For a lot of moms — those who have daughters, or haven’t experienced the nuances of baby boys — caring for a newborn and toddler boy’s “private area” can be a bewildering experience.
What should everything look like? Why is my son’s privates swollen? How do I clean the area?
These are commonly asked questions but topics that are not commonly discussed outside the pediatricians office.
“I remember when my son was born and worrying if everything looked normal,” recalls Elizabeth, mom of an 18-month-old toddler boy. “That area was totally foreign to me and I’m someone who is not entirely comfortable about talking about it.”
Boston Children’s Hospital urologist, Erin McNamara, MD, MPH, and several veteran moms of baby boys discuss these delicate topics and offer helpful tips to care for newborn and toddler boys.
A boy’s hands seem to be magnetically drawn to their penis. As soon as their diaper opens or once they are in “big boy pants,” they are shifting, cupping and tugging.
McNamara says tugging is a normal part of childhood development.
“Tugging can begin in boys as early as 4 to 6 months, while some boys start later in childhood,” she adds. “This happens because they are beginning to discover different parts of their body.”
For moms of toddler and older boys, the words, “hands out of your pants” are engrained in their daily dialogue.
“Both of my sons tug, and their hands are down their pants all the time,” says Laura, a mom of two sons. “My doctor told me it is very normal but suggests we talk to them about when tugging is appropriate and not appropriate.”
Although a normal activity, McNamara says it is important to monitor the timing and frequency of the tugging.
“If pulling on their penis and pain are occurring at the same time and associated with voiding [peeing) or wet diapers, your son may have a urinary tract infection (UTI) or something else may be bothering them,” she says. “It’s important to follow up with your pediatrician.”
Ups and downs of testicles
Before a baby boy is born, the testicles form in his abdomen. During the third trimester, the testicles travel from the abdomen, down the groin and into the scrotum (the sack of skin beneath the penis). An undescended testicle is a testicle that did not complete the descent process. The testicle may be located anywhere from the abdomen to the groin and may affect one or both testicles.
“It’s a normal, painless condition, and the testicle often descends naturally,” McNamara says.
If your child’s testicle does not descend on its own, your pediatric urologist will most likely recommend surgery to move it down into the scrotum around your baby’s first birthday.
Erections in babies
Newborn babies are full of surprises. And sometimes those surprises pop up when you least expect it.
“I remember being shocked when I saw my son’s little erection,” Elizabeth recalls.
“I asked my husband, ‘What is going on here?’…I was completely horrified.”
Like tugging, erections in babies are perfectly normal and a part of early development. Moms of newborns may also notice that their son’s penis and testicles are swollen or enlarged days after he is born. Not to worry. This is due to maternal birth hormones and the trauma of birth. The area typically shrinks in a few days.
“In newborns, there is a surge of testosterone that occurs in the first few months of life which may cause erections,” McNamara says. “No need to worry, it is completely normal and doesn’t cause discomfort.”
A hernia occurs when a section of intestine or other intra-abdominal structure pushes through a weakness in the abdominal muscles. A soft bulge is seen underneath the skin, where the hernia is located. Sometimes, a hernia appears in the groin area. This is called an inguinal hernia.
Kristin, a mom of two elementary school-aged boys, remembers the day she noticed her youngest son had a hernia.
“When he was a year old, I remember changing his diaper and seeing a lump,” she says. “I literally walked over to my husband and asked, ‘Does this look normal?’“
Kristin took her son to see a urologist at Boston Children’s at Waltham who confirmed he had a hernia. Soon after he was diagnosed, Kristin’s son underwent a common procedure to correct the hernia. “He did great and went home the next day,” she says.
Tips to clean
Babies are born with a sheath of skin that covers the entire head of the penis. In uncircumcised boys, the inner part of the sheath remains attached to the head of the penis, preventing foreskin retraction. In circumcised boys, the inner and outer sheath is removed.
Whether your son is circumcised or uncircumcised, cleaning the penis is an unfamiliar activity for moms.
“When I had my first son, I had no idea how to clean the penis area,” recalls Laura. “I remember he started to get a little infection, so I took him to the pediatrician and the doctor showed me how to clean the area.”
McNamara tells moms not to worry. Cleaning the area is easy and is the key to good health.
“It is important to keep the area clean to avoid irritation and infection,” she says. “During bath time, gently clean the penis with gentle soap and water.”
Specifically in circumcised boys, if you notice extra skin around the head of the penis followed by irritation and mild adhesions, McNamara suggests visiting your pediatrician or pediatric urologist to determine the cause or see if a revision is necessary.
Although some or all of these topics may make you blush, McNamara encourages parents and caregivers of baby boys to always ask questions.
“There are no stupid questions,” she says. “If you are thinking it, other parents have the same questions. Your pediatrician is a great resource and if they have any concerns, your pediatric provider will refer you to a specialist.”
Learn more about Boston Children’s Department of Urology.