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Are you worried that your son's foreskin is ballooning when he tries to pass urine? Well you're in the right place! In this post I will teach you about what ballooning means and how nearly all boy's foreskins will become retractable over time. Almost every boy is born with a foreskin that is non-retractile (physiological phimosis). It is normal, in young boys, for the inner surface of the foreskin to adhere to the head of the penis (the glans). The foreskin gradually becomes retractable due to a combination of intermittent erections (common in boys of all ages), and toughening (or keratinization) of the inner surface. Only 1% of 16-year-old boys will have non-retractile foreskins, compared with 10% at 3 years of age. Ballooning is one of the most common causes of worry for the parents that bring their boy's to see me in the clinic. In fact ballooning is another way that the foreskin becomes retractable - as it helps to loosen the adherent bits between the inner surface of the foreskin and the glans. As the foreskin becomes more retractable ballooning will settle. Is there anything that I can do to help my son's foreskin become retractable? I would not recommend that you try to pull your son's foreskin back for him. It is important to know that forceful retractions cause micro-tears and scarring that can actually make your son's phimosis (tight foreskin) even worse. Once your son is old enough to understand the principles (my two son's were about 4 or 5 before they were ready) he should be instructed how to gently retract his own foreskin. It is also really important to try to keep the inner surface of the foreskin as clean and dry as possible. This is easier said than done for a boy with a very tight foreskin. I suggest to all the boys that come to see me that they run the bath just before bedtime, do a wee and then clean the foreskin with soap and water in the bath just before bed. This ensures that the inner surface of the foreskin is clean and dry every night and will reduce the risk of infection or inflammation (such as balanitis). Is there any cream or other treatment available for my son's phimosis? Applying steroid cream to the inner prepuce twice daily for 6 weeks can help soften the skin and give your son the best chance of being able to retract his own foreskin. Using steroid cream for longer periods is not recommended as it then weakens the skin causing cracking and bleeding. What about surgery to treat my son's phimosis? Thankfully this is not commonly required. If there is white scarring of the prepuce then your son most likely has BXO and this requires a circumcision. If there is no BXO but he is either having painful erections, recurring balanitis or urinary tract infections then either a preputioplasty (procedure to widen the foreskin) or a circumcision can be considered. For more information on the procedures click here. If you think your son might need my help why not get in touch: you can email me directly at info@mrbrianmaccormack.com or simply call 02890667878 to book an appointment Until next time, take care of yourself and of your family. Best wishes

Are you worried that your child might need endoscopy? Well….you’re in the right place! In this post I'm going to teach you what this means for your child, and how someone like me can sort it out for them. Upper gastrointestinal endoscopy (or OGD) is a way for me to assess the food-pipe, stomach, and first part of the small intestine in your child. It is useful for diagnosing conditions such as gastro-oesophageal reflux, inflammation (such as in allergic conditions like eosinophilic oesophagitis), Crohn’s disease, and Coeliac disease. If your child is having endoscopy to confirm Coeliac disease they should have at least 4-6 weeks of a gluten-rich diet (ideally to the point where their symptoms are becoming difficult to tolerate) prior to the procedure, as this will massively increase our chance of making the diagnosis on biopsy. I perform this procedure under general anaesthetic and it usually takes me around 10 minutes to complete. During the procedure I will pass a flexible telescope via your child’s mouth – let me know if they have any wobbly teeth! During the procedure I can take tiny samples (or biopsies) of the lining of the gastrointestinal tract and can also take pictures and video to help discuss your child’s condition with you afterwards. Like in any operation there are small risks such as bleeding – but thankfully this is extremely rare and tends to settle on its own. Sometimes your child may have a sore throat or feel slightly bloated after the procedure. What I worry about is making a hole or a perforation. If your child develops severe abdominal pain, chest pain, breathlessness or temperatures after the procedure this is NOT normal and you should bring them to A&E immediately. This is vanishingly rare (about 1:2000). Following the procedure, I would expect your child to eat and drink and go home the same day. I will write to you as soon as I receive the results of the biopsies and let you know what else needs to be done based on these results. So, if you think your child might need endoscopy – why not get in touch? You can email me directly at info@mrbrianmaccormack.com or call 028 9066 7878 to book an appointment Until next time, take care of yourself and your family. Procedure information leaflet

