Pediatric Circumcision

Circumcision is a surgery to remove the skin covering the end of the penis. This skin is called the foreskin. This surgery is most often done one or two days after a baby’s birth. Circumcision can also be done on older children. This can be more complex. An older child may need medicine (general anesthesia) to put them to sleep during the procedure.

In some cultures, circumcision is a religious practice or a tradition. It's most common in Jewish and Islamic faiths. In the U.S., newborn circumcision isn't required. It's an elective procedure. This means you can choose to have your child circumcised or not. Circumcision is often done one to two days after birth. It's helpful to decide before your baby is born.

It's important to learn about the benefits and risks of circumcision. According to the American Academy of Pediatrics (AAP):

• Problems with the penis (such as irritation) can happen with or without circumcision.
• There is no difference in health and cleanliness (hygiene) with or without circumcision, as long as a child can handle cleaning and care.
• There is a higher risk of urinary tract infection (UTI) in uncircumcised children. This is more so in babies younger than one year old. The risk, however, for UTI in all children is less than 1%.
• Newborn circumcision does give some protection from cancer of the penis later in life, however, the overall risk of penile cancer is very low in developed countries, such as the U.S.
• Circumcised kids and adults may have a lower risk for some sexually transmitted infections. This includes HIV.

The AAP has found that the health benefits of circumcision are greater than the risks, but these benefits are not great enough to advise that all newborn babies be circumcised. Parents must decide what's best for their baby.

Circumcision has some risks; however, the rate of problems is low. The most common risks are bleeding and infection. There is also a risk of scar tissue formation.

The skin of the penis is also very sensitive after a circumcision. The area can get irritated from contact with the baby’s diaper or with the ammonia in urine. This can be treated by putting petroleum jelly on the penis for a few days.

There may be other risks. This depends on your baby’s health. Talk about any concerns you have with the healthcare provider before the surgery.

Make sure the healthcare provider fully explains the procedure. Ask if an anesthetic is used for a circumcision. The AAP advises anesthetic. This helps reduce a baby’s pain during the procedure.

If your baby is born early or has other health problems, they may not be circumcised until they're ready to leave the hospital. If your baby has a physical problem with their penis, they may not be circumcised. This is because the foreskin is used in a future surgery on the penis.

The procedure is usually done by an obstetrician or pediatrician in the hospital. When it's done for religious reasons, other people may do the surgery after the baby comes home from the hospital.

Circumcision is done only on healthy babies. The procedure is painful. So the AAP advises using a local anesthetic. This numbs the area of the penis where the incision will be made. There are different types of anesthetics. A healthcare provider may put a numbing cream on your child’s penis, or they may inject small amounts of anesthetic around the penis. There are risks with any anesthetic, but these are not considered serious. In addition to the anesthetic, your provider may give your baby a pacifier dipped in sugar water. This can help soothe them while the procedure is happening. Older children may be given general anesthesia (they sleep during the procedure).

A circumcision can be done in several ways. The procedure usually takes about 15 minutes or less. The procedure goes like this:

• The healthcare provider will give your baby a local anesthetic.
• The provider then cleans the penis with an antiseptic.
• The provider will gently loosen the foreskin from around the head of the penis, making a small slit in the foreskin.
• The provider may use one of the common methods to remove the foreskin. These methods use devices that help protect the penis while removing the foreskin.
• The provider may attach a clamp over the head of the penis. Or the provider may place a plastic ring over the head of the penis. This makes it easier to cut the foreskin.
• The provider will use surgical tools to remove the foreskin. This exposes the end of the penis.
• The provider may place some petroleum jelly or ointment on the head of the penis and cover it with a loose gauze dressing.

After the circumcision, you'll need to care for your baby’s penis until it heals. This includes cleaning the area with plain water at least once a day. You'll also need to clean it if the area is dirty after a bowel movement. Then let the area dry, and put petroleum jelly on it. This keeps the gauze dressing from sticking.

You may be asked to remove the dressing the next day. Or you may be asked to use a new dressing, and some petroleum jelly, each time you change diapers. When the gauze dressing is no longer needed, you may be told to keep putting petroleum jelly on the end of the penis for a few more days. This helps prevent the penis from sticking to the diaper.

Some swelling on the penis is normal. It's also normal for the penis to develop a crust. This will go away after a few days. A small amount of bleeding may occur. But if you see a blood stain on your baby’s diaper that's bigger than a quarter, call the healthcare provider right away. If the penis keeps bleeding, apply firm pressure with a washcloth for a few minutes. Then look to see if the bleeding has stopped. If the bleeding continues, bring your child to the emergency room.

If a plastic ring was used, it should fall off in 10 to 12 days. Tell your healthcare provider if this doesn’t happen.

A baby’s penis usually fully heals from a circumcision in 7 to 10 days.

Call your child’s healthcare provider if your baby has any of the following:

• Fever (see "Fever and children" below)
• Wound that doesn’t stop bleeding
• No urine six to eight hours after the procedure
• Redness or swelling that doesn’t get better after three days, or gets worse
• Yellow discharge or yellow coating on the penis after seven days

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

• Rectal. For children younger than three years, a rectal temperature is the most accurate.
• Forehead (temporal). This works for children age three months and older. If a child under three months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.
• Ear (tympanic). Ear temperatures are accurate after six months of age, but not before.
• Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.
• Mouth (oral). Don’t use a thermometer in your child’s mouth until they are at least four years old.

Use the rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell them which type you used.

Below is when to call the healthcare provider if your child has a fever. Your child’s healthcare provider may give you different numbers. Follow their instructions.

When to call a healthcare provider about your child’s fever

For a baby under three months old:

• First, ask your child’s healthcare provider how you should take the temperature.
• Rectal or forehead: 100.4°F (38°C) or higher
• Armpit: 99°F (37.2°C) or higher

For a child age three months to 36 months (three years):

• Rectal or forehead: 102°F (38.9°C) or higher
• Ear (only for use over age 6 months): 102°F (38.9°C) or higher

In these cases:

• Armpit temperature of 103°F (39.4°C) or higher in a child of any age
• Temperature of 104°F (40°C) or higher in a child of any age