What is a heart murmur? When the valves close in the heart, they make a noise. “Murmur” is a medical word to describe extra noises coming from the heart. Normally these noises are of no significance, and occur in the normal heart, but your GP has referred you to a paediatrician (children’s doctor) or paediatric cardiologist (children’s heart doctor) to make sure that the murmur is not being caused by a problem with the heart. The most common heart problems causing a murmur are minor, and many require no treatment. Tests may be performed to try and understand why therre is a heart murmur. These may include: ECG (electrocardiogram): stickers are placed on your child’s ankles and wrists and on the chest. Leads are then attached to these to record the electrical activity of the heart. The child must lie still for one minute whilst this test is done. chest x-ray blood pressure measurement pulse oximetry: a small probe is placed over the end of the finger to measure the amount of oxygen in the blood echocardiography: an ultrasound probe is held over the heart to give a picture of the heart much like the ultrasound scan used during pregnancy to give a picture of the unborn baby. Your child needs to lie still for 15-20 minutes during this test. If your child is too unsettled, a later appointment may be made for the test to be done under sedation (medication is given to make your child feel sleepy).

What is an inguinal hernia? An inguinal hernia is caused by a connection between the scrotum and the abdomen (uncommonly a similar connection occurs in girls causing an inguinal hernia). The connection is present in all babies in the womb during development, but in most babies has closed over before birth. The connection allows some contents of the abdomen to pass down towards the scrotum causing a bulge in the groin. The bulge is often more noticeable when the baby cries. The bulge (or hernia) can usually be pushed back into the abdomen by gentle pressure when the baby is settled. Uncommonly the hernia cannot be pushed back (“reduced”), which can be a serious complication because the tissue trapped in the connection can become swollen and damaged. An inguinal hernia can be repaired with a simple operation. Your family doctor will have referred you to a children’s surgeon who is experienced in repairing inguinal hernias. Laparoscopic: several small incisions are made in the abdomen and a narrow tube with a tiny camera attached (laparoscope) is inserted. Small instruments are inserted through the other cuts, allowing the surgeon to push the hernia (part of the intestine that is bulging through the abdominal wall) back into its original position. The weakness in the abdominal wall is repaired. Open: an abdominal incision is made and the hernia is pushed back into position. The weakness in the abdominal wall is repaired. Herniotomy: an incision is made in a skin fold in the groin and the hernia sac is cut out.

Undescended testes occur in less then 4% of children, and are more common in premature babies. Many “undescended” testes are simply lying very high in the groin and can be brought down by hand, and some true undescended testes will come down by themselves in the first year of life. After one year, undescended testes always remain so. It is important for your GP to refer your child to a paediatric surgeon (children’s surgeon) if the testes are not felt in the scrotum. If not treated there may be problems in adult life with infertility or an increased risk of cancer of the undescended testis. What will happen at the appointment? The surgeon will examine your child carefully to see if the testis can be felt in the body. If the testis can be felt, a simple operation under general anaesthetic (putting your child to sleep during the operation) would be performed between 9 and 12 months of age. If the testes cannot be felt, a different type of operation would be performed so that the surgeon can check where the testes are. In some cases, the testes are absent. Orchiopexy A small incision (cut) is made in the groin on the side of the undescended testicle and the testicle pulled down into the scrotum. Sometimes a small cut will need to be made in the scrotum as well.

