Parents' health queries answered by Dr Zak

I am very grateful to three parents who wrote in with questions regarding their children. My advice is given in good faith and reflects current approved guidelines. However, it cannot be a substitute for consulting your own routine GP.

I have noticed that my two-year-old boy’s foreskin doesn’t pull back. I hadn’t really given it much thought but now I am worried I am not cleaning him properly. What should I do? – Sally

It is normal for a boy’s foreskin to not fully pull back until they are much older. When bathing your son all you need to do is gently wash the area. At this age the chances of infection are limited. Smegma, the whitish material produced under the foreskin, and which may cause infection if not removed, starts being produced around puberty.

You should never try to pull the foreskin back as it may cause pain, and in the worst-case scenario, actually tear.

A tight foreskin only usually causes problems in a boy if there are recurrent infections in the area or the stream of urine is interrupted. This would be noticed if the foreskin balloons when passing water, or urine sprays. Very rarely the foreskin is that tight that urine cannot flow out properly. This may be noticed as recurrent urine infections.

These may be a reason for circumcision. However, in the majority of cases, the foreskin becomes looser and easy to move back and forward without any issue as the child moves toward puberty.

Do I need to have my baby daughter immunised? This is our second child. With our first I was a new mum and a bit overwhelmed. I don’t think I gave it a thought, and just went along with what I was told. - Noreen

It is entirely normal to question any treatment for ourselves and our children when they are not old enough to advocate for themselves. Even before the pandemic and the role out of the Covid vaccinations, there were an increasing number of parents asking questions about the routine childhood vaccination programme and indeed vaccines in general.

While this is a contentious issue, two things can be said. The childhood vaccination programme has been around for many years, and safety of vaccinations has been well established. It has been observed that when the uptake of childhood vaccinations is low, there is an increase of childhood diseases which the vaccinations prevent. Perhaps the most notable of these is measles. And while for many it may be a mild viral illness, some children with measles will suffer long lasting repercussions including permanent damage to hearing or the nervous system. Arguably because of the success of the vaccination programme, these diseases are not seen as often, so there is less awareness of their potentially devastating effects. I would always advise any parent to have their child immunised, unless they have been specifically advised not to by a senior healthcare professional.

My two-year-old has just started at nursery and seems to have a cough and cold all the time. He’s got a permanent runny nose. I’ve had him back to the GP’s more times than I care to remember. I’m worried there is something going on. – Jacci.

It is normal for young children to pick up viral infections from close contact with other children at nursery, and is part of the development of their immune system.

If it feels like you are always at your GP it may be keeping a record of exactly how many times you have been. Sometimes it feels that way when you may have only attended the normal number of times a parent would be expected to bring a young child.

It would be interesting to know how many times your child has required antibiotics. If the episodes have been simple viral infections that resolve on their own, then I would be less worried.

Equally important is whether your child is well between episodes. If they return to full health, are growing normally and have achieved their developmental milestones, this is a reassuring sign.

A child who goes from one infection to another, without getting better in between, and who seems to becoming steadily more ill is a cause for concern. However, these children are usually easy to identify and can be discussed with a paediatrician and even admitted to hospital on the same day, if needed.

If you have any concerns, please do not feel afraid to voice these with your GP, so they can fully understand your fears and fully address them.

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