2002 Perinatal guidelines for breastfeeding and circumcision

Guidelines for Perinatal Care, Fifth Edition, November 2002.

American Academy of Pediatrics, American College of Obstetricians and Gynecologists

[CIRP Note: This file contains extracts of the brief language regarding breastfeeding and neonatal circumcision that are taken from a much larger work on the care of the newborn. One notes that the classification of circumcision as an elective procedure to be performed at the request of the parents removes any suggestion that circumcision is medically recommended or that it is a normal part of hospital routine. In contrast, breastfeeding is highly recommended and apparently should be given priority.]

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Antepartum care

Support of Breastfeeding

During prenatal visits the patient should be counseled regarding the nutritional advantages of human breast milk. Human milk is the most appropriate nutrient for newborns and provides significant immunological protection against infection. Newborns who are breastfed have a decreased incidence of infection and require fewer hospitalizations than formula fed neonates. Women should be provided with information regarding available lactation consultation services and organizations (see “Breastfeeding” in Chapter 7).

Circumcision

The topic of newborn male circumcision should be discussed. Newborn circumcision is an elective procedure to be performed at the request of the parents, on newborn boys who are physiologically and clinically stable. The American Academy of Pediatrics 1999 Task Force suggests that existing scientific evidence demonstrates potential medical benefits of newborn male circumcision (eg, reduced incidences of phimosis, urinary tract infection, and penile cancer). However the data are not sufficient to recommend routine neonatal circumcision. Appropriate anesthesia should be provided for the procedure (see “Circumcision” in Chapter 7).

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Care of the Neonate

Circumcision

Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. The exact incidence of complications after circumcision is not known, but data indicate that the rate is low and that the most common complications are local infection and bleeding. Given this understanding, parents should make the determination in the interest of the neonate. To make an informed choice, the parents of all neonates should be given accurate and unbiased information on circumcision and be given an opportunity to discuss this decision. If circumcision is performed, analgesia should be provided. Swaddling, sucrose by mouth, and acetaminophen administration may reduce the stress response but are not sufficient for operative pain and cannot be recommended as the sole method of analgesia. Although local anesthesia and EMLA cream provides some anesthesia benefit, both ring blocks and dorsal penile blocks have proved more effective.

The uncircumcised penis is easy to keep clean. The foreskin usually does not retract for several years and should not be forced. Gentle washing of the genital area while bathing is sufficient for normal hygiene. Later, when the foreskin is fully retractable, boys should be taught the importance of washing underneath the foreskin on a regular basis.


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