Newborn Circumcision Referral Guidelines

As the baby grows, the foreskin becomes looser and can be retracted (moved back). This may take many months to years. The pediatrician will check this as part of a baby's checkups and will show parents/guardians how to retract the foreskin. This allows cleansing of the area. As a boy grows, he should be taught how to retract the foreskin and clean himself. The foreskin should never be retracted forcibly. Do not allow the foreskin to stay retracted for long periods as this may shut off the blood supply causing pain and possible injury. Sometimes the foreskin becomes stuck in the retracted position and cannot be pulled back down. This is called paraphimosis and is a medical emergency.

In some children, the foreskin cannot be retracted because of a restricted opening, causing a condition called phimosis. This condition may require circumcision later in childhood if it doesn't respond to medical treatment.

Refer any patient who desires a circumcision, ideally within the first week of life since we have an age limit (~6 weeks) and weight limit (~11-12 lbs). Early referral increases the opportunity to schedule evaluation and circumcision within the limits

Your patient will undergo a physical examination by one of the pediatric urologists. If the anatomy is conducive to newborn circumcision, then one can be performed the same day that the consultation is rendered.

How is circumcision performed?

• Circumcision is usually performed by the obstetrician in the hospital. When it is done for religious reasons, other persons may do the surgery as part of a ceremony after the baby is discharged from the hospital.
• Circumcision is performed only on healthy babies. Because the procedure is painful, the AAP recommends using some type of local anesthesia for newborn circumcision. Several types of anesthesia are available, including a numbing cream or injecting small amounts of anesthetic around the penis. Although there are risks with any anesthesia, local anesthesia is considered very safe.
• At Children’s National, we use the Gomco clamp method of circumcision. We begin by separating the foreskin from the head of the penis, cutting a small slit in the foreskin, and placing the clamp on the foreskin. The clamp is left in place for a few minutes to stop the bleeding. The foreskin can then be cut and removed.

What care is needed after a circumcision?

Circumcisions performed by a qualified doctor rarely have complications. Problems that occur are usually not serious. The most common complications are bleeding and infection. Proper care after circumcision helps reduce the chances of problems.

Your baby's doctor will give you specific instructions on the care of the circumcision. It is important that you keep the area clean. After the procedure:

• There may be a gauze dressing with petroleum jelly or an antibiotic cream. This may be removed at the first diaper change. Your baby's doctor may recommend applying a new dressing.
• The head of the penis may be very raw and red looking.
• There may be a small amount of blood at first or yellow-colored drainage later. These are part of normal healing.
• Your baby may have some discomfort with diaper changes the first few days.
• Keep the penis clean with soap and water.
• Circumcisions usually heal within one to two weeks.

Your baby may be fussy after circumcision. Cuddling him close and breastfeeding can help comfort him. Most boys do not require special care of the penis after the circumcision is healed.