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AAP and gentle retraction for exam

post #1 of 10
Thread Starter 
I'm not sure how much time I'll have to post right now, but the result of my talk ***with our pedi about retraction is that he found a part of the AAP that says that doctors are supposed to gently retract to visualize the meatus-- just once is all that is necessary- so once it is done it doesn't need to be done ever again.

*** editing to add for clarity: I KNOW it is wrong and unnecessary to gently retract... but I asked him what he does during my DAUGHTERs checkup because I wanted to see if I was going to switch to him. We had a good conversation. He's very pro-intact. He was trained to do a gentle retraction yet seemed open to new info, but seemed puzzled that it was a big deal. I offered to give him info and I brought it in before our next appt. He read it and he went to the aap website he foudn somethign that indicated they still recommend a gentle retraction.
He said he only does this once, and would not do it if the parent requested him not to. He compared it to the exam he would do for a baby girl.
----

Now I know I have seen something like this before but the AAP search has changed in the last years and the new search has sucked. So he didn't save the link for me,and I can't find it. He was going to try to copy it for me at our next visit for dd in November, but I hate to wait that long.

Does anyone know what he is referring to? Can anyone find it? I have the feeling that when I saw something it was in an obscure part- either on well baby exam procedures, or in a generic section (like on penis or genitals and not specifically about intact/circ). It was not an area that a parent would normally see.

Anyways, the docor, who I like very much, said that he does just one exam and is super extremely careful about being gentle-- as per the aap. Even though he was open to the information I gave him, he still doesn't want to give up the one look rule--- I guess to make sure the meatus is properly placed. He is pro-intact, otherwise, and a very laid back doctor that actually likes to talk to parents and seems to be open-minded. I mean, he took a 4 page thing from me and actually read it and looked stuff up.

Perhaps, docs these days see more problems with the meatis (due to circumcision) they feel they need ot be more vigilant about checking it out- even on intact boys??

Anyways, I'm not sure what to do-- this doctor is likely to be the best we have around here. My son is over 1 year, so he wouldn't be doing this anyways, and he already told me that if a parent requested him not to do this, he wouldn't. But I won't be recommending him w/o an explanation in this area.

I find it hard to blame the doctor if the AAP states this. He was willing to consider that things had changed since his training.... but since he could find this info on the AAP seemed to want to stick with the way things are. Now, I cannot really blame him on that, even though I disagree with the AAP on many issues.

I so was hoping he'd come back with a different answer.

Jessica
post #2 of 10
You don't have to do it, even if the AAP says it ok (I have no idea what they say on this). The AAP also says it's ok to start solids at 4 months, but that doesn't mean you have to.

I'm curious what he expects to see with this "one look". If your son is peeing fine and his penis looks normal on the outside, surely the doc doesn't expect to find some disfiguration that would cause medical problems?

Bottom line, there's nothing to see. No reason to look. Your doc is just horribly curious, like he expects to see something strange or interesting in there. Kind of weird if you ask me.

And he CAN hurt your son just "taking a peek". Even when my almost 3 year old yanks back hard on his foreskin, I can't see the meatus. And he's yanked it hard enough to hurt himself (only once though, I guess he learned his lesson ). If some doctor pulled it back that far, I don't doubt he could tear the skin.
post #3 of 10
I read a website once-- like AAFP or something that said that. But the AAP says no retraction-- its in their baby books, its in their circ statement, its in their pamphlets, hell it was even in that disgusting article from Cookie magazine (AAP pres saying dont retract)


Tell him to SHOW it to you if he is so convinced. I'm certain it is either:

1) old
2) a different organization
3) a MEMBER of the AAP making some comment about meatus visualizing-- that is, its NOT an actual policy of the AAP
post #4 of 10
Never thought this book would come in handy but from Caring For Your Baby and Young Child- publication of the AAP:

Quote:
Intially, the foreskin is connected by tissue to the glans, or head, of the penis so you shouldn't try to retract it...This [retraction] will not be for several months to years, and should never be forced; if you were to force the foreskin to retract before it is ready, you could cause painful bleeding and tears in the skin.
page 127


ETA: one thing to wonder is, WHY does he need to visualize the meatus? To make sure it exists? If your son is peeing fine...what else does he need to know by seeing the meatus?


BY the way, the article he may have read was from a 2002 issue of contemporary pediatriacs that I see cited a lot. It recommends gentle retraction to visualize the meatus. It is NOT a publication of the AAP or part of their statements in any way. HEre is the article found on CIRP:

http://www.cirp.org/library/hygiene/camille1/
post #5 of 10
Just because (allegedly) the AAP recommends it doesn't mean you have to agree to it. If you don't feel comfortable with your doctor examining, you don't have to let him do it.

