What to Expect the Toddler Years (171 page)

Change diapers as soon as they become wet or soiled.

Once she’s out of diapers, dress your toddler only in all-cotton underpants to minimize perspiration and maximize ventilation in the area.

Avoid bubble baths, bath oils, perfumes, harsh soaps, and diaper wipes that contain alcohol and/or perfumes, any of which may trigger an allergic reaction or irritate or “burn” the vagina, predisposing your daughter to vaginal or urinary tract infection. After the bath, rinse your child’s body in fresh water. Rinse the vaginal area with a hand-held shower spray, a small watering can, or a dripping washcloth.

Shampoo your daughter at bath’s end so that she won’t be sitting in potentially irritating shampoo suds. Have her stand as the water drains, and rinse her hair with the shower, a hand-held shower head, or a watering can or plastic cup. Alternatively, you can shampoo her in the sink.

Vulvovaginitis/vaginitis.
What is it?
An inflammation of the vagina and/or the vulva (the external female genitalia).
Who is susceptible?
Any female, of any age.
Signs and symptoms:
Vaginal itching, a smelly vaginal discharge, and occasionally, vaginal spotting or bleeding (when the inflammation irritates the delicate vaginal lining).
Causes:
Irritation (from bath water, wet diapers, an inserted object, harsh laundry detergents or soap), which makes the lining of the vagina susceptible to a variety of infectious organisms, such as candida.
Treatment:
Medical consultation is necessary; be certain to call the same day if there is any bleeding. The doctor will probably do an examination and take a culture from the area. Depending on the findings, a topical and/or oral medication may be prescribed. If infection has been caused by a foreign body inserted into the vagina, it will be removed. The doctor should warn the child against putting anything into her vagina, or letting anyone else put something in.

Vaginal (labial) adhesions.
What is it?
A condition in which irritated labia become stuck together.
Who is susceptible?
Babies and young girls, because they do not produce estrogen.
Signs and symptoms:
The labia minor (the inner lips of the external female genitalia) adhere to one another; in severe cases, there may be difficulty urinating.
Causes:
Irritation from urine or perspiration makes the labia raw; the raw surfaces then stick together.
Treatment:
If the labia can be separated, the child is able to urinate, and there is no pain involved, adhesions aren’t a cause for concern; nevertheless, the doctor will probably prescribe an estrogen cream to promote healing of the labia. In stubborn cases, the cream may have to be applied over a period of time and the labia separated only gradually. Occasionally, the labia must be separated by the doctor with a special instrument. Treatment is important since an inability to urinate or a pooling of urine under the labia could lead to an increase in urinary tract infections (see page 613). Some girls continue to develop adhesions until puberty, when estrogen production starts up.
Prevention:
Keep the vaginal area dry; don’t allow a toddler in diapers to stay wet for long; avoid synthetic underwear and pants to help prevent recurrence.

The circumcised penis.
Routine washing with soap and water is the only care a circumcised penis requires.

The uncircumcised penis.
No special care is required for the uncircumcised penis, either. It’s not only unnecessary but potentially harmful to try to forcibly retract the foreskin or to try to clean under it with cotton swabs, water, or antiseptics. Don’t worry about what looks like a cheesy material under the foreskin; this is the normal residue of cells shed as the foreskin and glans begin to separate. These cells gradually work their way out via the tip of the foreskin on their own, and continue to be shed throughout life.

Undescended testicles
(cryptorchidism).
What is it?
A condition in which one testicle (or sometimes both) has not descended down into the scrotum.
Who is susceptible?
Most often, boys who were born prematurely, but the condition can also occur in full-term infants.
Signs and symptoms:
One testicle (or both, in 10% to 30% of cases) cannot be felt in the boy’s scrotum; if it has not descended by the child’s first birthday, it generally does not do so on its own. The right testicle is more often affected. Most frequently the undescended organ is in the inguinal canal that leads to the scrotum (
see illustration
); but it may also lie elsewhere, just above the scrotum, for example, or higher up, in the abdomen. In
about 10% of cases, the testicle is completely absent.
Causes:
Hormonal reasons or a physical blockage, such as an inguinal hernia, explain some cases of undescended testicles, but the cause of other cases is unknown.
Treatment:
On examination, the doctor will try to manipulate an undescended testicle down into the scrotum. If this is not possible, and if the parent reports never having seen the testicle in the scrotum, treatment is generally initiated sometime after the first birthday (early treatment appears to be more effective and less traumatic). Treatment is usually a trial of human chorionic gonadotropin (hCG), which is injected, normally two or three times a week for three weeks, followed by testing to check hormone levels. If the hCG does not induce the descent of the testicle (or testicles), surgery (called orchiopexy) to move the testicle into the scrotum is generally recommended. Orchiopexy is performed sooner rather than later because testicles tend to deteriorate when not descended, increasing the potential for future infertility problems. In some cases, surgery is performed without a trial of hCG. It is believed that hormonal or surgical treatment early in childhood can reduce the likelihood of adult infertility.

Most often, an undescended testicle remains in the inguinal canal, though other locations are also possible.

Note:
If a child with an undescended testicle complains of groin pain, call his doctor immediately. It’s possible that the testicle has become twisted, cutting off its blood supply. If left untreated, the organ may be damaged permanently.

Meatal stenosis.
What is it?
A condition in which the urinary flow is blocked or impeded.
Who is susceptible?
Any young boy, but the condition is more common in boys who are circumcised.
Signs and symptoms:
A narrow urinary stream, difficulty urinating, slow or dribbling urination, and occasionally, repeated urinary tract infections (see page 613).
Causes:
Irritation of the tip of the penis causes the development of scar tissue around the meatus (the opening to the male urethra). The scar tissue reduces the size of the opening.
Treatment:
If the doctor determines that treatment is needed, minor surgery can correct the problem. A general anesthetic may be required for the brief procedure, but the discomfort that follows will disappear fairly quickly.
Prevention:
Avoiding rough under-clothes, harsh laundry detergents, prolonged wetness from unchanged diapers or clothing, or anything else that could, over a period of time, irritate the meatus and lead to scarring.

Bathing suits in January. Snowsuits in July. Sweaters put on backwards. Shoes put on the wrong feet. Once a toddler starts getting into the dressing act, the fashion faux pas are as inevitable as the wails of “I wanna pick it myself.” Still, self-dressing is an important part of your toddler’s growing up, and involving your toddler in the process is an important part of your letting go. And it is possible to invite that involvement while keeping the fashion police at bay (at least, most of the time). See page 279 for dealing with dressing dilemmas.

After dressing ourselves for two or three decades, we grown-ups tend to take the mechanics of putting on clothes for granted. For toddlers, however, even the simplest aspects of self-dressing can present a challenge. Help yours meet that challenge with some practical dressing tricks:

Set the front and back apart.
Your toddler will have less trouble differentiating the front of garments from the back if outfits have designs only on the front. When they don’t, teach your toddler to look for the label, which almost always is in the back of a garment. Garments that don’t have labels in the back can be marked with a laundry pen on the inside (if you mark the back with a “B,” your toddler will get a headstart on learning the alphabet). Boys have an easier time with underwear, since briefs and shorts come with a distinctive front; for girls, panties with a design or bow in the front will make their task simpler.