| |
-
- Knowledgebase:
Newborn Questions: General
- Questions about the care of newborns, rashes, stooling.
-
- 22. AAP: Q & A Regarding Circumcision - Top
- 1. It seems the AAP has flip-flopped on this issue over the years. First, throughout the 1970’s you said there was no indication for routine neonatal circumcision. Then, in the 1980s, you seemed to more strongly suggest that there are medical benefits that warrant the procedure. Finally, in the 90s, you¹re back to saying there is no medical reason to do it.
Answer:
The Academy continually reviews and updates its policies to reflect the latest research on clinical practice. As new studies become available, the Academy may update its policy recommendations accordingly.
For example, there’s been more research on pain control and urinary tract infections since the last policy was released.
However, one consistent Academy message is that parents should consult with their child’s pediatrician about this decision. After they review all the facts with the doctor, then they should make a decision on whether or not circumcision is right for their child.
2. What is new about this statement?
Answers:
After looking at almost 40 years of research on the benefits and risks of circumcision, the AAP concluded that we cannot recommend a policy of routine newborn circumcision.
While circumcision is not essential to a child’s well being at birth, it does have potential medical benefits. We do recommend that parents discuss the benefits and risks of circumcision with their pediatrician and then make an informed decision about what’s in the best interest of their child.
Finally, if a decision for circumcision is made, it is essential that pain relief be provided for the infant during the procedure.
(If pressed…)
Like the last Task Force on Circumcision, we agree that parents should make an informed decision after discussing the risks and benefits of circumcision with their pediatrician. Our Task Force, with the benefit of an additional decade of medical research, has concluded that we cannot recommend a policy of routine newborn circumcision.
3. How do the medical benefits compare with religious or cultural issues when parents are making a decision?
Answer:
There are potential medical benefits to circumcision. And, it’s legitimate for parents to take into account religious, cultural and ethnic traditions.
4. What are the potential medical benefits?
Answer:
The research shows that circumcised males have fewer urinary tract infections. They also have a lesser chance of developing penile cancer, which is a rare problem.
5. Why the change of heart on the anesthetic issue?
Answer:
The evidence is now clear that infants experience pain. And, according to numerous studies, there are several safe and effective methods to reduce the pain and stress associated with circumcision.
6. In the 1989 policy, you stated that anesthesia may be hazardous. Isn’t this the form of pain relief you are now recommending as the most effective?
Answer:
New research involving thousands of babies has shown pain control to be safe and effective in reducing the pain associated with circumcision.
(If pressed…)
These include EMLA cream, dorsal penile nerve block, and a subcutaneous ring block. In one study comparing these three forms of analgesia, the ring block appeared to be the most effective.
7. It is said that many parents choose to have their sons circumcised so they’ll look like Dad or so they’ll look like other boys in the locker room. For young boys who are uncircumcised today, are we seeing any particular social or psychological ramifications?
Answer:
Parents who decide to leave their son’s foreskin intact should feel comfortable with this decision.
(If pressed…)
There really is no data on psychosocial ramifications.
8. Your statement indicates there is a higher incidence of urinary tract infections among uncircumcised males. How dangerous are urinary tract infections?
Answer:
Urinary tract infections are usually not life threatening and are easily treated in most cases. Uncircumcised infant males have a four to ten-times higher risk of urinary tract infection during the first year of life compared to circumcised infant males. However, studies vary on the rate of the urinary tract infections in boys.
9. If uncircumcised males are 3 to 10 times more likely to develop penile cancer, why not recommend routine neonatal circumcision?
Answer:
Whether boys are circumcised or not, penile cancer is very rare. Studies suggest that there is at least a three-time higher risk of penile cancer in uncircumcised males; however, penile cancer is very rare, so increasing the risk several fold still means that penile cancer in uncircumcised males is still very rare.
There is some suggestion in the literature that hygiene may affect the risk of penile cancer. But it’s really unclear. Parents have to teach a child good hygiene whether a boy is circumcised or uncircumcised. It’s just a matter of teaching the proper way to keep the area clean.
10. What are the ramifications for health care coverage? Do most managed care plans cover the cost of circumcision? What is the cost? Will the new recommendations on the use of analgesia affect whether health care plans cover it for this procedure?
Answer:
This new policy reflects the medical literature on circumcision, not funding issues. And since costs vary by region, it will really be up to the individual states and health plans to determine insurance coverage issues.
11. Last October, a baby boy in Ohio died because he had to undergo surgery to correct a botched circumcision. Isn’t this reason enough to say that the procedure shouldn’t be done?
Answer:
Circumcision is generally a very safe procedure. And although I’ve not seen the medical history of that child, I can tell you that most complications associated with circumcision are minor.
12. In the current statement, it says that circumcisions performed later in a boy’s life may be more involved and risky. What is the likelihood that an uncircumcised infant will go on to require a circumcision later in life?
Answer:
The vast majority of uncircumcised boys do very well and it’s unlikely that an uncircumcised infant will require circumcision later in life.
13. What other organizations agree with your statement?
Answer:
American College of Obstetricians and Gynecologists support this policy. And both the Australian and Canadian pediatric societies have similar positions.
14. If you had a baby boy today, would you have him circumcised?
Answer:
That’s a very personal question that involves not only medical facts, but also personal issues such as culture, religion and ethnicity. I think a better question for all parents is: “Do you have all the facts on circumcision.” Because as parents, all of us should remember to ask our children’s pediatrician about the facts on circumcision.
(If pressed by reporter)
I’m really here to talk about the new Academy policy recommendations and not my own personal views.
15. What are the risks associated with the circumcision procedure?
Answer:
Circumcision is generally a very safe procedure. According to information contained in the Task Force statement, one can estimate that there is a 1 in 200 to 1 in 500 chance of complication from the circumcision procedure. And even these complications are minor, such as soreness or bruising.
(If pressed…)
Medical reports suggest that the complication rate is between 0.2 and 0.6%, and that most of these complications are minor.
16. Is it true that circumcised males report reduced sexual pleasure?
Answer:
In the current medical literature we examined, we found that this issue was very subjective and that there’s really no clear evidence either way.
17. Does neonatal circumcision make babies more sensitive to pain?
Answer:
We’ve known since 1989 that infants experience pain, but there was concern that there was not enough data available to ensure that anesthesia safe for newborns. For example, baby’s who received analgesia during circumcision showed less sensitivity to pain at their four-month shot than babies who received no analgesia. received the highest pain response. But that’s why it’s important that baby boys receive some form of pain relief during the procedure.
18. Should hygiene factor into the decision to circumcise boys?
Answer:
Parents have to teach a child good hygiene whether a boy is circumcised or uncircumcised. It’s just a matter of teaching the proper way to keep the area clean.
19. What about female circumcision?
Answer:
There are no medical benefits to female circumcision. In fact, the Academy has a policy strongly opposes this practice. - Updated: March 5, 2001
-
-
[e-Mail
me the Knowledgebase] - [Search
our Knowledgebase] - [Question Not Answered?]
|
|