I'd ask the doctor to show you the information just out of curiosity if nothing else. I'm agreeing with the other poster that it is probably outdated, from another organization, or as a comment made in an AAP publication that isn't official AAP policy. For what it's worth, I have never seen anything from the AAP indicating that the foreskin has to be retracted at all to examine the meatus.
post #6 of 10
Other points for you to think about (and possibly make to him if you feel like it)

-visualizing the meatus would require the foreskin to be detached from the meatus...if the foreskin is adhered to the meatus, that would cause pain and bleeding

-if he is trying to visualize the urethra opening to diagnosis possible hypospadias, it would be useless because hypo that mild would not require correction (that is, no problems with the foreskin and urination is fine)
post #7 of 10
Our new pediatrician is wonderful! When she examined my 3yo, he didn't even have to disrobe, she just peeked down there to check the testes, didn't even touch his penis. I said he wasn't circumcised, and I don't want her to retract his foreskin. Ped said, "Of course not! Some boys aren't even retractable until puberty." I was so giddy and relieved to hear her use the word puberty in relation to the foreskin! LOL (And I'm in the midwest, where my town seems to have a 99% circ rate )

But then we had to see her coworker (can't remember if she was a NP or PA) for our new baby's 2 week checkup. As she was opening his diaper, I said not to retract his foreskin as she was reaching for his penis. Then, as she is slightly retracting his foreskin overhang she said, "No, I won't retract, I'm just making sure there isn't anything in there that shouldn't be." It was over in a second, before I could do or say anything. She just barely retracted the overhang, and I know she didn't hurt him, but what is with doctors who don't know that they are retracting??? : The way she phrased it - "making sure there isn't anything in there that shouldn't be" really threw me off. WTF is she looking for, broccoli?

I didn't say anything more at the time, but I will be bringing it up with the pediatrician at our next appointment.
post #8 of 10
Quote:
Originally Posted by QueenOfThePride View Post
Our new pediatrician is wonderful! When she examined my 3yo, he didn't even have to disrobe, she just peeked down there to check the testes, didn't even touch his penis. I said he wasn't circumcised, and I don't want her to retract his foreskin. Ped said, "Of course not! Some boys aren't even retractable until puberty." I was so giddy and relieved to hear her use the word puberty in relation to the foreskin! LOL (And I'm in the midwest, where my town seems to have a 99% circ rate )
Yay for that Ped!

Quote:
But then we had to see her coworker (can't remember if she was a NP or PA) for our new baby's 2 week checkup. As she was opening his diaper, I said not to retract his foreskin as she was reaching for his penis. Then, as she is slightly retracting his foreskin overhang she said, "No, I won't retract, I'm just making sure there isn't anything in there that shouldn't be." It was over in a second, before I could do or say anything. She just barely retracted the overhang, and I know she didn't hurt him, but what is with doctors who don't know that they are retracting??? :
I'm not retracting, I'm just pulling it back! Really! :

Quote:
The way she phrased it - "making sure there isn't anything in there that shouldn't be" really threw me off. WTF is she looking for, broccoli?
post #9 of 10
Talked to a ped once about this, she said it was ABSOLUTELY wrong. She said that some doctors use the "hypospadias" excuse as a reason to retract. HOWEVER, she said if the hypospadias was severe enough to warrant surgery it would be obvious as the foreskin wouldn't be properly formed. :

Your doctor need the correct information.
post #10 of 10
Thread Starter 
Sorry, I should have prefaced my post with more info on the letter I gave my pedi.
I KNOW it is wrong and unnecessary. I don't have an infant boy, I'm checking him out for referals for other parents.
He is not old, he is not creepy.... that is why I am pursueing this- I was hoping he would realize that his training was outdated. He seemed more than willing to do that, but then the current aap recommendation was conflicting.

Most doctors received bad information about circ and intactness in their training. If we immediatly write all these doctors off, we are not going to re-educate any doctors.

If the aap is saying this in a section to the doctors, then that is just one more thing we need to be aware of. We already know that many doctors regard the do not retract as advice to parents that doesn't necessarily apply to them.

And, I know I know, what the heck is he 'looking' for? I don't know, but he is adamant about the fact that he doesn't really retract, just very gently would examine.

The only other pedi that is okay around here is 40 min away-- but the office does circumcisions and I am uncomfortable with that.


Brocolli, omg!!
Jessica
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