Male Circumcision

Male circumcision consists of the surgical removal of some, or all, of the foreskin (or prepuce) from the penis. It is one of the most common procedures performed all over the world. In the United States, the procedure is commonly performed during the newborn period.

Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks, and the benefits of newborn male circumcision justify access to this procedure for those families who choose it. However, parents should weigh the health benefits and risks in light of their own religious, cultural, and personal preferences, as the medical benefits alone may not outweigh these other considerations for individual families.

The three most common operative methods of circumcision for the newborn male include:

1. The Gomco clamp
2. The Plastibell device
3. The Mogen clamp

There are also other variations derived from the same principle on which each of these devices is based.

Care Of The Circumcised Penis

One of the first decisions you will make for your new baby boy is whether or not to have him circumcised.

Taking care of your son’s circumcision is usually very easy. After the procedure is performed, your pediatrician will instruct you on how to do this. If a Plastibell ring or device was used for the procedure, there is usually nothing to do. And generaly the device will come off after a few days.

However, if one of the other methods, Gomco or Morgan clamp, was used, you will need to apply a suitable lubricant regularly to the penis after circumcision. This is usually done with each diaper change, and a non-perfumed lubricant, such as Vaseline, should be sufficient.

Care Of The Uncircumcised Penis

If you have chosen not to have your son circumcised, there are some things you should be aware of and teach your son as he gets older.

What is Foreskin Retraction?

Sometime during the first several years of your son’s life, his foreskin, which covers the head of the penis, will separate from the glans. Some foreskins separate soon after birth or even before birth, but this is rare. When it happens is different for every child. It may take a few weeks, months or years.

After the foreskin separates from the glans, it can be pulled back away from the glans toward the abdomen. This is called foreskin retraction.

Most boys will be able to retract their foreskins by the time they are 5 years old, yet others will not be able to until the teenage years. As a boy becomes more aware of his body, he will most likely discover how to retract his own foreskin. But foreskin retraction should never be forced. Until separation occurs, do not try to pull the foreskin back – especially an infant’s. Forcing the foreskin to retract before it is ready may severely harm the penis and cause pain, bleeding, and tears in the skin.

What is Smegma

When the foreskin separates from the glans, skin cells are shed. These skin cells may look like whitish lumps, resembling pearls, under the foreskin. These are called smegma. Smegma is normal and nothing to worry about.

Does my Son’s foreskin need special cleaning?

Your son’s intact or uncircumcised penis requires no special care and is easy to keep clean. When your son is an infant, bathe or sponge him regularly and wash all body parts, including the genitals. Simply wash the penis with soap and warm water. Remember, do not try to forcibly retract the foreskin.

If your son’s foreskin is separated and retractable before he reaches puberty, an occasional retraction with cleansing beneath will do. Once your son starts puberty, he should retract the foreskin and clean beneath it on a regular basis. It should become a part of your son’s total body hygiene, just like shampooing his hair and brushing his teeth. Teach your son to clean his foreskin in the following way:

• Gently pull the foreskin back away from the glans.
• Rinse the glans and inside fold of the foreskin with soap and warm water.
• Pull the foreskin back over the head of the penis.

Is there anything else I should watch for?

While your son is still a baby, you should make sure the hole in the foreskin is large enough to allow a normal stream when he urinates. Contact our office or call your pediatrician if any of the following occurs:

• The stream of urine is never heavier than a trickle
• Your baby seems to have some discomfort while urinating
• The foreskin becomes considerably red, swollen or painful to touch.

[Adapted from the AAP   www.aap.org]

Is My Baby Getting Enough Formula, Or Too Much?

Signs that your baby may be getting too little formula are:

• Slower-than-normal weight gain
• Diminished urine output
• A loose, wrinkly appearance to baby’s skin
• Persistent crying or fussiness

If your baby is showing signs of being underfed, increase the amount of milk offered. Feed more volume and or at more frequent intervals. Burp as needed.

Signs that your baby is being fed too much at each feeding are:

• A lot of spitting up or vomiting immediately after the feeding, more than considered normal
• Colicky abdominal pain (baby draws his legs up onto a tense abdomen) immediately after feeding
• Excessive weight gain

If these signs of overfeeding occur, offer smaller-volume feedings more frequently, burp baby once or twice during the feeding, and occasionally offer a bottle of water instead of formula.

Choosing Nipples

Nipples can be made of rubber, latex and silicone substitues and come in a variety of contours all claiming to imitate the natural action and shape of the mother’s breast. None actually do!

Latex nipples are softer and more flexible, but they don’t last as long and some babies are allergic to them. Silicone nipples are firmer and hold their shape longer.

