Have Pediatric Questions? Ask a Pediatrician.
I'm happy that you have asked me to assist you with your child and hope that you can benefit from my many years of helping parents like you.
First, Merry Christmas and this is I'm sure not what you were planning this morning!
Definitely not what I was planning :) Merry Christmas to you too.
At his age the foreskin should retract completely and if it won't then that is the reason it is red and swollen today. Secretions accumulate normally under the foreskin as a protective mechanism to keep it from completely sticking to the head of the penis. Occasionally these secretions, if not washed off and with normal boys' hygiene, the head of the penis and foreskin can become a bit inflamed with a superficial infection.
You don't need to take him in today for sure as long as he can urinate fine and is not in a lot of pain. Wash off the head of his penis with the foreskin retracted as far as it can go and then just apply whatever antibacterial cream or ointment you have on hand: Neosporin, Triple antibiotic, etc..
This will help with the inflammation for now and then he just needs to gradually keep retracting the foreskin more and more, and it will be a bit uncomfortable, until it fully retracts behind the corona, or darker rim at the base of the head of his penis.
When I see kids in the office with this I treat them pretty much like I do an ingrown toenail. Yes it will be a bit painful, but a quick retraction of the foreskin, tearing the adhesions, will fix the problem, just as I do cutting the ingrown nail out with a sharp scissor. It hurts a bit but until you or he pulls it back it will continue to be inflamed.
You can do the slow and less painful route as described above with just soaking in a tub, retracting it more and more, and applying the cream/ointment over a few days but it's kind of like that bandaid that is stuck - one quick swipe and it is over, though it will hurt a bit and may also bleed for a day or so.
I've also read that if the foreskin is too tight it can get caught behind the glans. Is this a risk? Also read that cortisone creams can help ease the retraction and that this full retraction occasionally doesn't happen until puberty and that forcing it can cause more damage.Of course I don't believe everything I read, this is why I wanted a professional opinion.
If the foreskin has retracted completely in the past then I'm sure it won't take much to fix this. On the other hand, if it has never fully retracted then it may take more aggressive measures.
It will not get stuck completely if after retracting it you apply the cream and then pull it back over the head again.
It will heal just fine but should be fully retractable by 5 years of age.
It has never fully retracted. Only ever been able to reveal the tip of the glans.
I've done this many times and it always heals, but I've made plenty of little boys upset with me in the process. I just tell them to be diligent about retracting and cleaning it every time they shower or bathe and it won't do that again.
Thank you! Happy holidays.