A baby will cry vociferously if circumcised without any anesthesia. In fact, most babies will cry just from undressing them and placing them on the Circumstraint board with their legs restrained by Velcro. However, if the baby is properly anesthetized and is comforted during the procedure by a pacifier dipped in sweet wine, the baby will usually be extremely comfortable and not cry at all during his circumcision. Although in years past circumcisions were performed by doctors in hospitals without the use of analgesia, both the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists now specify that analgesia/anesthesia should be provided for all babies undergoing circumcision.
The anesthetic technique most commonly used is called a ring block. All digits—a finger, a toe, the penis—have two nerves on their top—dorsal—surface and one nerve on the bottom—ventral—surface. If these nerves are numbed with a small amount of 1% to 2% lidocaine, then roughly 90% of babies will not cry during their circumcision. Unfortunately, anesthetic creams such as EMLA (Eutectic Mixture of Local Anesthetics) are not effective in preventing the pain of circumcision. If applied to the base of the penis roughly an hour before the lidocaine is injected, EMLA might make the administration of lidocaine for the ring block less uncomfortable for the baby. But the cream is relatively expensive and the FDA does not approve its use in babies less than 30 days of age.
Babies are also extremely comforted during their circumcision by the sweet wine traditionally given to them on a pacifier or on a wine-soaked piece of gauze. Pediatricians who have studied this use of wine say that it is not the alcohol that calms the baby but rather the “sugar high” that the baby gets. It is therefore problematic when a couple, instead of providing the mohel with a traditional sweet kosher wine such as Manischewitz for the bris, gets a high quality Israeli dry wine. The baby will have no interest in this whatsoever.
Complications from circumcision—whether performed as part of the brit milah ceremony or in a hospital—are extremely rare. When they do occur, they fall into 3 categories: Infection, bleeding, or the appearance of inadequate skin having been removed.
- Infections are an almost unheard-of consequence of circumcision. Signs of infection are swelling and redness of the head or shaft of the penis, pus, and odor. If any of these are seen in the days following a circumcision, the baby must be brought to see his pediatrician immediately.
- Bleeding. There are usually a few small spots of blood seen on the baby’s diaper in the first couple of changes following a circumcision. There should never be a pool of blood and the penis should never be covered in blood. In either of these cases—or if there continues to be blood on the diaper eight or more hours after the procedure—the mohel or the child’s pediatrician should be notified so that the baby can be evaluated.
- Excessive or inadequate skin removed. While bleeding and infection post circumcision are rare, one not infrequently sees the skin of the shaft of the penis trying to ride up over the head of the penis in the first few days following the procedure. This does not indicate that the mohel has taken off too little skin. The amount of skin that the mohel removes is largely determined by the anatomy of the penis. Rather, this appearance of excessive residual skin is caused by either redundancy of the skin of the penile shaft or by a fat pad in the baby’s lower abdomen which pushes the skin of the shaft further up the penis than is usually the case. If the parents gently uncover the head of the penis by pushing the skin of the shaft back towards the baby’s abdomen each time they change the diaper for the first few days following the circumcision, the mobile skin on the shaft will eventually stick to the underlying penis in the correct position. Long term appropriate healing will then ensue.