Optimal Times for Surgery/Intervention in Early Children’s Disorders

Squint (fixed or alternating)

• 12–24 mths

• absolutely before 7 yrs

Deafness (children are born with hearing)

• screen at or before 8 mths

• hearing aids required by 12 mths

Tongue tie: either in first 4 mths when avascular or later at 2–6 yrs

Ear deformity: after 6 yrs

Cleft lip: <3 mths

Cleft palate: 6–12 mths

Undescended testis

• best assessed before 6 mths

• surgery best 6–12 mths. Don’t leave >12 mths.

Umbilical hernia

• leave to 4 yrs

• surgery at 4 yrs if persistent (tend to strangulate after 4)

• never tape down!

Para-umbilical hernia: any age; best after 6 mths

Epigastric hernia: any age; best after 6 mths

Inguinal hernia

• general rule is ASAP, esp. infants and irreducible ones

• reducible herniae: the ‘6–2’ rule:

  • – birth–6 wks > surgery within 2 d

  • – 6 wks–6 mths > surgery within 2 wks

  • – over 6 mths > surgery within 2 mths

Femoral hernia: ASAP

Torsion of testicle: surgery within 4 h (absolutely within 6 h)

Hydrocele: leave to 12 mths then review (often resolve—if not, repair by 2 yrs)

Varicocele: leave and review

Macromastia: late adolescence when breast growth is complete