Simple measures provide comfort to the newborn during a humane circumcision procedure
A more humane circumcision experience for your infant comes through the use of appropriate pain medications, safe distractions, comfortable padding and coverings, and attentive aftercare.
If allowed, make sure your baby is not hungry at the time of the procedure. Many ask that your child not have anything to eat for 1-2 hours prior so that their stomach is empty during the procedure to avoid spitting up/vomiting. Although this is preferred by some, you should ask if your child can eat up to 30 minutes prior.
Unless contraindicated, acetaminophen (Tylenol) should be given prior to or during the procedure. This should decrease any discomfort during and after the procedure. Some provide an oral suspension dose and others prefer a rectal suppository—both provide similar results. Administering acetaminophen prior to the procedure gives pain relief during circumcision, but does shorten the effect of such relief afterward.
If the acetaminophen is given orally during the procedure, the taste of the medicine commonly causes infants to focus on the taste sensation and less on the procedure, causing a distraction. If your child receives the acetaminophen prior to the procedure, ask that a sugar suspension be given in small amounts by mouth during the procedure to cause taste bud stimulation and distract him while the circumcision is performed.
Padding or covering the surface of the circumcision restraint board will increase comfort and diminish the cold sensation of lying on plastic. Try to avoid having your baby completely unclothed so that he is not cold during the procedure. A baby blanket wrapped around the upper body and arms (swaddling) should do the trick.
Care providers should carefully position the board’s safety restraint straps over the knees and elbows. Ideally, the straps are soft and avoid pressure points on the skin. If approved by the parents, a pacifier should be available and used.
Topical & Injected Anesthesia
UNLESS CONTRAINDICATED, ALL INFANT CIRCUMCISIONS SHOULD BE DONE WITH LOCAL ANESTHESIA! If your care provider does not routinely offer this, perhaps you should consider an alternative provider for a more humane circumcision.
Topical numbing cream can be used to decrease superficial skin discomfort, but this does not usually penetrate deeply enough into the tissues to provide maximum pain control for the procedure. It can provide some relief from the injection pain of the local anesthesia that is commonly administered to maximize procedural pain control.
Topical cream takes 15-20 minutes to penetrate the skin for maximum effect. Because it is water soluble, it is easily washed away prematurely with urination or accidentally wiped away by the diaper if not covered. The cream can cause temporary skin swelling and irritation that may slightly distort anatomy during the circumcision.
Injection of local anesthesia into and around the penis is usually recommended for maximum pain control during newborn circumcision. The care provider will most likely use lidocaine or bupivacaine. This local anesthesia should be injected through a very fine needle into the dorsal penile nerves (base of the penis nearest the abdomen) and ideally, it should also be injected all around the superficial base of the penis (a circular ‘ring block’).
Lidocaine numbs more quickly, but bupivacaine lasts longer. It is very important to allow a few minutes to pass after the injection before starting the procedure to ensure the local injections have taken effect.
Ideally, circumcision should take no longer than 10-15 minutes. Of course, a shorter procedure will not only lessen the discomfort of the procedure itself but also decrease the time your baby is restrained and exposed.
After the procedure, holding, swaddling, and feeding will comfort your child. Unless instructed otherwise, you should not aggressively wipe or scrub the circumcision site, as this will only cause more discomfort and is usually unnecessary since infection is very rare.
Rarely, additional acetaminophen (Tylenol) doses may be needed intermittently for several days to provide relief. Refer to our Care section for more information.
We are not providing medical advice; if you need advice, please consult with your child’s physician or care provider regarding personal concerns, risks, and outcomes.