What's the Best Age for Newborn Circumcision?

We have found that the baby / family experience is best if children are less than 2 months old at the time of the procedure. The younger the better. It is safe to perform a circumcision on the day after delivery if the child is healthy.

Why is younger better?

• Stronger calming from sucrose taste.
• Less skin means less bleeding.
• More comfortable lying flat on the back for a few minutes during the procedure.
• Younger babies tend to feed and sleep more during recovery, with fewer signs of discomfort (less crying and fussing) during the 2–3 days that the wound is sore after the procedure.

We safely circumcise older babies too, but past about 8 weeks the sucrose calming reflex fades, so older babies typically fuss and cry during the procedure from the positioning, not from pain. Older babies also cry more during the first few days of recovery at home. Parents need to understand and be comfortable with this before deciding to proceed.

We have a large experience offering circumcision for children up until 9 months old. It is described in the medical literature that complications such as bleeding or infection rates are higher for children outside of the newborn period. Our clinic has not had any issue with the surgery or the recovery for our older patients.

The important information parents need to appreciate if their child is older than 8 weeks:

Younger newborns (8 weeks or less) tend to have a stronger reflex to relax in response to tasting sucrose. As they get older, this no longer works the same way and therefore, as soon as we lie the children flat, and use Velcro straps to restrain the legs, they tend to fuss and try to sit up. Despite the nerve block injection, older babies tend to cry throughout the procedure simply from the positioning.

We perform the procedure despite this fussing and accept they will cry and wriggle around throughout. The surgical technique is designed to work even when babies are wriggling or moving, so there is not a risk that the movement will lead to a surgical error (this is an understandable fear or concern from many of our families). However, the wriggling and movement is challenging for the parents to watch and witness.

At our clinics, we allow parents to be with their children for all elements of the procedure. This means, for parents who choose, they can be in the procedure room. For older children, seeing their child restrained and crying can be difficult to witness and distressing. This should be carefully considered before deciding whether to be present or not.

We are often asked how we can be sure the crying is from the positioning, rather than from pain – perhaps the nerve block is not working fully or as intended. The truth is, if babies start crying during positioning and won't settle, it is challenging to know for sure what they are feeling. Typically, the crying doesn't worsen from the parts of the procedure that we know would be painful, and we see that children settle very quickly once the procedure is over and they are back in their parents' arms.

Also, we occasionally have older children that don't fuss from the positioning, and in these cases, we don't see a reaction to the surgery that would indicate pain. From these children we gain confidence that the nerve block is effective – even for children who are fussing from the get go. So we assume that children who are fussing from the moment we get them in position for the procedure are not experiencing the pain of the procedure.

When we agree to perform the procedure for older children, we enter into an agreement with the parents that they are OK with the procedure taking place while the child is visibly upset.