Surgery in Children

Children often put objects like small toys, safety pins, batteries and buttons into their mouths. In most cases, if swallowed, small items will pass through the body without causing any damage. However, certain items can get stuck in the swallowing pipe (oesophagus), intestine, or breathing pipe (trachea) and this can be extremely dangerous.

The most dangerous of all objects are button batteries (watch and remote control) and magnets. Children should never be allowed to play with these objects and if you suspect your child has swallowed these, it is important to contact your local hospital immediately.

Symptoms:

Includes drooling, pain on swallowing, feeding difficulty or refusal.

For objects in the trachea, symptoms can include difficulty breathing, cough, or funny noises when breathing in and out.

Treatment:

Treatment depends on your child’s symptoms, where the object is lodged and what type of object is swallowed. Some objects may be removed with an endoscopic camera through your child’s mouth under general anaesthetic. In rare cases surgery may be required.

How to keep your children safe:

• Keep small magnets and coins away from children. These include magnets found in construction sets, toys and fridge magnets.
• Check all toys for loose pieces and warn your child not to put things in his/her mouth
• Keep all devices (remote controls, watches, calculators, candle lights) that use button batteries out of reach of small children.
• Keep loose batteries locked away.
• If you suspect your child has ingested a battery, coin, toy or magnet go to the hospital immediately. Don’t try and make your child vomit. Rather be seen by a medical professional

Caustic ingestion refers to the swallowing of any substance that is able to burn or damage tissue including the lips, mouth, oesophagus (swallowing pipe), trachea (breathing pipe), and stomach. Common household products like cosmetics, cleaning agents and bleach are extremely dangerous to children and should be kept locked away at all times. If ingested, caustic substances can cause tissue damage that results in scarring in the oesophagus making it narrower and hard for your child to swallow.

Symptoms:

These may include:

• Pain on swallowing
• Difficulty breathing
• Refusing food
• Weight loss
• Drooling
• Hoarse cry
• Burns on their lips or in their mouths

Treatment:

If your child swallows a caustic substance seek medical help immediately. Do not make your child vomit as this can worsen their injury. The doctors may  perform an endoscopy, a procedure that uses a camera to see into the oesophagus, stomach and first part of the intestines. They will then advise on the best treatment plan depending on the findings.

How to keep your children safe:

• Store all household products, cleaning solutions and poisonous items out of children’s sight and reach using safety locks. Remember, young children are often eye level with items under the kitchen and bathroom sinks.
• Read product labels to find out what can be hazardous to children.
• Dangerous household items include makeup, personal care products, plants, pesticides, lead, art supplies, alcohol and laundry detergent pods.
• Make sure that all medicines, including vitamins, are stored out of reach and out of sight of children.

Appendicitis is the inflammation and infection of the appendix, a small piece of tissue located on the lower right side of the abdomen (belly) and attached to the large intestine. Appendicitis in children usually results from blockage in the appendix caused by dried mucus, hard stool, or parasites and worms. The blockage can decrease blood flow through the appendix, causing swelling and infection.

It is vital that appendicitis is treated early before complications arise. If you suspect that your child has this condition, seek immediate medical help.

Symptoms:

Children often experience vague belly pain that moves from the middle of the abdomen to the right lower side. The pain gets worse with time and can be associated with decreased appetite, vomiting, diarrhoea, and fever.

Treatment:

Appendicitis is not preventable and treatment is removal of the appendix with surgery (appendectomy). If the appendix has not burst (perforated) before surgery, most children can feed and go home within 1-2 days and return to school 1 week after the operation. Wound care after surgery is easy and uncomplicated and can be safely performed at home.

Intussusception is a condition in children where one part of the intestine falls into an adjacent part of the intestine and gets stuck. This results in a blockage that prevents food or fluid passing through the intestine as normal. If left untreated, intussusception can be extremely dangerous.

Symptoms:

Intussusception usually affects children between 6 months and 3 years old. Children often have a viral respiratory or gastrointestinal infection before they develop intussusception, and often experiences episodes of severe tummy pain and sweating that resolve spontaneously. As the condition progresses, the tummy pain may be associated with vomiting and bloody stool. Intussusception is usually diagnosed with sonar. If you suspect your child is ill, seek early medical advice.

Treatment:

Treatment of intussusception involves pushing the intestines back into the correct position through an air enema or surgery. All children with intussusception require admission and resuscitation before the intussusception is addressed.

Testicular torsion is the twisting of the tube, called the spermatic cord, which leads to the testicle. When the blood vessels are twisted, they can cut off cthe blood supply to the testicle and cause permanent damage

Testicular torsion can happen at any age. However, it is most common in newborns or boys going through puberty. When testicular torsion happens during the newborn period, there is a very high chance that the testicle has already been severely damaged and may not be saved. The testicle can survive for only about six to eight hours without any blood flowing to it. After that, the tissues are damaged and the testicle no longer works. This condition is a surgical emergency.

Causes:

There are no specific causes of testicular torsion. The testicles develop inside the belly and drop down into the scrotum around the seventh month of pregnancy. Once the testicle drops into the scrotum, it attaches to the inside. When a testicle does not drop down into the scrotum (undescended testicle), it does not attach correctly, which causes a higher risk of twisting.

