Circumcision for Children
What is circumcision for children?
Circumcision is a surgery to remove the skin covering the end of the penis. This is called the foreskin. This surgery is most often done 1 or 2 days after a baby boy’s birth. Circumcision can also be done on older boys. This can be more complex. An older boy may need medicine (general anesthesia) to put him to sleep during the procedure.
Why might my child need circumcision?
In some cultures, circumcision is a religious practice or a tradition. It is most common in Jewish and Islamic faiths. In the U.S., newborn circumcision is not required. It is an elective procedure. This means you can choose to have your child circumcised or not. Circumcision is often done 1 to 2 days after birth. It is helpful to decide before your baby is born.
It is 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 boy can handle cleaning and care.
- There is a higher risk of urinary tract infection (UTI) in uncircumcised boys. This is more so in babies younger than 1 year old. But the risk for UTI in all boys is less than 1%.
- Newborn circumcision does give some protection from cancer of the penis later in life. But the overall risk of penile cancer is very low in developed countries, such as the U.S.
- Circumcised boys and men have a lower risk for some sexually transmitted diseases. This includes HIV.
The AAP has found that the health benefits of circumcision are greater than the risks. But the AAP also found that these benefits are not great enough to advise that all newborn baby boys be circumcised. Parents must decide what is best for their baby.
What are the risks of circumcision for a child?
Circumcision has some risks. But the rate of problems is low. The most common risks are bleeding and infection.
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.
How do I help my child get ready for circumcision?
Make sure the healthcare provider fully explains the procedure. Ask if 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, he may not be circumcised until he is ready to leave the hospital. If your baby has a physical problem with his penis, he may not be circumcised. This is because the foreskin is used in a future surgery on the penis.
What happens during circumcision for a child?
The procedure is usually done by an obstetrician or pediatrician in the hospital. When it is 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 recommends using a local anesthetic. This numbs the area of the penis where the incision will be made. There are different types of anesthetic. A healthcare provider may put a numbing cream on your child’s penis. Or he or she may inject small amounts of anesthetic around the penis. There are risks with any anesthetic, but these are considered safe. In addition to the anesthetic, your healthcare provider may give your baby a pacifier dipped in sugar water. This can help soothe him while the procedure is happening.
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 healthcare provider then cleans the penis with an antiseptic.
- The healthcare provider will gently loosen the foreskin from around the head of the penis, making a small slit in the foreskin.
- The healthcare 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 healthcare 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 healthcare provider will use surgical tools to remove the foreskin. This exposes the end of the penis.
- The healthcare provider may place some petroleum jelly or ointment on the head of the penis and cover it with a loose gauze dressing.
What happens after circumcision for a child?
After the circumcision, you will 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 will 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 is also normal for the penis to develop a crust. This will go away after a few days. A small amount of bleeding is not unusual. But if you see a blood stain on your baby’s diaper that is bigger than a quarter, call the healthcare provider right away. If the penis keeps bleeding, apply firm pressure with a washcloth for several 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 within 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 section below)
- Wound that doesn’t stop bleeding
- No urine 6 to 8 hours after the procedure
- Redness or swelling that doesn’t get better after 3 days, or gets worse
- Yellow discharge or yellow coating on the penis after 7 days
Fever and children
Always use a digital thermometer to check your child’s temperature. Never use a mercury thermometer.
For infants and toddlers, be sure to use a rectal thermometer correctly. A rectal thermometer may accidentally poke a hole in (perforate) the rectum. It may also pass on germs from the stool. Always follow the product maker’s directions for proper use. If you don’t feel comfortable taking a rectal temperature, use another method. When you talk to your child’s healthcare provider, tell him or her which method you used to take your child’s temperature.
Here are guidelines for fever temperature. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old.
Infant under 3 months old:
- Ask your child’s healthcare provider how you should take the temperature.
- Rectal or forehead (temporal artery) temperature of 100.4°F (38°C) or higher, or as directed by the provider
- Armpit temperature of 99°F (37.2°C) or higher, or as directed by the provider
Child age 3 to 36 months:
- Rectal, forehead, or ear temperature of 102°F (38.9°C) or higher, or as directed by the provider
- Armpit (axillary) temperature of 101°F (38.3°C) or higher, or as directed by the provider
Child of any age:
- Repeated temperature of 104°F (40°C) or higher, or as directed by the provider
- Fever that lasts more than 24 hours in a child under 2 years old. Or a fever that lasts for 3 days in a child 2 years or older.
Before you agree to the test or the procedure for your child make sure you know:
- The name of the test or procedure
- The reason your child is having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- When and where your child is to have the test or procedure
- Who will do the procedure and what that person’s qualifications are
- What would happen if your child did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or your child has problems
- How much will you have to pay for the test or procedure
December 09, 2017
Neonatal Circumcision: Risks and Benefits. UpToDate, Pediatrics: Circumcision Policy Statement. Task Force on Circumcision. 2012;130(3):585-86., Pediatrics: Circumcision Policy Statement. Task Force on Circumcision. 2012;130(3):e756-85., The Gale Encyclopedia of Nursing and Allied Health. Narins B. 2013:3:770-71.
Adler, Liora C, MD,Cunningham, Louise, RN,Freeborn, Donna, PhD, CNM, FNP