Are you worried that your child has a tongue-tie? Well….you’re in the right place! In this post I'll to teach you what this means for your child, and how someone like me can fix it for them. As your child developed in the womb their tongue separates from the floor of their mouth. A tongue-tie occurs when this process doesn’t occur properly. Tongue-ties can be quite variable – some are really flimsy, while others can be quite thick. As children get older some tongue-ties can tear on the lower teeth when the child chews on something. If the tongue-tie is causing feeding problems (particularly in breast feeding babies – painful nipples, poor latch, poor weight gain), then dividing the tongue-tie is the only effective treatment. Tongue-ties can cause problems with oral hygiene or make it uncomfortable for a child to stick out their tongue. The effects of tongue-ties and their division on speech is a controversial area. Some tongue-ties can cause problems with making front of mouth sounds such as ‘l’, ‘t’, ‘th’, and ‘s’. Additionally, the clicking sounds used in some African languages need the tongue to be extremely mobile. However, tongue-tie division can never be completely guaranteed to prevent your child from developing a speech problem or to improve an existing one. If your child has a tongue-tie and is less than 3-months of age, then I can release the tongue-tie in the clinic without the need for a general anaesthetic. The procedure takes just a few seconds and involves me wrapping them up tightly in a blanket, elevating the tongue with my finger and carefully releasing the tethering with a pair of sterile scissors. Although some babies cry, others can remain asleep throughout. The short moment of discomfort is worth it to avoid the risks of a general anaesthetic and to improve your child’s feeding. You should feed your child immediately following the procedure. I will then check the area following the feed to ensure there is no bleeding. If your child is older than 3-months of age then they will have head-control that is too good to safely have the procedure performed in the clinic. In this case I will perform the procedure on my next available list under general anaesthetic. For particularly thick or fleshy tongue-ties in older children I can also use electrocautery to more safely perform the procedure. Like in any operation there are small risks such as bleeding or infection – but thankfully these are often straightforward to treat. Following the procedure, I would expect your child to be feeding straight away and to go home the same day. So, if you’re worried that your child has a tongue-tie – why not get in touch? You can email me directly at info@mrbrianmaccormack.com or call 028 9066 7878 to book an appointment Until next time, take care of yourself and your family. Best wishes. Procedure information leaflet

Are you worried about a lump that your child has developed? Well….you’re in the right place! In this post I’m going to teach you what this means for your child, and how someone like me can fix it for them. Children develop a wide variety of lumps and bumps and these can often cause a great deal of concern for families. Thankfully most lumps in children are entirely benign, but it is worth taking all of them seriously because sadly children can very occasionally develop more sinister tumours. I take each child’s lump on its merits and can usually make a diagnosis at the first clinical assessment. Occasionally further investigations such as scans are required. Sometimes I will need to remove your child’s lump to confirm the diagnosis – or even when the diagnosis is not in question but to prevent any future complications (such as bleeding, infection, or the lesion just getting bigger). I perform the procedure under general anaesthetic and for most lumps it takes less than 1 hour to complete. I give local anaesthetic to the area before the end of the procedure so that the area is nice and numb when your child awakes. All of the stitches that I place are dissolving and buried under the skin. I also use special skin glue to protect the wound following the procedure. I send the lump off to the lab for confirmation of the diagnosis and will write to you immediately as soon as I have the results. Like in any operation there are small risks such as bleeding or infection – but thankfully these are often straightforward to treat. In some circumstance’s lumps can reform after they are removed – but thankfully this is vanishingly rare. Following the procedure, I would expect your child to be able to go home the same day. Once the wound is healed I would recommend rubbing in bio-oil on a daily basis and avoiding sunburn as this can really help improve the overall appearance of the scar in the long-term. So, if you’re child has a lump – why not get in touch? You can email me directly at info@mrbrianmaccormack.com or call 028 9066 7878 to book an appointment Until next time, take care of yourself and your family. Best wishes.

