Question: Dear Sir,
My son, 3 year old, is recovering from URTI which started on August 7th - sudden coughing with fever.

Antibiotic dose 3ml of Advent Forte (strength 457 mg/5ml) twice a day for 5 days is over on August 13th.

But little bit of coughing (before sleep mostly) and thick yellowish mucus persisted till now.

Doctor advised Montelukast LC Kid syrup 5ml (strength 4mg Montolukast+2.5mg of cetrizine) daily for 3 weeks starting August 16th.

My son urinated involuntarily for 2 times in the night of August 19th while sleeping. And next day again while he was awake.

Thinking it is a side effect of Montolukast (he is used to cetrizine through Hattrick syrup in the past) we visited the clinic on August 20 afternoon.

As main doctor was not available, the ER doctor evaluated the patient. He examined the penis foreskin and said it is too tight and could have caused incobtinence. And quickly pushed the foreskin back and then forth. My son cried for a while.

When we were home my son complained of pain while urinating (this time voluntary urination) for at least 3 minutes.

We went back to the hospital in the evening. Main doctor evaluated the patient. There was little bit of swelling+redness on one side. Doctor said it would get back to normal in few days and prescribed HH Fudic cream (masotemose furoate+fucidic acid) for pain relief+anti-infection. CUE was done and doctor said it is normal.

My questions are:
1) Is doctor advising us properly? And not trying to cover his employee doctor for the mistake? My only concern is proper treatment for my son.
2) What symtoms I should look for as an warning of downturn?
3) Should I give him Paracetamol? Will it reduce the pain?
The pain remains mostly for duration of the urination and few minutes after that. He has complained of little bit pain long after urination but he cries only while urinating.
4) Should I continue Montelukast LC Kid in this situation? Was it the reason for incontinance?
5) Present condition:
Sleeping normally, no fever, taken the food normally, interacting, playing nomally. But pain complaint on urination and he cries for few minutes.

Thank you Sir.
Further queries/observations.

1) Present condition of the foreskin problem:
a. One involuntary urination while awakening from sleep around 8:30 am with no pain complaint.
b. One voluntary urination at 1:15 pm, with no pain.
Urine is expelled at less pressure than it used to earlier as I think the tract opening might have widened a bit.
c. Little bit redness and prominence on a blood vessel.
d. Overall swelling/redness seems to have reduced a bit.

2) Overall present condition:
Eating food, physically active, had sufficient sleep in the night, no fever.

3) Urine microscopy and culture sensitivity test:
As I mentioned earlier CUE was normal yesterday evening i.e. 7 hours after the foreskin retraction incident.
Should I still go ahead with Urine microscopy and culture sensitivity test?
I hope, that test is not invasive and is based on urine sample only.

4) Will antibiotic treatment (Advent Forte) completed on August 11th will remain effective and prevent any new infections if any related to urine tract?


5) Should we give him more water/coconut water?
Will it help further or unnecessarily add the stress on urine system?

6) Montelukast observations:

My son is unwell since August 7th.
He started eating well on August 13th and physical activity was improved as well.
Therefore, my perception (could be wrong) is that weakness should not surface on August 19th i.e. 6 days after he started feeling better and eating well.
The only important change happened on August 15th was: we started Montelukast only (with no other medicine)

Apart from urinary incontinence, there are/were other symptoms present like:
Swelling of face during night and early morning (we give Montelukast LC Kid around 7pm) which is happened today as well.
Minor rash observed on August 17th on forehead and nose but went away automatically in couple of days after applying DermaDoe (Caloe) on doctor advise.

Should we still continue Montelukast full dose i.e. 5 ml?

7) Was forced retraction of foreskin by ER doctor necessary?

I don’t want to prove the ER doctor wrong or initiate any action.
But I am interested in knowing and let all parents know about why they should stop the doctor from retracting the foreskin. Unfortunately, I never knew about this topic and could not do anything but to let the doctor do what he told me was just an examination.

Following is the presentation to the ER doctor.
My only ask is does this presentation warrants forced retraction of the foreskin by the doctor:
a. My son is 3 year old
b. Had 3 instances of urinary incontinence during the recovery phase of respiratory problem. We never said to doctor that there is any other problem with passing urine.
c. He is recovering from respiratory tract infection and already had one dose of antibiotic completed one week back
d. He is feeling better, eating and activity normal
e. So only complaint is to clarify on whether the incontinence is a side effect of any medicine
f. On first few second of examination doctor said that foreskin is tight

Doctor went ahead with retraction on his own without explaining the consequences.
I genuinely believe that retraction cant be considered as examination here.

8) My focus here is how to get the best possible cure for the problems and avoid any unknown risks.
And let this be a learning, could be in a very small way, for whoever is reading.

9) As an example of how different doctors can create a confusion in the minds of the parents:

I (in person) consulted another as reputed pediatrician as the present one for Montelukast/incontinence problem and he advised to stop Montelukast and start Syrup Relent.
He did not even mentioned or thought about the examination of foreskin.
Which sums up the sorry state of today’s healthcare profession (at least the subset of it).
I understand that the doctor advise is not deterministic but it should not swing to extremes as happened in this case.
Trying times for parents.

Thanks.