Q&A:
Should babies get local anesthesia for circumcision?

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Answered by Suzanne Dixon M.D., M.P.H.

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"There is nothing so amazing as the development of a child," says Suzanne Dixon, M.D., a behavioral and developmental pediatrician who was one of the founding members of the Pampers Parenting Network. "Every day is a new adventure when you have a child around you. I never get tired of learning from the children who have been a part of my life, professionally and personally."Suzanne Dixon, M.D., M.P.H., was born and raised in Minnesota and graduated from the University of Minnesota, School of Medicine. She did her pediatric training at Massachusetts General Hospital in Boston and then completed a fellowship in Child Development at Boston's Children's Hospital. Dr. Dixon joined the faculty at the University of California, San Diego, and did patient care, teaching, and research for 20 years. She ran a large newborn service, performed research in early child development, and was involved in many community outreach activities in maternal child health. Throughout her entire professional life she has maintained an interest in cross-cultural activities, living and working in many parts of the world, including Mexico, India, Kenya, Indonesia, and several countries from the former U.S.S.R. Dr. Dixon is the author of numerous research articles, review articles, and textbook chapters in pediatrics, child and family development, and public health. Her textbook, written with Dr. Martin Stein, Encounters With Children: Pediatric Behavior and Development, has become a classic in child health education and is in its fourth edition. She is Editor in Chief of the Journal of Developmental and Behavioral Pediatrics, an international journal of high standing in the professional world. She also has served as an associate editor for Infant Mental Health and currently reviews for several major pediatric journals. Dr. Dixon is a fellow of the American Academy of Pediatrics and served in national positions in that organization. She is a member of the Society for Pediatric Research, the Society for Research in Child Development, the American Public Health Association, and the Executive Council of the Society for Developmental and Behavioral Pediatrics. She serves as consultant to several national and international organizations and has received an award from Healthy Mothers, Healthy Babies.Dr. Dixon continues to lecture and consult worldwide on aspects of maternal, child, and family health. She practices behavioral and developmental pediatrics in Montana and works with local advocacy groups on education and women''s health. Dr. Dixon has been married for over 30 years and has three sons. She and her husband travel frequently, are outdoor enthusiasts, and enjoy being amateur anthropologists.

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Question

I am an American living in the United Kingdom and was told that local anesthetic can not be given to a child younger than 6 months, so a baby would have to feel the pain if he is circumcised. I read in one article on this site that circumciI am an American living in the United Kingdom and was told that local anesthetic can not be given to a child younger than 6 months, so a baby would have to feel the pain if he is circumcised. I read in one article on this site that circumcision should be done before a child is 1 month old (my baby is 10 weeks old).

Answer

Practices vary around the world, but local anesthesia is given for many procedures in young infants, even preemies, and has been for some time, atleast in this country. So we are very comfortable with using it for this painful procedure. We give a dorsal penile block, a local anesthetic with a novocaine relative, which studies have shown to be safe and effective in relieving pain.

In this country, circumcision is often done with certain equipment that assures safety and reduces bleeding. Infants older than a month are often too big to use this, requiring that circumcision be done as a real surgical procedure, often by a urologist, a specialist who deals with problems of the urinary system. That's why we recommend that circumcision be done early if it's going to be done, as the procedure is much simpler for a newborn. Infants feel pain just as adults do, so I regard it as inhumane to do a circumcision without some anesthesia.