Circumcision of Baby Boys

Circumcision of baby boys is an optional surgical procedure to remove the layer of skin (called the foreskin or prepuce) that covers the head (glans) of the penis. It is most often done during the first few days after birth. Parents who decide to circumcise their newborn boys often do so for religious, social or cultural reasons. If you are trying to make a decision about circumcision, talk to your baby's health care provider.

Potential benefits of circumcision

A few studies suggest that boys who have been circumcised may be less likely to develop cancer of the penis later in life (though this cancer is extremely rare), less likely to get HIV and HPV infections, and less likely to get a urinary tract infection during childhood. Female partners of circumcised men are also less likely to get cervical cancer.

Potential risks of circumcision

Circumcision is a painful procedure. Problems resulting from the surgery are usually minor, though serious complications, while very rare, do occur — including too much bleeding or infection in the area, too much skin removed, or side effects from the method or medicine used for pain relief. The risk of complications is lower in young babies than in older children. To minimise the risks, the procedure should be done by a trained and experienced practitioner using a sterile technique, and someone should follow up with you in the days after to make sure bleeding has not increased.

Caring for an uncircumcised penis

The foreskin covers the head (glans) of a boy's penis. During the early years of a boy's life, the foreskin starts to separate from the glans, but may not be fully retractable until a boy is 3 to 5 years old, or even until after puberty. This is a natural process that occurs over time — you do not need to do anything to make it happen.

An uncircumcised penis is easy to keep clean and requires no special care:

• Keep your baby's penis clean by gently washing the area during his bath. Do not try to pull back the foreskin, and never force it.
• When your son is old enough, teach him to keep his penis clean as part of washing the rest of his body.
• As the foreskin separates, shed skin cells may look like white, cheesy lumps (smegma). You don't need to force them out — just wipe them away once they come out.
• When the foreskin is fully retractable, teach your son to wash underneath it each day.

If you decide to have your baby boy circumcised

Talk to your baby's health care provider about the possible complications described above, and about pain relief. Newborn babies feel pain — the practitioner should use a local anaesthetic given by a needle in the area where the circumcision is done. Additional methods include sucking on a pacifier dipped in a sugar solution, topical anaesthetic cream and acetaminophen. Anaesthetics do carry their own small risks (bruising, swelling from the needle; redness or swelling from creams). Sometimes babies have health problems that increase the risk of complications after circumcision — a contraindication your provider will screen for.

Caring for a circumcised penis

• After the circumcision, comfort your baby by holding him and nursing him often.
• The penis will take 7 to 10 days to heal. The area may be red for a few days with some yellow discharge, which should decrease as it heals — ask your provider what to expect.
• Follow the practitioner's instructions about caring for the dressing, using petroleum jelly, keeping the area clean and bathing.

Call your health care provider if you see persistent bleeding at any time during healing, if redness and swelling do not start to go down within 48 hours, if your baby develops a fever (rectal temperature of 38.0°C or higher), if your baby seems unwell, if he does not pass urine within 12 hours of the procedure, or if there is a greenish or foul-smelling discharge from the penis.

Jaundice in newborns

Jaundice is very common in newborn babies. It makes a baby's skin and the whites of the eyes turn a yellow colour, and happens when a high amount of bilirubin (a brownish-yellow substance produced after red blood cells break down) is produced, or the liver can't get rid of it quickly enough. The body normally clears bilirubin through the stool. Most jaundice is not severe and complications can usually be prevented.

Most of the time, jaundice goes away on its own. Sometimes babies need help bringing bilirubin levels down — one way is phototherapy, where the skin is exposed to light that helps the body get rid of bilirubin more easily through stool and urine. Phototherapy is usually done in a hospital, though sometimes babies can be treated at home; exposing your baby to sunlight instead can be harmful, so don't do this without discussing it with your health care provider first.

Phototherapy is safe — your baby's eyes will be protected with special eye patches. It can sometimes cause skin rash or loose bowel movements, and your baby may need extra fluids, such as more frequent breastfeeding.

When should I be more concerned about jaundice?

Jaundice can be more serious for babies who were born before 37 weeks' gestation, who weigh less than 2,500 g (5.5 lb) at birth, whose blood group is incompatible with their mother's, who develop jaundice early in life (especially in the first 24 hours), whose jaundice has moved into the arms and legs, who have a lot of bruising or swelling under the scalp after birth, or whose siblings had jaundice at birth that needed treatment with an exchange transfusion.