Our trip to the ER with my intact DS (a cautionary tale)

[mom2evan]

Yesterday evening, DH and I took our DS to the emergency room for the first time.

DS went to daycare yesterday morning. DH picked him up at 2:30. All afternoon, DS was his usual happy-go-lucky self. At 5 p.m., though, when DH took off his diaper and put him into the tub, DS let out a howl of pain.

When DH looked more closely, he realized that DS's penis was swollen to twice its normal size, and appeared red and inflamed.

We took DS first to the emergency room at our local community hospital, where they did a visual exam and decided we should see a specialist at a hospital approximately 30 minutes away.

I won't go into the gory details of our experience with hospital bureaucracies, patronizing nurses, and confinement to a tiny exam room with a 21-month-old toddler for 3 hours while we waited for the one urologist in the hospital to come out of surgery. I will only say that I began to lose my composure when a nurse tried to tell me not to nurse DS, after an hour of sitting and waiting, without food or water, and having had no dinner, "in case he needs am emergency circumcision."

When we finally saw the urologist, he was very kind and extremely gentle with DS. After a visual exam, however, he said to me that he planned to retract DS's foreskin so he could take a closer look.

I said "uh, NO. You aren't supposed to retract the foreskin," to which he replied "where did you hear that? From a family practitioner?" No. From the pediatricians in your own hospital (which is where I had DS). From my own pediatrician, who trained at that hospital. From the American Academy of Pediatricians. I said all this, and he said "well, I never heard that, but I'll make a call to a pediatric urologist and ask him."

Of course, he came back a few minutes later and said "you're right, he said not to do it."

This all happened at a spectacularly good hospital, with some of the best-trained physicians in the country. I must say that I did appreciate the doc's willingness to listen and to admit he was wrong - but it just goes to show that you can't really ever expect that docs will know how to care for an intact penis - even a urologist.

(For those who are curious, we never did find out exactly what was/is wrong with DS. He is taking antibiotics - ugh - for a possible infection, and we're in a wait and see mode. We have to go back to see the pedi urologist tomorrow.)

[Kathryn]

I'm surprised he admitted he wasn't right (in a roundabout way anyway). Sorry about your kiddo though. Did they do a swab culture?

[hummingbear]

Yahoo, the doctor not only listened but was content to be corrected!
I am so glad this wasn't another retracted in the ER story. But Frank will probably come along and ask if the hospital took a culture. Unless they took a culture to discover the specific bacteria, a general antibiotic could help, but maybe only partially so that symptoms change and may not be completly effective in eliminating the problematic bacteria. Maybe you could ask when you see the pediatric urologist tomorrow. Since he has been on the antibiotic already it may be too late and maybe not?

But that nurse : Just shows the typical mentality: "Something wrong down there? Well then we better be prepared to circumcise!" At that age my son was regularly nursing every 1 1/2 to 2 hours. And if we were in a waiting room he probably wouldn't have bothered to stop nursing.

[Quirky]

Wow, so great that you were so well-informed and were able to inform the doctor!!

I wonder, though - is there any possibility he was retracted at daycare by someone changing his diaper? I would review intact care with them just to make sure there's not someone new who might be misinformed.

Hope your little guy is feeling well soon!

[mom2evan]

No, they did not do a swab culture. What, exactly, would they swab? There isn't any discharge or anything - it's just hugely swollen and red.

The "no nursing" thing really ticked me off. Not only was DH hungry and thirsty, he was exhausted (it was hours past his bedtime) and in pain. There was NO way I would deny him the comfort of nursing.

We did talk with the daycare, and they are very insistent that they would not have retracted his foreskin (they have several intact little boys there). Believe me, though, the thought crossed my mind more than once.

[~Megan~]

That is incredibly scary. It did remind me to tell dh what he needs to do in that situation.

[paquerette]

And EVEN IF he needed emergency surgery of any type, nursing would not be contraindicated, until right before a surgery.

They can swab even if there isn't a discharge or fluid there, I believe. If they just touch the q tip to the area, it would pick up some of whatever germs might be lurking there.

[InDaPhunk]

I'm sure that was incredibly stressful. Way to keep your cool .

I'm impressed that the dr even called someone else to consult. It seems the usual protocol is to condescendingly tell the parent they're incorrect and then do everything in his/her power to retract the foreskin. Yes, he should have known better but anyone is allowed to be wrong. Now he knows better. The nurse however, should be taken behind the hospital and summarily shot.

[gabysmom617]

They need to do a culture to see what is causing the infection.

For a culture, all they do is take a sterile q-tip thing and rub it around the tip of the penis, and around the forskin, withour retracting. You could probably even have them let you do it yourself, so you can assure that the forskin won't be retracted.

Then they take the swap and culture it to see what type of bacteria grows, and then they should prescribe an antibiotic appropriate to that particular bacteria.

P.S.
I hope you nursed him anyway, and ignored that idiotic nurse.

[Kathryn]

He shouldn't be taking an antibiotic if they don't know what exactly is wrong and they can't know unless they swab. Antibiotics do much more harm than good if they aren't actually needed.

[mom2evan]

Thanks, all, for the support and suggestions.

When we see the pediatric urologist tomorrow, I will ask him to swab and do a culture.

