Simple measures to keep your baby comfortable during his humane circumcision
A more humane circumcision experience for your baby comes with the use of pain medication, 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 providers ask that you not feed him anything for 1-2 hours prior so that his stomach is empty during the procedure to avoid spitting up or vomiting. Although this is preferred by some, you should ask if your baby can eat up to 30 minutes prior.
If it’s safe for your baby, acetaminophen (Tylenol®) should be given before or during the procedure to decrease pain during and after the procedure. Some provide an oral suspension dose and others prefer a rectal suppository—both provide similar results. Administering acetaminophen before the procedure gives pain relief during circumcision, but will continue relief for a shorter time 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 baby receives the acetaminophen before the procedure, ask them to give him a sugar suspension in small amounts by mouth during the procedure. This will stimulate his taste buds and distract him while the circumcision is performed.
For safety, your baby will likely be placed on a circumcision restraint board like the one pictured here during the procedure. Padding or covering the surface of the board will be more cozy and comfortable for him. Try to avoid having your baby completely unclothed so that he is not cold during the procedure. A baby blanket wrapped around his 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 safety straps are soft and avoid pressure points on the skin. If you approve, 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. 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 to 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.
For maximum pain control, injection of local anesthesia into and around the penis is usually recommended. The care provider will most likely use lidocaine or bupivacaine. Let’s get technical for a moment! The local anesthesia should be injected through a very fine needle into the dorsal penile nerves (at the base of the penis nearest the abdomen). 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. After injection, it is very important to allow a few minutes to ensure the local injections have taken effect before starting the procedure.
Ideally, the circumcision should take no longer than 10-15 minutes. Of course, a shorter procedure will lessen the discomfort of the procedure itself. It will also decrease the time your baby is restrained and exposed.
After the procedure, spend time holding, swaddling, and feeding to comfort your baby. Unless you are instructed otherwise, don’t aggressively wipe or scrub the circumcision site. This will only cause more discomfort. It is usually unnecessary, since infection is very rare.
Rarely, you may have to give him additional acetaminophen (Tylenol®) doses on and off for a few days. Refer to our Care section for more information.
Circumcision is a simple procedure. An experienced provider and careful attention to comfort and minimizing pain during the procedure are vital.