Lumps and bumps
1) Diastasis Recti
This is a common condition caused by a relative weakness in the linea alba between the two rectus abdominus muscles.
It presents as a painless, vertical bulge in the midline of the child’s abdomen when intra-abdominal pressure increases.
It does not herniate and will resolve overtime as the musculature develops. No treatment is needed, only reassurance.
2) Umbilical Hernias
Umbilical hernias are common affecting 10% of Caucasian children25. The incidence is higher in preterm babies and those with Down’s syndrome26.
Like the Diastasis Recti it presents as a painless, midline swelling in child’s abdomen when intra-abdominal pressure is increased. However, in this case it is due to protrusion of the peritoneum-containing sac through the umbilical ring.
Incarceration is rare and overtime the ring constricts to obliterate the defect.
As spontaneous resolution is anticipated surgery is delayed until 4-6 years of age27 so most cases require reassurance only.
3) Communicating Hydrocoeles
Presents as a painless scrotal swelling due to collection of fluid inside the tunica vaginalis.
Occurs in neonates and infants occurs due to the presence of a persistent processus vaginalis where the testicle descends through the inguinal canal into the scrotum during foetal development.
It may be difficult to distinguish from a inguinal hernia but typically you can “get above” the swelling, no separate testicle can be felt and it trans-illuminates brightly. However, if there is uncertainty a Paediatric Surgeon should be consulted.
The persistent processus vaginalis will resolve spontaneously and hence, 89% will resolve in the first year of life28.
Most cases require reassurance only however, parents should be advised to return if symptoms of infection develop or there is a dramatic increase in size.
4) Undescended Testes
Most undescended testes are present at birth.
The condition affects 3-5% of term infants but can affect up to 30% of those who are premature29.
By 3 months the incidence falls to 0.8% and subsequent resolution is unlikely30. Hence, most cases will improve spontaneously and reassurance is all that is required.
Rational for treatment after 3 months is the prevention of testicular cancer, subfertility and testicular torsion. Hence, for older infants, outpatient surgical opinion is required.
NB: Bilateral non-palpable undescended testes in a phenotypical male should be considered a genetic female with congenital adrenal hyperplasia until proven otherwise
5) Umbilical Granulomas
Umbilical granulomas appear after cord separation and present as a soft, pink lesion with a moist appearance.
Treatment with silver nitrate is historically the gold standard however, chemical burns to the abdomen have been reported31.
There is evidence application of salt to the area led to 100% resolution of the condition without the inherent risk of the harm to the patient32
6) Prominent Xiphisterum
Presents are a firm, immobile lump in the midline of the chest.
Over time this normal anatomy will become less visible. Reassurance is all that is required.
so good these presentations, usually create lot of concerns for mums and doctors are frustrated too because of lack of knoweledge
good precise account of neonatal conditions
Very good session