Nipples are also available in a range of sizes and flow speeds. You may have to try a few sizes to find the one that works best for your child.

Watch to make sure your baby isn’t having a hard time getting milk or isn’t getting so much that he’s choking or spitting up. Don’t alter a small nipple to increase its flow and, of course, discuss any feeding concerns with your baby’s doctor.

Because you can’t know beforehand which type or size nipple your child will prefer, it’s best to play it safe and buy one of several types. Once you’ve determined your child’s preference, you can purchase enough to last for months.

Orthodontic- type nipples

• Insert farther back into baby’smore natural milking action of the tongue, but inconveniently require a “which way to turn the nipple” decision. Be sure baby sucks on the widened base of this nipple, not just the mouth, allowing a tip.

Expandable rubbin nipples

• Designed to elongate during sucking but only if baby opens his mouth wide enough and sucks hard enough to draw the nipple farther in. Most, however, only suck on the protruded part. This nipple should be avoided for the breastfeeding baby, who may learn lazy latch-on habits from it.

Standard bulb-type nipples

• The easiest, with a wide base that best allows baby to form a tighter seal.

For the full-time bottle feeding baby, simply experiment with various types of nipples to see which one works best for your baby. If baby is both breastfeeding and bottle feeding, use a nipple with a wide base.

To lessen the rubbery taste of an artificial nipple and to sterilize them, boil for five minutes before first use. To avoid the possibility of a baby choking on a nipple, carefully follow the manufacturer’s caution advice on the package.

When To Replace Nipples

Formula should drip steadily out of a nipple. If it pours out in a stream, the hole is too big and the nipple should be replaced. Check nipples periodically for signs of wear, such as discoloration or thinning, and replace worn ones, which could break and become a choking hazard.

If the nipple becomes cracked or torn, discard it. Some nipples come with a variety of hole sizes to fit the type of liquid and the age of the baby. The nipple hole should be large enough for the formula to drip at an approximate rate of one drop per second when you hold a full, unshaken bottle upside down. Larger nipples and nipple holes are available for older babies.

Once the decision to breast feed is made, the next important thing is to select the type of formula you want to use. For most babies who are bottle fed, this process is usually initiated in the newborn nursery, and if the chosen formula is being well tolerated, there is really no need to switch to a different formula.

If there is a need to change to another type of formula, please call your pediatrician, or contact our office, to make an appointment to have your child evaluated. We will be very happy to discuss the options with you.

Choosing a Formula

Be sure to choose a DHA-enriched formula. Most, if not all of the US formula companies offer AA/DHA-enriched formulas.

There are some subtle differences among the major brands of infant formulas which may affect how your baby tolerates one formula over another. The vitamins and minerals in all formulas are similar, however, the nutritional fine points of the fats, carbohydrates, and proteins differ from one brand to another.

Standard formulas are those that are tolerated by most infants. Infants with special digestive needs require special formulas.

You may click here for some guidelines on how standard formulas differ and compare formula content. This may be of help in matching the formula to your baby’s needs.

Bottle Feeding Basics

Most mothers who make the decision to bottle feed their babies usually have a lot of questions about the process. There are several things to consider if you choose to bottle feed. These include formula preparation, sanitizing utensils, and feeding positions.

Here are seven simple steps that you can follow to successfully bottle feed your baby.

