Do Infants Feel Pain During Circumcision

The statement that infants don’t feel pain because their nervous system isn’t developed enough is often used to justify minimal – sucking on a sugar-coated piece of gauze, being given a small amount of wine – or no pain relief during a circumcision. It was also believed that if the circumcision cut were done exceedingly quickly – in a minute or two – it wouldn’t hurt. Finally, still another sign of no-pain was a quiet infant who didn’t cry.

Historically

Circumcision has been around since antiquity and is, in fact, the oldest known surgical procedure. Historically, it was often a procedure to merely remove the tip of the foreskin that extended past the end of the penis. This is interesting because if a man’s opening to the foreskin was too tight and didn’t allow an erection, and therefore allow an ejection, removing the tightness would make him fertile. Doing it to an entire tribe of men could increase their numbers dramatically over centuries.

In the past, and in some cultures today, circumcision was/is regarded as painful. Only the male was/is expected to endure the pain. Enduring the pain gives him the rite of passage into adulthood and into his tribe or community of grown men. It also gains their respect. Thus, circumcisions used as a rite of passage into adulthood, and especially as rite of passage into the warrior class, expect pain, only the pain is expected to be endured – without whimpering, crying, or any other outward sign of intolerance to the pain. Such cultures tend to perform the circumcisions on older children and young adults and not on infants.

Studies about infants and pain

In the news, in September 2013, were the results of a recent study that shows that pain can be felt as early as the second trimester of gestation. While the study was cited as proof that late abortions (or all abortions) should be legally banned, the study is also proof that an infant already born can feel the pain of his circumcision when no pain relief – or when inadequate pain relief – is used.

Another study, lead by Dr. Rebecca Slate, at a leading medical college in London also showed that infants could feel the pain of being cut during circumcision. But it also showed that traditional circumcision pain relief, such as oral sucrose (sugar to suck on) is inadequate, and that the pain the infant will feel, despite the effect of sugar on his brain, can even cause his brain to be damaged by the trauma he feels. What’s a parent to do?

One anesthesiologist, recently interviewed about infant pain for this article, was totally against the use of even topical pain relief. She favored the use of wine, convinced that its alcohol could prevent the infant’s brain from feeling the pain of his circumcision, especially of a quick circumcision. Although she had been medically educated nearly half a century ago, her belief was that topical pain relief could have a serious detrimental effect on children who were allergic to it even causing them to stop breathing. In contrast, she believed that alcohol in wine given during a traditional circumcision could numb the pain for most infants.

What is adequate pain relief for a newborn’s circumcision?

Given that the statement that infants feel no pain is totally untrue, what should be done to relieve the pain of a circumcision? First, as any dentist, surgeon, or ordinary person knows, individuals have radically different tolerance for pain. Thus, some can fall, break a hip, and feel only slight discomfort, while others can be traumatized by the same events. Ditto for splinters, paper cuts, and dental work, including root canals. So perhaps it is true that topical pain relief may be sufficient pain relief for one infant going through a circumcision and totally inadequate for another. Yet how do you know which infant, especially one only a few days old, is going to be resistant to pain and which is going to be less resistant, even terrified and traumatized by the pain?

The conclusion here is that a baby who is undergoing a circumcision without pain relief can, and most likely does, feel pain. Even if he doesn’t cry, he may be traumatized from the pain which may stay with him for life, imbedded deep in his brain. While many advocate pain relief that is topical or, as in the case of sucking on a sugar-coated piece of gauze, being served a small amount of wine, or having a topical ointment applied, we believe in local, injectible pain relief for newborns and infants under 15 pounds or less than 2 or 3 months old and general anesthesia for older or heavier infants and children. Other parents may opt to prevent any pain – by choosing to leave their son’s foreskin intact and forgoing the circumcision altogether.

What is most important to know is that many, if not most, infants can feel pain, and that since adequate pain relief is available, they deserve to have it used on them. That an infant feels no pain is incorrect and should therefore not be used to justify: leaving them alone, strapped to a cold restraint board, waiting to be circumcised. All newborns deserve to be coddled both before and after the procedure. And of course, as already mentioned but worth mentioning again all infants undergoing a circumcision deserve adequate – and modern – pain relief.

Given the potential seriousness of any medical problem, we advise you to consult with your doctors for further information.