Are you worried that your son’s scrotum is very swollen? Well….you’re in the right place! In this post I’m going to teach you what this means for your son, and how someone like me can fix it for them. All boys have a connection between the tummy cavity and the scrotum before birth. This normally closes before or shortly after birth in most boys. When the connection stays open fluid from inside the tummy cavity can track down and collect around the testicle. This is called a communicating hydrocoele. It is vital that a doctor examines your son carefully to ensure that the underlying testicle is normal as very rarely an abnormal testicle can actually cause fluid to collect around it. Thankfully most communicating hydrocoeles will get better without surgery. If your son’s hydrocoele is still present at age 3 then it is unlikely to go away and more often than not will just get bigger over time. I perform a hydrocoele repair under general anaesthetic and it usually takes me about 20 minutes to complete. During the procedure I will tie off the connection in the groin and also release any remaining fluid from around the testicle. All of the stitches are dissolving and under the skin and I use special skin glue to protect the wound afterwards. There are of course small risks such as bleeding and infection that can happen in any operation and are usually straightforward to sort out. The things I worry about would be damage to the sperm tube or the blood supply to the testicle. Thankfully this only occurs in less than 1% of boys. Following your son’s procedure, he should be able to go home the same day and be back to his normal activities within a few days. Once the scar is well healed I would recommend rubbing in bio-oil on a daily basis and avoiding sunburn as this can really help improve the overall appearance of the scar in the long-term. So, if your worried that your son has a hydrocoele – why not get in touch: You can email me directly at info@mrbrianmaccormack.com or call 028 9066 7878 to book an appointment Until next time, take care of yourself and your family. Best wishes. Procedure information leaflet

Are you worried that your son needs a circumcision? Well….you’re in the right place! In this post I’m going to teach you what this means for your son, and how someone like me can fix it for them. Circumcision is a procedure performed to remove a boy’s foreskin. I recommend this procedure for boys who have a scarred foreskin – a condition called BXO. Most boys have a tight foreskin in early childhood. This is called a physiological phimosis and can persist into late childhood in some boys. A persisting non-retractile foreskin can often be treated successfully with a bit of effort from your son with regards to gentle retraction every time he passes urine and sometimes with the help of a 6-week course of topical steroid cream. If there is no sign of BXO or scarring, and your son is motivated enough, another option is to widen the foreskin in a procedure called a preputioplasty. I perform a preputioplasty under general anaesthetic and it usually takes me about 20 minutes to complete. I make a single incision to release the tight ring of tissue that prevents your son’s foreskin from coming back. I then close this with dissolving stitches in a way that allows the foreskin to be easily pulled back. Topical anti-bacterial cream is applied to the area twice daily for 1 week. For the preputioplasty to be successful your son needs to start retracting the foreskin 48 hours after the procedure and this can often be a little uncomfortable. If there is BXO or we decide that a preputioplasty is not suitable for your son then I would perform a circumcision. Again, I perform this procedure under general anaesthetic and place dissolving stitches to close. I prescribe anti-bacterial cream to be applied to the wound twice daily for 1 week following the procedure. Like in any operation there are small risk such as bleeding or infection – but thankfully these are often straightforward to treat. Very occasionally the penis can be injured or the procedure need be revised due to cosmetic reasons – this is extremely rare. Lastly when a circumcision is performed (especially for BXO) the pee-hole can occasionally narrow down making it difficult for your son to pee afterwards – this is called meatal stenosis, and again is very rare. After the procedure I would expect your son to go home the same day and be back to his normal activities within 5-7 days. For more information about the procedures click here. So, if your worried that your son needs a circumcision or a preputioplasty – why not get in touch: You can email me directly at info@mrbrianmaccormack.com or call 028 9066 7878 to book an appointment Until next time, take care of yourself and your family. Best wishes. Procedure information leaflet - Circumcision

