Optimal times for surgery/intervention in early children’s disorders

Question 1

Head and Neck

Answer 1

Squint (fixed or alternating)

• 12–24 mths
• absolutely before 7 yrs

Deafness (children are born with hearing)

• screen at or before 8 mths
• hearing aids required by 12 mths

Tongue tie: either in first 4 mths when avascular or later at 2–6 yrs

Ear deformity: after 6 yrs

Cleft lip: <3 mths

Cleft palate: 6–12 mths

Question 2

Urology

Answer 2

Undescended testis

• best assessed before 6 mths
• surgery best 6–12 mths.
• Don’t leave >12 mths.

Torsion of testicle: surgery within 4 h (absolutely within 6 h)

Hydrocele: leave to 12 mths then review (often resolve—if not, repair by 2 yrs)

Varicocele: leave and review

Question 3

Hernias

Answer 3

Umbilical hernia

• leave to 4 yrs
• surgery at 4 yrs if persistent (tend to strangulate after 4)
• never tape down!

Para-umbilical hernia: any age; best after 6 mths

Epigastric hernia: any age; best after 6 mths

Inguinal hernia

• general rule is ASAP, esp. infants and irreducible ones
• reducible herniae: the ‘6–2’ rule:
• –birth–6 wks > surgery within 2 d
• –6 wks–6 mths > surgery within 2 wks
• –over 6 mths > surgery within 2 mths

Femoral hernia: ASAP