What is a urine infection? A urine infection is the presence of bacteria in the urinary tract (bladder and kidneys). Urine should be sterile (free of bacteria). Why did my child get a urine infection? Approximately 1% of boys and 3% of girls get a urine infection in the first ten years of life. Bacteria can enter the urinary tract from the skin around the urethra (where the urine normally comes out), or occasionally from infection within the body. Constipation can contribute to a urine infection and children who hold on to their wees for long periods are also at risk of developing a urine infection. Some children will have a blockage in the urinary tract, or a back flow of urine from the bladder towards the kidneys (called vesico-ureteric reflux VUR) which has cause the infection. How is the urine infection treated? A course of antibiotics will treat a urine infection. If your child is vomiting or too unwell to take antibiotics by mouth, hospitalisation for intravenous (in the vein) antibiotics may be needed. Antibiotics should improve symptoms within 48 hours. If they have not, see your GP. Why does my child need to have tests done? All babies and very young children should have tests done to check their urinary tract. In up to 40% of young children with a urine infection, there is a back flow of urine towards the kidneys, and in a very small percentage there is a blockage in the urinary tract. These conditions stop the urine flowing normally and make children more likely to have repeated urine infections. Blockages and severe VUR may need to be repaired with surgery, and VUR may need long term treatment with antibiotics to help prevent kidney scarring and possible kidney failure. It is important therefore to take antibiotics until the tests are done, in case VUR is diagnosed. What tests will be done? The tests your GP has referred you for may include: kidney ultrasound: this is similar to the ultrasound to check the baby in the womb during pregnancy. It shows the size and shape of the kidneys and is usually done about one month after referral micturating cystourethrogram (MCUG): this test uses x-rays to see dye moving out of the bladder. It will detect back flow of urine (VUR) and blockages in the urinary tract. The dye is put into the bladder through the urethra using a thin tube called a catheter. Your child is then held still for several minutes while x-rays are taken. Inserting the catheter can be uncomfortable, and hands-on support by the accompanying adult may be needed. Arranging child care for any other children in your care is advisable for this test. In children older than about 18 months, sedation may be offered to make your child sleepy and less aware of the test. The MCUG is done approximately one month after the referral. What if the tests show an abnormality? You should see your GP after these tests have been done. Your GP may refer your child to a children’s doctor (paediatrician). Antibiotics should be continued unless you are told otherwise. Will my child get further urine infections? Repeated urine infections can occur even when antibiotics are being taken. It is important to have your child’s urine checked if the following symptoms develop: fever; strong smelling or discoloured urine; pain on passing urine; your child is “not well” or has unsettled behaviour. To prevent further infections, avoid constipation, avoid bubble baths (or other irritating soaps), take antibiotics when prescribed, change soiled nappies quickly, and wipe the bottom from the front to the back.

Laparoscopic: several small incisions (cuts) are made in the lower right abdomen and a narrow tube with a tiny camera attached (laparoscope) in inserted. This allows the surgeon a view of the appendix and, by inserting small surgical instruments through the other cuts, the appendix can be removed.

The foreskin is pulled away from the body of the penis and cut off, exposing the underlying head of the penis (glans). Stitches may be required to keep the remaining edges of the foreskin in place.

A fold of tissue (frenum) that attaches to the cheek, lips and/or tongue is surgically removed.

A small cut is made in the scrotum and the fluid is drained from the hydrocoele sac (a fluid-filled mass that forms in the scrotum). The sac may either be removed or is folded back behind the testicle.

A minor surgical procedure is performed to widen the urinary meatus or opening (where the urine exits the body).

Radical Neck Dissection All lymph nodes (bean-shaped glands that filter harmful agents picked up by the lymphatic system) from the collar bone to the jaw and from the front of the neck to the back are removed, along with the sternocleidomastoid muscle (moves the head from side to side), the spinal accessory nerve (involved in speech, swallowing and some head movements), the submandibular gland (one of the salivary glands) and the internal jugular vein. Modified or Functional Neck Dissection All lymph nodes (bean-shaped glands that filter harmful agents picked up by the lymphatic system) from the collar bone to the jaw and from the front of the neck to the back are removed.

Shave Biopsy: the top layers of skin in the area being investigated are shaved off with a scalpel (surgical knife) for investigation under a microscope. Punch Biopsy: a small cylindrical core of tissue is taken from the area being investigated for examination under a microscope. Excision Biopsy: all of the lesion or area being investigated is cut out with a scalpel for examination under a microscope. Incision Biopsy: part of the lesion is cut out with a scalpel for examination under a microscope.

Skin lesions such as cysts and tumours are removed by cutting around and under them with a scalpel.

A small cut is made in the scrotum, the cord supplying blood to the testicle is untwisted and both testes are sutured (stitched) to the scrotum to prevent another torsion.