Are you worried that your child has ingrown toenails? Well….you’re in the right place! In this post I’m going to teach you what this means for your child, and how someone like me can fix it for them. Children get ingrown toenails when the nail (usually on the big toe) grows into the skin around it. This often causes pain and recurrent infections. The most common cause of ingrown toenails is that the nails have been cut too short and especially that they have been cut back in the corners. This is usually done to try and stop IGTN but the problem is that this practice actually encourages the nail to grow further into the surrounding skin making the whole thing worse. Thankfully most cases of IGTN can be successfully managed by cutting the nail straight across rather than rounding off the edges. I would encourage your child to wear shoes that don’t constrict their toes and allow their feet to breathe. Getting them out of their school shoes and into the habit of washing their feed as soon as they get home each day is also really helpful. If your child’s IGTNs are not settling you need someone like me to fix it for them. For most children I perform the procedure under general anaesthetic and it usually takes about 10 minutes to complete. The most common procedure that I perform for IGTN involves me removing a small wedge of the nail on the affected side and then using a chemical called phenol to stop it from growing back again. This will leave your child with a slightly narrower nail but should sort the problem for them. Like in any operation there are small risks such as bleeding or infection – but thankfully these are often straightforward to treat. Very occasionally the IGTN can occur again after the procedure, in which case we can discuss a variety of different procedures to treat particularly stubborn IGTN – this is exceedingly rare. At the end of the procedure I dress the toe with non-stick gauze, bandage and Elastoplast. I would recommend that they bring some open-ended sandals / sliders to make it easier to get home following the procedure. 48 hours later the bandage and dressings should be removed and can often be replaced with a simple plaster. Regular bathing of the area and letting the air at it helps to improve the healing process. So, if your worried about your child’s IGTN – why not get in touch? You can email me directly at info@mrbrianmaccormack.com or call 028 9066 7878 to book an appointment Until next time, take care of yourself and your family. Best wishes. Procedure information leaflet

Are you worried that your son’s testicle is not where it should be? Well….you’re in the right place! In this post I’m going to teach you what this means for your son, and how someone like me can fix it for them. The testicle develops inside the tummy cavity and usually makes it’s way down through the groin and into the scrotum by about 35 weeks of pregnancy. If your son’s testicle is not in the scrotum by 6 months of age then he needs a procedure called an orchidopexy, because it’s not going to come down on its own at that stage. Performing the orchidopexy by 18 months of age preserves your son’s fertility potential. It is also vital that your son can easily examine his own testis in adulthood so that he can identify any potential problems such as testicular cancer. I perform the orchidopexy procedure under general anaesthetic and it usually takes me around 40 minutes to complete. During the procedure small openings are made in the groin and scrotum to allow me to safely bring the testicle down. All of the stitches are dissolving and under the skin and I also use special skin glue to protect the wounds afterwards. There are of course small risks such as bleeding and infection that can happen in any operation and are usually straightforward to sort out. The things I worry about would be damage to the sperm tube, the testicle shrinking or going back up towards the groin after the procedure. Thankfully this only occurs in about 1-2% of boys. Following your child’s procedure, they should be able to go home the same day and be back to their normal activities within 5-7 days. I would recommend that your son avoids sitting astride things like a bicycle seat for at least two weeks following the procedure. I like to see them back 6 month’s following the procedure to check that the testicle has survived the journey and that it has stayed down where I left it at the end of the procedure. So, if your worried that your son’s testicle isn’t down where it should be – why not get in touch: you can email me directly at info@mrbrianmaccormack.com or simply call 028 9066 7878 to book an appointment Until next time, take care of yourself and your family. Best wishes. Procedure information leaflet

Does your child have a lump at their belly button that comes and goes? Then you’re in the right place! In this post I’m going to teach what this means for your child and how someone like me can fix this for them. If your child has a lump at their belly button that comes and goes they most likely have an umbilical hernia. This is where the stuff inside the tummy cavity pushes out into the belly button through a small weakness in the tummy wall. Thankfully most of these hernias will get better without surgery by the time a child reaches age 3. If your child’s belly button hernia is still visible at this age then they usually need someone like me to fix it for them as it is unlikely that it will go away by itself. Although belly button hernias very rarely get stuck out (less than 3 in 1000) in childhood complications are more likely in adulthood. I repair belly button hernias through a small opening within the natural skin crease just below the belly button. The procedure is performed under general anaesthetic and usually takes me around 30 minutes to complete. All of the stitches are dissolving and under the skin and I also use special skin glue to protect the wound afterwards. I also place a small pressure dressing over the area to reduce the risk of fluid collecting under the skin. There are of course small risks such as bleeding and infection that can happen in any operation and are often easy to sort out. If the intestines beneath the defect were injured during the procedure you would identify this in the first few days following the procedure – so if your child looked unwell, with temperatures, abdominal pain or vomiting you should bring them immediately to the accident and emergency department. Thankfully this is extremely rare. Following your child’s procedure, they should be able to go home the same day and be back to their normal activities within a number of days. The pressure dressing can be removed at home or with the community nurse 48 hours after the procedure. Once the scar is healed I would recommend rubbing in bio-oil on a daily basis and avoiding sunburn as this can really help improve the appearance of scar in the long term. So, if your child has a lump at their belly button – why not get in touch: You can email me directly at info@mrbrianmaccormack.com or simply call 028 9066 7878 to book an appointment Until next time, take care of yourself and your family. Best wishes. Procedure information leaflet

