  • Treat it like just any other body part – clean the genitals with water and a mild soap (no role for using anti-bacterial soaps in routine bathing, as it only encourages the emergence of bacteria that are resistant to multiple drugs).
  • When the foreskin becomes retractable: Later, when the foreskin is fully retractable, boys should be taught the importance of washing beneath the foreskin on a regular basis. The foreskin should be dried before pulling it forward. The pulling it back to its normal position is very important, as if left behind, it becomes swollen and painful, a condition called as paraphimosis – if this should ever happen, please seek urgent, immediate attention.

Doctor, my child’s testis cannot be felt! Should we do an ultrasound examination?

Is an ultrasound necessary in a child who has an undescended testis?

Almost every patient that comes to me for consultation for undescended testis, comes armed with an ultrasound (USG) report, that the parent will promptly proceed to show me after the initial formalities, even before I have had a chance to ask as to why they are consulting me.
The sad part is that ultrasound is not only unnecessary but actually misleading in children with undescended testes [1].

USG is accurate in predicting examination findings in only 54% of children. Additionally it delays required surgery in infants by as many as 3 months.
The algorithm for managing undescended testis only requires whether an experienced pediatric surgeon can palpate the testis or not. So please do not get unnecessary tests done.
1. Ultrasound Overused to Diagnose Undescended Testicle

Witch’s Milk! Should I do something about it?

This is a common refrain and the common practice is to express the milk out by squeezing the baby’s breasts as it is considered to be bad for the baby. This is mostly done by the दाई (the maid who looks after and massages and bathes the baby).

Breast abscess following massage
Large breast abscess whose ‘witch’s’ milk was being expressed

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Keeping Children Safe In Parked Cars

Kids, 2 & 4, get locked in car, die of suffocation

The headlines practically screamed at me! What a waste of precious life! All because we cannot take basic precautions? It immediately brought back memories of another headline just a few month back

Four Children Suffocate to Death in Locked Tamil Nadu Car

How many times have we left our kids in the car while we finished off an errand in “just a

Car parked in the sun
Car Parked in the sun for an hour can get by as much as 22° C over the surrounding temperature

minute”. Most unknowingly, that minute can turn into a few minutes and that for a child trapped in a hot, parked car can be fatal. It is the sun and the resultant heat stroke, that kills, not the temperature outside. Even on a cool day, just by virtue of being out in the sun, in closed confines, can heat up the inside by around 22° C in an hour! Most of this (80%) increase occurs in the first half an hour.

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Tongue Tied? Could be literally true!

Tight Frenulum causing tongue tie
Note the tight cord anchoring tongue to the floor of the mouth

While most of us get tongue tied when we are overawed by a famous personality or when asked to speak in public, or too overcome by emotions, in the case of your infant, it could be due to the fact that the cord of tissue (called the frenulum) that holds the tongue in place against the floor of the mouth is too tight / thick / rigid.

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