Paediatric Circumcision
Circumcision services for children after age-appropriate clinical assessment
What is paediatric circumcision?
Circumcision is the surgical removal of the foreskin, the sleeve of skin covering the head of the penis. The edge of the remaining skin is joined to the skin behind the head with stitches that dissolve on their own, so nothing needs to be removed afterwards.
There are two broad techniques. In the conventional method, your surgeon marks and excises the foreskin and closes the edge with fine dissolving sutures. Device-assisted methods use a clamp or a stapler that cuts and seals the edge at the same time, which shortens the operation and reduces bleeding, and the device is either removed at the end or separates by itself over the following days. Both are established, and your surgeon will explain which one they are using and why.
Age changes how the procedure is done more than what is done. In a newborn it can be performed with local anaesthetic alone, while in an infant or older child a general anaesthetic is used so that the child is completely still and remembers nothing. Your child is examined beforehand to confirm the anatomy is suitable and to check they are well enough for an anaesthetic on the day.
What it involves
Your child has a general anaesthetic, given by mask or through a small cannula, and is asleep throughout. Your surgeon adds a local anaesthetic block at the base of the penis or in the lower back while your child is asleep, and that block is what keeps them comfortable for several hours after waking. You will be given fasting instructions to follow exactly, usually no solid food for six hours and clear fluids permitted until two hours before.
The operation itself takes twenty to thirty minutes. A dressing or a light coating of ointment is applied at the end.
This is a Day Care procedure. You are usually asked to arrive in the morning, and one parent can normally stay until your child falls asleep and be there in recovery when they wake. Children are often unsettled or tearful for the first half hour after an anaesthetic, which is the anaesthetic wearing off instead of pain. Your child goes home the same day once they are awake, drinking, comfortable and have passed urine, which the nursing staff will wait for before discharge.
Recovery
Expect soreness for three to five days, worst on the second day, and controlled with paracetamol and ibuprofen at the doses your paediatrician writes down for your child's weight. Swelling and bruising of the area are normal and settle over one to two weeks.
Passing urine stings for the first few days. Warm baths help, and letting a younger child sit in warm water to pass urine makes it easier. Keep the area clean and dry, apply the ointment you are given so that the raw edge does not stick to the nappy or underwear, and change nappies more often than usual for the first week. A yellowish film forms over the healing area within a few days and is part of healing instead of infection.
Most children are back at school or nursery after about a week. Avoid cycling, straddling toys, swimming and rough play for two to three weeks. The final appearance takes four to six weeks to settle, and the area can look uneven and swollen well before it looks finished, so judge it at the follow-up visit.
Questions about paediatric circumcision
Will my child remember it, and does age make a difference?
Under a general anaesthetic your child is fully asleep and will have no memory of the procedure itself. What older children remember is the days around it, so how the visit is explained matters. Newborns can be done under local anaesthetic alone and heal very quickly. Infants and older children need a general anaesthetic to stay still, and the older the child, the more swelling and discomfort there tends to be afterwards and the longer the settling period. Your surgeon will discuss timing with you, taking into account your child's health, the reason for the procedure and school or holiday timing, since a week of quiet activity is easier during a break.
How much pain will there be and what do I give at home?
A local anaesthetic block is given while your child is asleep and keeps them comfortable for several hours after waking. After that, expect soreness for three to five days, worst on the second day. Paracetamol and ibuprofen given regularly for the first two to three days control it well in most children, at the dose for your child's weight written on your discharge sheet. Give them by the clock in those first days instead of waiting for crying. Passing urine stings, and warm baths or letting a younger child pass urine sitting in warm water helps considerably. Applying the ointment you are given stops the raw edge sticking to clothing, which is a common cause of pain.
When can my child go back to school and swimming?
Most children return to school or nursery after about a week, once they are comfortable, passing urine easily and no longer needing regular painkillers. Avoid cycling, straddling toys, climbing frames and rough play for two to three weeks, since a knock to the area is painful and can restart bleeding. Swimming usually waits until the wound is fully healed and there is no crusting or discharge, which is around two to three weeks, and your surgeon will confirm at the follow-up. The appearance keeps settling for four to six weeks and can look swollen and uneven well before it looks finished, so avoid judging the result too early.
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Day CareTalk to a care coordinator about paediatric circumcision
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one