Has your child got a lump in the groin that comes and goes? Well they probably have an inguinal hernia. I'm going to tell you what this means for your child and how I can fix it for them. If your child has a lump in their groin that comes and goes they most likely have an inguinal hernia. This is where the stuff inside the tummy cavity pushes down towards the scrotum in boys, or the labia in girls. The problem is that their hernia won’t better without surgery and sometimes it can come out and get stuck! This is an emergency because the bowel, testicle or ovary can be damaged very quickly. So in a stuck hernia the lump stays out, gets painful, red, or causes your child to vomit. If any of these things are happening to your child you should bring them to A&E immediately. Thankfully this is not common. I repair inguinal hernias through a small opening in the groin. The procedure is performed under general anaesthetic and usually takes me around 30 minutes to complete. All of the stitches are dissolving and under the skin and I also use special skin glue to protect the wound afterwards. There are of course small risks such as bleeding and infection that can happen in any operation. Damage to the sperm tube, the blood supply to the testicle, or to the bowel or nerves is thankfully extremely rare. After the procedure the testicle can be pulled up towards the groin or the hernia can very occasionally come back. Lastly, watch out for a hernia on the other side (occurs in <5% of children who are born at full-term). Following your child’s procedure, they should be able to go home the same day and be back to their normal activities within a number of days. Once the scar is healed I would recommend rubbing in bio-oil on a daily basis and avoiding sunburn as this can really help improve the appearance of scar in the long term. So, if you’re worried that your child has an inguinal hernia – why not get in touch: You can email me directly at info@mrbrianmaccormack.com or call 028 9066 7878 to book an appointment Until next time, take care of yourself and your family. Best wishes. Procedure information leaflet

Children swallow all sorts of things that I have to retrieve as an emergency procedure. The scariest for me as a Consultant Paediatric Surgeon is the big powerful lithium-ion button battery. That is because if one of these batteries gets stuck in a child's food pipe it can cause catastrophic internal bleeding or even death. Tragically at least 2 children die every year from swallowing a button battery. Help me spread the word about the risks by sharing this post. It is really important that we keep objects that contain button batteries out of reach of our children and that you act quickly if you think your child may have swallowed one. This video shows the deadly button battery at work: This video show the tragedy that button batteries can cause: More information Learn more about the risks of button batteries. Know about where children can find button batteries. Understand why flat batteries are still dangerous. Download top tips about how to protect your children from button batteries. Find out what to do in an emergency if you think your child has swallowed a button battery.

Traditionally it was up to doctors to decide what risks needed to be communicated to parents and patients. Following the Montgomery court ruling this has thankfully changed. Now doctors must ensure that patients are informed of all risks that would be considered materially significant by an individual patient, not just a doctor. Patients and parents must also be given enough time to make informed decisions about their treatment. Mr MacCormack will be leading the way with a fully digital consent solution for children in Northern Ireland. By partnering with EIDO we will be offering a reliable, paperless, data secure consent process. The entire consent process is accessible from home on any device and is completed before the day of surgery. Digital information leaflets and a clear explanation of the risks and benefits allow you to make fully informed decisions about your child's care. On the day of your child's procedure you confirm your consent by simply signing on our iPad. This allows you to focus on your child on their big day. Join us in leading the way with digital consent for children in Northern Ireland.