1. Make sure all bottles, nipples, and other utensils are clean.
   If the water in your home is chlorinated, clean the utensils in your dishwasher or wash them in hot tap water with dishwashing detergent and then rinse them in hot tap water. If you have well water or non-chlorinated water, either place the utensils in boiling water for five to 10 minutes or use a process called terminal heating.In terminal heating you clean, but do not sterilize, the bottles in advance. You then fill them with the prepared formula and cap them loosely. Next, the filled bottles are placed in a pan with water reaching about halfway up the bottles, and the water is brought to a gentle boil for about 25 minutes.
2. Read the directions.
   Be sure to follow the manufacturer’s directions exactly for the formula type you choose. Too much water and your baby won’t get the calories and nutrients she needs; too little water and the high concentration of formula could cause diarrhea or dehydration.
3. Preparing the formula.
   Bring the water you plan to use in the formula to a boil for approximately one minute. Then add it to the formula powder. If you’re preparing this in advance, be sure to store it in the refrigerator. If the formula is left out of the refrigerator for longer than one hour or if you don’t use refrigerated formula within 24 hours, throw it out.
4. Warm the refrigerated formula.
   Refrigerated formula doesn’t necessarily have to be warmed up for your baby, but most infants prefer it at least at room temperature. The easiest way to warm refrigerated or frozen milk is to place the container in a pan of water on the stove at low heat and rotate it frequently. Microwave ovens should not be used for heating bottles; this can overheat the milk in the center of the container. Even if the bottle feels comfortably warm to your touch, the superheated milk in the center can scald your baby’s mouth. Also, the bottle itself can explode if left in the microwave too long.If you warm a bottle or use it immediately after terminal heating, test it in advance to make sure it’s not too hot for your baby. The easiest way to test the temperature is to shake a few drops on the inside of your wrist.
5. Place your baby in a proper feeding position.
   Cradle her in a semi-upright position and support her head. Don’t feed her lying down — formula can flow into the middle ear, causing an infection. To prevent your baby from swallowing air as she sucks, tilt the bottle so that the formula fills the neck of the bottle and covers the nipple.
6. Take note of your baby’s intake.
   The pediatrician will probably ask you how much your baby has eaten, so be prepared to answer the question. Your newborn will probably take between two and four ounces per feeding during his first few weeks (during the first few days, he may take less than an ounce at feedings), and will probably be hungry every two to four hours. It’s best to feed your baby on demand.Don’t force your baby to finish the bottle if he or she is not interested. And if your baby is still sucking enthusiastically when the bottle is empty, offer more.
7. Burp your baby.
   Babies get fussy and cranky when they swallow air during feedings. This happens more often with bottle fed infants, though breast fed infants can also swallow air. To prevent a tummy full of air, burp your baby frequently — after every two or three ounces of formula. If your baby doesn’t burp after a couple of minutes of trying, resume feeding. Here are the three best positions:
   • Over the shoulder: Drape your baby over your shoulder and firmly pat or rub her back.
   • On the lap: Sit your baby upright, lean her weight forward against the heel of your hand, and firmly pat or rub her back.
   • Lying down: Place baby stomach-down on your lap and firmly rub or pat her back.

Types of Formula 

• Ready To Feed – Premixed liquid. Do not add water. Be sure to shake well before feeding as it may have settled.
• Liquid Concentrated – Mix with equal amount of water. Be sure to shake well before mixing to blend ingredients.
• Powder – Mix 1 level unpacked scoop of powder, using the scoop that comes with the container, with 2 ounces of water. Be sure to shake all together.

Breast feeding is a very rewarding experience for the mother. It can be challenging too, especially for the first-time mom.

The decision to breast-feed is one that most pediatricians encourage and actively support. However, not every mother eventually ends up breast feeding their children, and some that do so, do it for varying lengths of time.

We encourage every mother to make the decision to breast feed. We also understand that some mothers are not able to breast-fed for various reasons. For those mothers, there are several alternatives out there that will provide your offspring with adequate nutrition.

Before you choose not to breast feed, consider the following advantages of breast feeding.

Advantages to the BABY

Breastfeeding is good for your baby because:

1. It provides warmth and closeness. The physical contact helps create a special bond between you and your baby.
2. Human milk has many benefits.
   • It’s easier for your baby to digest.
   • It doesn’t need to be prepared.
   • It’s always available and at the right temperature
   • It has all the nutrients, calories, and fluids your baby needs to be healthy.
   • It has growth factors that ensure the best development of your baby’s organs.
   • It has antibodies (that formulas don’t have) that protect your baby from a variety of diseases and infections. Because of these protective substances, breast fed children are less likely to have
     • Ear infections
     • Diarrhea
     • Pneumonia, wheezing, and bronchiolitis
     • Other bacterial and viral infections, such as meningitis
     • Research also suggests that breastfeeding may help to protect against obesity, diabetes, sudden infant death syndrome (SIDS), and some cancers.

Advantages to the MOTHER:

Breastfeeding is good for your health because it helps:

• Release hormones in your body that promote mothering behavior.
• Return your uterus to the size it was before pregnancy more quickly.
• Burn more calories, which may help you lose the weight you gained during pregnancy.
• Delay the return of your menstrual period to help keep iron in your body.
• Reduce the risk of ovarian cancer and breast cancer.
• Keep bones strong, which helps protect against bone fractures in older age.

Importance of Good Positioning and Latch-on during Breast feeding

There are various factors that can determine whether you have a successful breast feeding experience or not. One of them is positioning. The other is proper latch-on. You can adopt one of many positions during breast-feeding depending on your preference and what suits you and your baby best. The importance of this cannot be over emphasized, because done wrongly, it can frustrate you and your baby.

Useful Breast Feeding Tips

• Nurse early and often
• Nurse with the nipple and areola fully in the baby’s mouth, not just the nipple
• Breast feed on demand as much as possible