Steps to prepare your baby for circumcision

Please feed you baby before arriving to our office.
Have your baby take Tempra or Tylenol one hour before arrival at the clinic:

Less than 3 months ½ cc (0.5 ml)
4-11 months 1 cc (1 ml)

Apply a small amount of EMLA cream (a topical anesthetic available over the counter) to your baby’s penis 1 hour prior to arrival at the clinic.

The primary purpose of this application is to reduce the pain the baby feels when we inject the Xylocaine. EMLA cream is optional.
Apply the cream around the base of the penis (the lower pelvic area above the penis shaft) follow our instructions, not the instructions that are written on the box.

Apply plastic dressing over the EMLA cream.
A pacifier may be helpful to comfort your baby.
Bring an extra diaper to go home.
Bring Polysporin Ointment, NOT CREAM, to the appointment.

What can you expect after the circumcision?

• A Xylocaine injection is used for circumcision. When the freezing wears off, the child may experience pain or discomfort. These symptoms should disappear after about 24 hours when treated with Tylenol.
• A dressing is applied, which is removed 24 hours after the procedure. Parents will be instructed on how to remove the dressing. If the dressing sticks to the skin, cut away the portion of the dressing that has come loose. Dampen the adhered portion, and gently remove it.
• If this method is not successful, wait until the child takes bath in 4 days.

There will be swelling following circumcision, especially on the underside of the penis (the frenulum). This is normal. Swelling along the healing incision line will slowly subside over 6-8 weeks. The surface of the head of the penis is often a raw after the procedure resulting in the formation of a crust, which gradually comes off during the first two weeks leaving behind healthy skin.

Please understand that after circumcision, two different kinds of skin (penile shaft skin and prepucial mucousa) with different textures and appearances are brought together. Do not be concerned if the blending of these two types of skin is slow. It takes many months for them to blend together as the healing process to come to an end.

Babies may have pubic fat that can hide the penis. After circumcision, this pubic fat may prolapse over the penis, resulting in a hidden or trapped penis. If this happens, carefully retract the penile shaft skin to prevent the skin from covering the glands of the penis.

 What to do at home after circumcision?

 Give your baby 0.5 ml of Tempra or Tylenol every four hours if he seems uncomfortable.
Apply Polysporin ointment to the head and shaft of the penis with each diaper change after the dressing is removed. This will keep the area moist and prevent it from sticking to the diaper. It will also help to prevent infection.
Give baby daily sponge bath for 4 days following the procedure instead of bathing in a tub.
Avoid rubbing the area when washing.
Make sure that the diaper is snug to avoid rubbing the penis.
During the first 12 hours following circumcision, change the infant’s diaper every 2-3 hours, or check the diaper to ensure that there is no hemorrhage.

What are the complications of circumcision?

 Bleeding (hemorrhage)- a small to moderate amount of bleeding often follows circumcision, causing staining of the diaper. After removal of the bandage there is often a short period of bleeding which normally stops within 30 minutes. Although quite rare, if significant hemorrhaging occurs, the child should be taken to the emergency department, preferably Sick Kids Hospital. The diaper will contain a large amount of blood, and may include blood clots
Infection – Even though infection is rare following circumcision, inflammation and swelling are quite common. Regular use of oral antibiotics is not recommended. However, the ointment that is applied after circumcision contain a small amount of antibiotic. If significant redness, swelling, pain and tenderness are seen within 48 hours of circumcision, the baby should be examined. In the case of infection, treatment with antibiotics is required.

What follow up appointments are needed?

A routine follow-up visit is not necessary, but if any of the aforementioned problems arise, a follow-up visit should be arranged.