A Noteworthy Nappy Change

Author: Emily Watts / Editor: Sarah Edwards / Codes: / Published: 31/01/2023


A 5-month-old baby boy is brought to the Emergency Department (ED) by his concerned mother, who has spotted a change to his scrotum. She describes a normal appearance at his first nappy change this morning, but at lunchtime the right side of his scrotum got red and swollen. Concerned by this change, she has brought him for assessment.

The baby is acting as normal: no distress, feeding well, passing urine and stool regularly. Mum has not noticed any change to smell / colour / quantity of urine. The baby does not look distressed when passing urine, he has not had any fever, or appeared unwell in the last few days.


Mum had a midwife-led pregnancy and delivery. The baby had an unremarkable post-natal period. He had normal baby checks at birth and 6 weeks of age. He is up to date on his immunisations.

On Examination

He is a happy and active baby boy. His observations are all in normal range. His abdomen is soft and non-tender with active bowel sounds. The left side of his scrotum appears normal, the testicle lies within the scrotum and there is no distress on examination.

The right side of his scrotum is erythematous and swollen, but there is no blue spot sign. He becomes distressed with examination. There is a palpable mass within the right scrotum, which is indiscriminate from the testicle and tender to palpation. It is smooth, firm, and non-fluctuant. It is non-reducible and does not transilluminate. The baby settles immediately after the examination ends.

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