Introduction
This table summarises the main clinical situations that prompt referral to pediatric surgery, organised by anatomical area and indicating the ideal age for referral.
Head
For dermoid cysts at the eyebrow tail, correction is usually elective, and referral from 6–12 months of age is appropriate. In prominent ears, referral is usually made after the age of 5 years, preferably before starting primary school. In cleft lip and palate, referral should be made at diagnosis, because early coordination with a multidisciplinary team and surgical planning at defined ages are required: lip repair at around 3 months and palate repair between 9–18 months. Branchial fistulas and cysts may be referred at any age, ideally after 3 months of age and outside an inflammatory phase.
Urogenital
For communicating hydroceles and spermatic cord cysts, referral is appropriate if they persist after 12–18 months, or earlier if they are large or associated with inguinal hernia. In cryptorchidism, bilateral forms should be referred at diagnosis, especially if the testes are non-palpable; in unilateral forms, referral should occur if the testis has not descended by 6 months of age, with orchidopexy ideally performed between 6–12 months, and no later than 18 months. Testicular torsion is a surgical emergency and should not be delayed by imaging. Physiological phimosis should only be referred after the age of 5 years if persistent or symptomatic, whereas recurrent balanitis or recurrent febrile urinary tract infection justifies early referral. Paraphimosis is an urgent condition because immediate reduction is required. Imperforate hymen should be referred at diagnosis, with correction planned around puberty to prevent haematocolpos. Hypospadias should always be referred at diagnosis, avoiding previous circumcision, and correction is usually planned between 6–18 months.
Abdomen
Umbilical hernia is monitored until 4–5 years of age if small and asymptomatic; earlier referral is appropriate if it is very large, incarcerated or a major source of family concern. Inguinal hernia should be referred at diagnosis for semi-elective correction in the following weeks, with urgent referral if incarcerated.
Other situations
Syndactyly and polydactyly are referred for elective correction, generally between 6–12 months, depending on morphology and functional impact. Haemangiomas and lymphangiomas benefit from early referral to a team experienced in vascular anomalies, as management may be medical, expectant or surgical depending on the case.
Practical use of the table
Overall, the table helps distinguish between urgent and planned referral and supports the prevention of delays that may compromise functional, reproductive or aesthetic outcomes. As a tool for non-surgical clinicians, it facilitates timely referral in the primary care setting.
