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What

Nerve cells (ganglion cells) are missing from the end of the bowel, always starting at the rectum and extending upwards. That segment can't relax, so it acts like a blockage.

Who

About 1 in 5,000 babies. Boys are affected about 4 times more often. About 1 in 10 have Down syndrome.

Spot it

Delay in passing meconium beyond 24 to 48 hours, a swollen tummy and green vomiting. Older children may have severe constipation.

Test

Rectal suction biopsy showing absent ganglion cells.

Treatment

A “pull-through” operation removes the affected bowel and joins healthy bowel to the anus.

Watch out

Hirschsprung-associated enterocolitis is a dangerous complication, before or after surgery.

Source: Patient.info Professional

Gastroschisis

A defect to the right of the umbilical cord, with bowel outside the body and no covering sac. More common in young mothers. Usually an isolated problem, though about 1 in 10 have intestinal atresia.

Exomphalos

A central defect at the umbilicus, with contents covered by a membrane sac. Often associated with other anomalies, including heart defects, trisomy 13, 18 or 21 and Beckwith-Wiedemann syndrome.

Found

Both are usually picked up on the antenatal scan.

Treatment

In gastroschisis the bowel is returned straight away, or gradually using a silo. A small exomphalos is closed early; a giant one may be painted and left to skin over, with closure later.

Source: Radiopaedia: gastroschisis · Radiopaedia: omphalocele

What

A hole in the diaphragm, usually on the left, lets bowel and other organs move up into the chest. The lungs don't develop properly (pulmonary hypoplasia), and pulmonary hypertension is common.

Who

About 1 in 3,000 babies. Around 6 in 10 are picked up before birth.

Spot it

Breathing difficulty at birth, a sunken (scaphoid) abdomen and bowel sounds heard in the chest.

First steps

Avoid bag-and-mask breathing, which inflates the bowel in the chest. Intubate and pass a tube into the stomach to decompress it.

Treatment

The hernia is repaired once the baby is stable. In severe cases, a balloon can be placed in the baby's trachea (windpipe) before birth (FETO) to help the lungs grow.

Source: Radiopaedia · BAPS on FETO

What

The oesophagus ends in a blind pouch, so milk can't reach the stomach. Most babies also have a tracheo-oesophageal fistula (TOF), an abnormal link between the trachea (windpipe) and the oesophagus.

Who

About 1 in 3,000 to 4,500 babies. It often comes with other anomalies (the VACTERL association).

Spot it

A frothy, drooly baby who chokes, coughs or goes blue with feeds. Before birth there may be too much amniotic fluid (polyhydramnios).

Test

A tube passed into the mouth won't go down to the stomach, and on X-ray it coils in the pouch.

Treatment

Usually surgery in the first days of life to close the fistula and join the two ends. If the gap is long, the join may have to wait.

Source: Radiopaedia

What

The most common kidney cancer in children. Also called nephroblastoma.

Who

Around 90 children a year in the UK, most often under 7.

Spot it

Often a painless lump in the tummy, found by a parent at bath time. Sometimes blood in the urine or high blood pressure.

Treatment

Chemotherapy and surgery to remove the kidney, sometimes with radiotherapy. In the UK, chemotherapy is usually given first.

Outlook

About 9 in 10 children are successfully treated.

Source: CCLG

What

Inflammation of the appendix, and one of the most common reasons for emergency surgery in children. About 10,000 children a year in England have their appendix removed.

Spot it

Pain that moves to the right lower abdomen, loss of appetite, vomiting and fever.

Under 5s

Often present atypically, and are more likely to have perforated by the time they're diagnosed.

Treatment

Appendicectomy, now most often done by keyhole surgery in England (about 8 in 10).

Source: GIRFT