American Medical Association Family Medical Guide - American Medical Association [207]
Treatment of an undescended testicle should be performed when the child is between ages 1 and 2 and depends on where the testicle is. For example, if the testicle is very near the scrotum, injections of male hormones may cause it to descend into the scrotum. If the testicle is in the groin area, a surgical procedure called orchiopexy can be performed in which the surgeon makes a small cut in the groin area and then lowers the testicle into the scrotum. This procedure takes about an hour and the child usually goes home the same day. If the child also has an inguinal hernia, the surgeon will repair it at the same time. Once the testicles are in place inside the scrotum, children seldom have any more problems. However, some boys may have decreased fertility.
Vulvovaginitis
Vulvovaginitis is inflammation of the vulva (the outer, visible genital area around the vagina). The condition affects only a small number of girls, usually those whose vulva is especially sensitive to irritation. In many cases, the cause of the condition is unknown. In other cases, vulvovaginitis is caused by microorganisms in stool or is an allergic reaction caused by contact with wool, nylon, soap, bubble bath, baby wipes, fabric softener, or detergent. Bed-wetting (see page 427) or pinworms (see page 444) also are possible causes of vulvovaginitis. In rare cases, the condition occurs after a child has inserted a foreign object into her vagina. In some cases, vulvovaginitis is a sign of child sexual abuse resulting from someone inserting a finger, penis, or other object into the child’s vagina. Vulvovaginitis can occur at any age.
Symptoms
The symptoms of vulvovaginitis include redness, itching, and soreness in the genital area; a foul-smelling discharge from the vagina; painful urination; and a frequent urge to urinate. Because of symptoms such as the frequent urge to urinate and painful urination, vulvovaginitis may be mistaken for a bladder infection. If your daughter has symptoms of vulvovaginitis, see the doctor right away.
Diagnosis and Treatment
A diagnosis of vulvovaginitis is based on the child’s symptoms and the results of a physical examination. The doctor will examine your daughter’s vagina. If the doctor finds a foreign object, he or she will remove it. If the doctor suspects sexual abuse, he or she is required by law to contact the local department of public health, the department of social services, or the police department.
In most cases, careful hygiene eliminates the problem. Girls should be taught to wipe themselves from front to back after a bowel movement to help prevent bacteria from the anal area from reaching the vaginal area. Bathe the child every day with mild soap, but do not allow her to sit in soapy water, and do not use bubble bath or other potentially irritating bath additives. After bathing, dry the affected area thoroughly but gently and apply a zinc oxide paste or other protective medication the doctor has recommended. Wash the child’s genital area carefully after each bowel movement. Make sure your child wears clean underpants each day. Underpants should be loose-fitting and made of cotton or have a cotton insert or panel in the crotch.
Disorders of the Muscles, Bones, or Joints
Injuries are the most common cause of muscle, bone, or joint problems in children, and in most cases, these injuries heal quickly and completely. However, some disorders that affect the muscles, bones, or joints in children—such as rheumatic fever, osteomyelitis, and juvenile rheumatoid arthritis—can be life-threatening and often result in permanent impairment.
Rheumatic Fever
Rheumatic fever is an inflammatory disease that can develop after an infection with streptococcal bacteria, such as strep throat (see page 652). Rheumatic fever can affect the heart, brain, joints, and skin. The disease can occur at any age but usually affects