Undescended Testicle in Babies: What to Watch Before Age 1

There are few parenting moments more unsettling than changing a diaper and thinking, Wait… is something missing? If you can’t feel one (or both) testicles in your baby’s scrotum, take a breath. This can happen for a few reasons, including normal scrotal tightening when babies are cold or upset, or an issue your pediatrician may already be watching.

In this article, I’ll walk you through what an undescended testicle means, how it’s different from a retractile testicle, when pediatricians check for this, and what follow-up usually looks like in the first year.

Quick definitions

Undescended testicle (cryptorchidism)

An undescended testicle means a testicle has not moved down into the scrotum the way it usually does before birth or shortly after. It may be located in the groin area or higher up in the abdomen. Unilateral (one-sided) is more common than bilateral (both sides).

Why your clinician cares about location: the scrotum keeps the testicle a little cooler than the abdomen or groin, which matters for healthy development over time.

Retractile testicle

A retractile testicle is different. The testicle has descended, but it can temporarily pull up out of the scrotum because of a normal reflex called the cremasteric reflex. In plain language: some babies and kids have testicles that “pop up” when they’re cold, startled, crying, or being examined.

One nuance: “retractile testicle” is discussed most often in toddlers and older kids. In young infants, an “empty-looking” scrotum is also commonly due to normal scrotal tightening and exam variability. Either way, it is something your clinician should sort out on exam.

Practical difference

• Retractile: often can be gently guided down into the scrotum during an exam and may stay there briefly when the child is relaxed and warm.
• Undescended: generally cannot be brought down into the scrotum, or if it can, it will not stay there.

Important note: this is something your child’s clinician should assess. Repeated “checking” at home can irritate tender skin and does not give you a clear answer.

When doctors check

Testicle position is typically checked:

• At birth (newborn exam, often in the hospital)
• At early pediatric visits (within the first days and weeks)
• At routine well-child checks throughout infancy and childhood

If a testicle is not felt in the scrotum on exam early on, your provider will often monitor and recheck because some testicles descend on their own in early infancy.

What’s normal in year one

It can disappear briefly

Especially in babies and young children, it’s common for the scrotum to look tighter or “empty” when your baby is:

• Cold (after a bath, during a diaper change in a cooler room)
• Crying hard
• Startled
• Being examined

In these moments, a descended testicle can ride higher. When your baby is warm and relaxed later, you may notice it again.

When watchful waiting fits

If a baby is diagnosed with an undescended testicle at birth, clinicians often monitor during the first months because spontaneous descent can happen early on.

When not to wait

If the testicle is still not in the scrotum by about 6 months of age, guidelines typically recommend referral to a pediatric urologist or pediatric surgical specialist for evaluation. After 6 months, spontaneous descent becomes uncommon, so it is better to get specialist input rather than stretching a wait-and-see plan.

Timing note for babies born early: providers often use corrected age when deciding when 6 months is “due.”

Follow-up and referrals

Here’s a common pattern many families experience:

• Your pediatrician confirms the finding during a calm, warm exam. Position can be tricky to assess during a squirmy diaper change at home.
• Repeat checks at well visits to see whether descent occurs in early infancy.
• Referral by around 6 months (corrected age if premature) if the testicle remains out of the scrotum or the exam is uncertain.
• Specialist exam to confirm whether the testicle is undescended, retractile, or “ascending” (a testicle that was down but later rides high).

If treatment is recommended, the most common approach is a minor surgery called orchiopexy to bring the testicle into the scrotum and secure it there. In many cases, orchiopexy is planned in the 6 to 18 month window, often earlier rather than later. Your specialist will walk you through timing for your child’s situation.

After orchiopexy, kids still need routine checkups. And if your child has a retractile testicle, it should be monitored over time because a small number can become persistently high (acquired undescended or ascending).

Do we need an ultrasound?

This is a super common question. In many cases, imaging is not the first step for an undescended testicle because a skilled physical exam is often more useful, and ultrasound may not reliably locate a non-palpable testicle.

In fact, imaging often is not recommended before specialist referral because it frequently does not change what happens next. Your pediatrician or pediatric urologist will decide if imaging is needed based on the exam and your baby’s history.

If a provider suggests an ultrasound, it’s okay to ask: “How will this change what we do next?”

What to watch at home

You do not need to do daily checks. But you can keep a gentle eye out during normal care:

• Does the scrotum sometimes look fuller when your baby is warm and relaxed?
• Is one side consistently emptier than the other over weeks?
• Any new swelling in the groin or scrotum?

If you’re unsure, bring it up at the next well visit. This is a very normal question for parents to ask, and your pediatrician has heard it a thousand times.

Red flags

Most undescended or retractile testicles are not emergencies. But certain symptoms are time-sensitive. Seek urgent care or emergency evaluation if your baby has:

• Sudden, significant distress (inconsolable crying that seems different or severe)
• New or rapidly increasing swelling of the scrotum or groin
• Redness, bruising, or color change of the scrotum
• Firm, tender scrotum or a new hard lump
• Vomiting along with groin or scrotal swelling (can be concerning for a hernia complication)
• Fever with scrotal redness or tenderness

These signs can point to conditions like testicular torsion (twisting of the blood supply), an incarcerated hernia, or infection, all of which need prompt assessment. In infants, torsion does not always look like obvious pain at first. Swelling and color change can be key clues.

Common questions

Did I cause this?

No. An undescended testicle is related to fetal development and hormones. It is not caused by diapering, how you hold your baby, or something you ate or didn’t eat.

Is it dangerous to wait a bit?

It’s usually safe to follow your pediatrician’s plan in the first months. The key is not losing follow-up. If the testicle is not in the scrotum by about 6 months (corrected age if premature), referral is typically recommended.

What about fertility or cancer risk?

These are the worries that keep parents up at night. The calm, practical takeaway is this: a testicle that stays undescended long-term can have higher risks later in life, which is exactly why clinicians monitor closely and recommend bringing it down when needed. Early management is aimed at supporting the healthiest long-term outcome.

Can it be “there” sometimes and not others?

Yes. That pattern can fit a retractile or high-riding testicle, or simply normal scrotal tightening in a young infant. Either way, it’s worth mentioning at routine visits so your clinician can track whether the testicle is consistently in the scrotum over time.

Are hormone shots a thing?

Some families hear about hormone treatment. In many current practices, it is not a first-line approach for an undescended testicle. If it comes up, your pediatric urologist can explain what is and is not recommended for your child.

What to ask your pediatrician

If you want to feel confident you’re covering the right bases, here are a few questions that get you clear answers quickly:

• “Today, could you feel the testicle in the scrotum, the groin, or not at all?”
• “Does this seem retractile, high-riding, or truly undescended?”
• “When do you want to check it again?”
• “If it’s not down by 6 months (corrected age), will you refer us to pediatric urology?”
• “What symptoms would mean we should be seen sooner?”

Bottom line

If you can’t feel a testicle in your baby’s scrotum, you’re not alone, and you’re not overreacting by asking. The goal is simple: figure out whether it’s a normal high-riding pattern, retractile, or truly undescended, keep regular checkups, and know the red flags that require urgent care.

Bring your observations (one side or both, always absent or comes and goes, term or preterm) to your next visit so your pediatrician can document what they find and guide the next steps.