Circumcision for Children
What is circumcision for children?
Circumcision is a surgery to remove the skin covering the end of the penis. This skin
is called the foreskin. This surgery is most often done 1 or 2 days after a baby’s
birth. Circumcision can also be done on older children. This can be more complex.
An older child may need medicine (general anesthesia) to put them to sleep during
the procedure.
What should I consider when deciding about circumcision for my child?
In some cultures, circumcision is a religious practice or a tradition. It's most common
in Jewish and Islamic faiths. In the U.S., newborn circumcision isn't required. It's
an elective procedure. This means you can choose to have your child circumcised or
not. Circumcision is often done 1 to 2 days after birth. It's helpful to decide before
your baby is born.
It's important to learn about the benefits and risks of circumcision. According to
the American Academy of Pediatrics (AAP):
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Problems with the penis (such as irritation) can happen with or without circumcision.
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There is no difference in health and cleanliness (hygiene) with or without circumcision,
as long as a child can handle cleaning and care.
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There is a higher risk of urinary tract infection (UTI) in uncircumcised children.
This is more so in babies younger than 1 year old. The risk, however, for UTI in all
children is less than 1%.
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Newborn circumcision does give some protection from cancer of the penis later in life,
however, the overall risk of penile cancer is very low in developed countries, such
as the U.S.
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Circumcised kids and adults may have a lower risk for some sexually transmitted infections.
This includes HIV.
The AAP has found that the health benefits of circumcision are greater than the risks,
but these benefits are not great enough to advise that all newborn babies be circumcised. Parents
must decide what's best for their baby.
What are the risks of circumcision for a child?
Circumcision has some risks; however, the rate of problems is low. The most common
risks are bleeding and infection. There is also a risk of scar tissue formation.
The skin of the penis is also very sensitive after a circumcision. The area can get
irritated from contact with the baby’s diaper or with the ammonia in urine. This can
be treated by putting petroleum jelly on the penis for a few days.
There may be other risks. This depends on your baby’s health. Talk about any concerns
you have with the healthcare provider before the surgery.
How do I help my child get ready for circumcision?
Make sure the healthcare provider fully explains the procedure. Ask if an anesthetic
is used for a circumcision. The AAP advises anesthetic. This helps reduce a baby’s
pain during the procedure.
If your baby is born early or has other health problems, they may not be circumcised
until they're ready to leave the hospital. If your baby has a physical problem with
their penis, they may not be circumcised. This is because the foreskin is used in
a future surgery on the penis.
What happens during circumcision for a child?
The procedure is usually done by an obstetrician or pediatrician in the hospital.
When it's done for religious reasons, other people may do the surgery after the baby
comes home from the hospital.
Circumcision is done only on healthy babies. The procedure is painful. So the AAP
advises using a local anesthetic. This numbs the area of the penis where the incision
will be made. There are different types of anesthetics. A healthcare provider may
put a numbing cream on your child’s penis, or they may inject small amounts of anesthetic
around the penis. There are risks with any anesthetic, but these are not considered
serious. In addition to the anesthetic, your provider may give your baby a pacifier
dipped in sugar water. This can help soothe them while the procedure is happening.
Older children may be given general anesthesia (they sleep during the procedure).
A circumcision can be done in several ways. The procedure usually takes about 15 minutes
or less. The procedure goes like this:
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The healthcare provider will give your baby a local anesthetic.
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The provider then cleans the penis with an antiseptic.
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The provider will gently loosen the foreskin from around the head of the penis, making
a small slit in the foreskin.
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The provider may use one of the common methods to remove the foreskin. These methods
use devices that help protect the penis while removing the foreskin.
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The provider may attach a clamp over the head of the penis. Or the provider may place
a plastic ring over the head of the penis. This makes it easier to cut the foreskin.
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The provider will use surgical tools to remove the foreskin. This exposes the end
of the penis.
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The provider may place some petroleum jelly or ointment on the head of the penis and
cover it with a loose gauze dressing.
What happens after circumcision for a child?
After the circumcision, you'll need to care for your baby’s penis until it heals.
This includes cleaning the area with plain water at least once a day. You'll also
need to clean it if the area is dirty after a bowel movement. Then let the area dry,
and put petroleum jelly on it. This keeps the gauze dressing from sticking.
You may be asked to remove the dressing the next day. Or you may be asked to use a
new dressing, and some petroleum jelly, each time you change diapers. When the gauze
dressing is no longer needed, you may be told to keep putting petroleum jelly on the
end of the penis for a few more days. This helps prevent the penis from sticking to
the diaper.
Some swelling on the penis is normal. It's also normal for the penis to develop a
crust. This will go away after a few days. A small amount of bleeding may occur. But
if you see a blood stain on your baby’s diaper that's bigger than a quarter, call
the healthcare provider right away. If the penis keeps bleeding, apply firm pressure
with a washcloth for a few minutes. Then look to see if the bleeding has stopped.
If the bleeding continues, bring your child to the emergency room.
If a plastic ring was used, it should fall off in 10 to 12 days. Tell your healthcare
provider if this doesn’t happen.
A baby’s penis usually fully heals from a circumcision in 7 to 10 days.
Call your child’s healthcare provider if your baby has any of the following:
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Fever (see "Fever and children" below)
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Wound that doesn’t stop bleeding
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No urine 6 to 8 hours after the procedure
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Redness or swelling that doesn’t get better after 3 days, or gets worse
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Yellow discharge or yellow coating on the penis after 7 days
Fever and children
Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer.
There are different kinds and uses of digital thermometers. They include:
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Rectal. For children younger than 3 years, a rectal temperature is the most accurate.
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Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has
signs of illness, this can be used for a first pass. The provider may want to confirm
with a rectal temperature.
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Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.
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Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any
age with signs of illness. The provider may want to confirm with a rectal temperature.
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Mouth (oral). Don’t use a thermometer in your child’s mouth until they are at least 4 years old.
Use the rectal thermometer with care. Follow the product maker’s directions for correct
use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass
on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the
healthcare provider what type to use instead. When you talk with any healthcare provider
about your child’s fever, tell them which type you used.
Below is when to call the healthcare provider if your child has a fever. Your child’s
healthcare provider may give you different numbers. Follow their instructions.
When to call a healthcare provider about your child’s fever
For a baby under 3 months old:
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Rectal or forehead: 100.4°F (38°C) or higher
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Armpit: 99°F (37.2°C) or higher
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A fever of ___________as advised by the provider
For a child age 3 months to 36 months (3 years):
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Rectal or forehead: 102°F (38.9°C) or higher
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Ear (only for use over age 6 months): 102°F (38.9°C) or higher
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A fever of ___________ as advised by the provider
In these cases:
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Armpit temperature of 103°F (39.4°C) or higher in a child of any age
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Temperature of 104°F (40°C) or higher in a child of any age
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A fever of ___________ as advised by the provider
Next steps
Before you agree to the test or the procedure for your child, make sure you know:
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The name of the test or procedure
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The reason your child is having the test or procedure
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What results to expect and what they mean
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The risks and benefits of the test or procedure
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When and where your child is to have the test or procedure
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Who will do the procedure and what that person’s qualifications are
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What would happen if your child did not have the test or procedure
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Any alternative tests or procedures to think about
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When and how you will get the results
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Who to call after the test or procedure if you have questions or your child has problems
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How much you will have to pay for the test or procedure