I have now realized that it is possible something happened to DS at daycare. While the two regular teachers there know how to care for an intact child, it now appears that they have not given any instruction to the college students who work there as part of their ECE program.

I spoke with one of the teachers again this morning and asked her please to ensure that the students are told that they should never, under any circumstances, retract the foreskin when cleaning and diapering DS.

If one of the students had done so, though, wouldn't he have been showing signs of pain or discomfort earlier?

[Kathryn]

Not necessarily. When they are forcibly retracted, it causes small tears throughout the foreskin edges and also rips the skin away from the glans. Kids are pretty good at hiding pain sometimes. However, if the tears got infected, whew... that would be painful. That may be what has happened with him.

[QueenOfThePride]

When we see the pediatric urologist tomorrow, I will ask him to swab and do a culture.

Once antibiotics are started, a swab and culture is useless.

[LeosMama]

Are there any other slightly older children at the daycare? Other two-year olds might have messed with your son's penis. I've seen this happen before to a friend's child, one of the other children kept putting his hand down her son's pants and scratching and pulling at his penis, eventually causing inflammation and damage and a fungal infection. This went on for weeks with the daycare unaware, only the ds telling us "Joseph did it" and then the mother and I 'spying' on Joseph (only 3 years old, not a bad boy, just makes you wonder) discovered it.

[morning glory]

Are there any other slightly older children at the daycare? Other two-year olds might have messed with your son's penis. I've seen this happen before to a friend's child, one of the other children kept putting his hand down her son's pants and scratching and pulling at his penis, eventually causing inflammation and damage and a fungal infection. This went on for weeks with the daycare unaware, only the ds telling us "Joseph did it" and then the mother and I 'spying' on Joseph (only 3 years old, not a bad boy, just makes you wonder) discovered it.

It does make you wonder...and it makes me wonder what the heck was the staff doing that they failed to notice this? What else do they not notice? Scary.

In terms of the op though I would be wondering about potential sources of trauma that may have brought this on. Its so frustrating when they are too young to just tell you what is going on.

Casey

[Frankly Speaking]

I want to thank every one for doing most of my post for me!

Mom2evan, you did an admirable job! You've been reading and it sunk in. Just imagine how many boys you've protected just by that one simple action! You're my hero!

Yes, the urologist should have done a culture. A culture is one of the most basic diagnostic tools and should have always be done in a case of suspected infection. The urologist was just taking a short cut in caring for your son.

Now, for the problem . . . Yes, it could be a case of your son being forcibly retracted. There is no way of ruling that out unless you poll every employee at day care. But from what you describe, I suspect a case of simple separation trauma. Read the sticky at the top of the forum titled "Red, Swollen or Inflamed Foreskin?" and I think you may find the answer. These cases come on very quickly, can result in considerable inflamation and swelling and are always suspected of being an infection. They also subside very quickly with no treatment at all. Usually within 24 hours, all or most of the symptoms are gone and within another 12 - 24 hours everything is back to normal. The thing that usually happens is that the child is rushed to the doctor, an antibiotic is prescribed and the next day, the antibiotic is given credit instead of the child's own healing powers. It also starts another story of a problematic foreskin that got an awful infection when there was no infection at all.


Frank

[mom2evan]

Frankly Speaking - DS does look almost back to normal today, and we are feeling a bit foolish for rushing him to the ER two nights ago. My DH admits he may have overreacted because of the location of the trauma! I wish I had read more of these threads before our trip to the ER. I do NOT credit the antibiotics. :

I will go back to the sticky and reread it, but what do you mean by simple separation trauma? Is it something that happens as part of the process of natural retraction?

Thank you all again for the support and information. There's always more to learn!

[Frankly Speaking]

Originally Posted by mom2evan

I will go back to the sticky and reread it, but what do you mean by simple separation trauma? Is it something that happens as part of the process of natural retraction?

Yes, exactly. The foreskin is bonded to the glans at birth in almost all boys just as the fingernails are bonded to the nail beds. As the time for retraction begins to approach, these bonds will begin to disolve. But, it is not an even process and there will be spots that are attached with loose areas all around them. When the child has erections or when he is playing and pulling on his penis, it will cause slight microscopic tears in the foreskin or glans and because it is such a sensitive area, it responds very noticeably with redness and swelling just as your son had. This is fairly common and we've had dozens and dozens of reports of it here and that's why I'm so familiar with it.

Unfortunately, the vast majority of doctors don't see enough intact boys to have much experience with this and so they automatically diagnose infection. Without a culture to back up that visual diagnosis and without the experience, often these boys get unnecessary antibiotics or even worse, a circumcision that is totally unnecessary.

Don't worry about the over reaction. Our culture has taught us that the foreskin is an infection waiting to happen and that is a hard thing to erase from our minds. The medical profession has also taught us that circumcision is the cure for all ills when it actually cures nothing. The medical profession has also denied themselves the opportunity to gain valuable experience with their blood thirsty zeal to perform procedures and their mostly lacking ability to use common reason and logic. We are all going through a re-education process. We are rebuilding the base of knowledge that has been lost over the past 130 years. When your son's son has a problem like this, you will be the calm and reasonable grandmother that says "Wait until tomorrow to take him to the doctor. It'll probably pass in a day or so." You'll be so smug in your hard earned knowledge!



Frank