When the cord twists, it blocks the blood leaving the testicle, which causes swelling and pain. This can lead to permanent damage to the testicle. Once testicular torsion has occurred on one side, there is a higher chance it can occur on the other side. This can happen anywhere from a few weeks to months later.

Symptoms:

Symptoms can vary based on the age of the child.

• In newborns, there is usually no pain, but the affected side of the scrotum becomes swollen, red and hard. Parents may notice scrotal swelling during a diaper change.
• In older children and adults, the most common symptom is a painful and swollen scrotum.
• Vomiting and nausea is often associated with scrotal pain.
• Scrotal pain that develops suddenly
• Increasing scrotal pain despite treatment with pain medication
• Redness and swelling of the scrotum
• High-lying testicle

Treatment:

Testicular torsion is a surgical emergency. If the twist has been present for more than eight hours, there is only a low chance of saving the testicle. During the surgery, the spermatic cord is untwisted returning blood flow to the testicle. If the testis is alive, it will be left. It is important to check the unaffected side so that it can be fixed and prevented torting at the same time as treating the affected side.

Paediatric trauma is most often related to motor and pedestrian vehicle accidents, injuries sustained during sport, fall from height, burns and minor bumps and bruises. Children are an extremely vulnerable population and due to differences in children’s anatomy and physiology, management of paediatric trauma is a highly specialised field. Urgent and appropriate investigation and management are of utmost importance to minimise the risk of complications. This may include admission, X-ray or CT scanning, blood tests, and sometimes even intubation and ventilation. If your child sustains trauma, seek medical attention early.

The doctors have extensive experience in the management of a wide range of paediatric trauma, and are committed to excellence in the care of injured children.

How to keep your children safe:

• Ensure all young children are supervised at all times.
• Keep hazardous objects safely locked away, and out of the reach of children.
• Ensure all children are placed in the back seat with a seat belt on, or secured in a car seat when travelling.
• Avoid walking/playing on the road.
• Ensure your child is wearing a helmet when riding a bicycle

Most burns in children are due to hot water. These burns usually occur when bathing, cooking, or playing in the home. Some burns may be due to fire, chemical exposure, electric shock or contact with hot objects. Due to their unique physiology (including thinner skin), burns in children can be extremely dangerous and have severe debilitating effects. Critically, paediatric burns are largely preventable.

Burns are categorised according to how much of the body they affect, and how deep they are. Generally speaking, the different levels of burns may be thought of as:

• Superficial thickness burns (STB) – these burns are usually classified as sun burn and often present as red painful skin without any blisters. Superficial thickness burns are usually treated with pain killers, soothing creams and rest. Most STB will heal by themselves within 2 weeks of injury and do not require hospitalisation,
• Partial thickness burns (PTB) – these burns are usually due to hot water and present with redness, pain and blistering. Depending on the site and severity of the burn, these burns may require admission, cleaning of the burn area in theatre, multiple wound dressings and in some cases a skin graft. PTB can heal without significant permanent scarring within 3 weeks of injury,
• Deep burns (DB) – DB burns are extremely serious and present with pain, blistering, and redness. These children require immediate care in an expert setting. Most DB involve repeated trips to the operating theatre, the possibility of skin grafting and a prolonged period of healing.

Treatment:

Many burns may be safely treated without admission, but some require admission, intensive therapy including the possibility of multiple trips to theatre, and rigorous rehabilitation. The doctors have extensive experience in the management of paediatric burns.

All paediatric burns are managed in conjunction with a team of excellent, dedicated professionals including physiotherapists, occupational therapists, dieticians, wound care nurse practitioners, and paediatric intensivists. Your child’s unique treatment plan will depend on his/her symptoms, age, severity of burn and general health.

How to keep your children safe:

• Keep hot foods and drinks away from the edges of tables and counter tops.
• Never carry a child while holding hot items.
• Test bath water with your elbow before bathing a child
• Never let young children use the microwave to prepare hot foods or drinks.
• Keep children away from the kitchen during food preparation.
• Make sure pot and pan handles are turned toward the back of the stove.
• Tuck cords of appliances out of reach of children.
• Never leave irons, hair dryers, or curling irons on around children.
• Keep hazardous materials safely stored out of reach of children.
• Cover electrical outlets when not in use
• Keep your child out of the sun. Use sunscreen when your child is old enough, usually at 6 months.

Skin and soft tissue infections can occur anywhere on your child’s body and are extremely common. The soft tissues are made up of the skin and its appendages (hair follicles, sweat glands), fat, muscle, tendons, and ligaments. Skin infections and abscesses often result from minor scrapes and grazes that go unnoticed, but are more common in serious injuries such as cuts, burns and bites. Soft tissue infections can be extremely serious if treated incompletely or left untreated. If in doubt about your child’s condition, it is safer to seek expert medical opinion early.

Symptoms:

Injury and infection of any of the soft tissues can appear as a rash, swelling or discolouration, and can be associated with pain, fever, irritability, vomiting, diarrhoea, and a reluctance to move the affected part of the body.

Treatment:

Most soft tissue infections can be treated with antibiotics, rest and pain killers. Sometimes, surgery is needed to remove dead tissue or drain an abscess. Such procedures are usually minor, requiring a short hospital stay and quick trip to the operating theatre. The doctors will explain your child’s wound care and follow up to you before you leave the hospital.