Circumcision - how do I discuss it with my 3yo?

[Gracie123]

Long story, but basically DS needs a circumcision for medical reasons.

We have decided to go privately as the NHS version looks horrendous and private doctor will come to our house, less scarring, faster healing time, shorter waiting list... etc...

I'm not here to have people make me feel guilty about a toddler getting circumcised. He needs it for medical reasons and it's been a very emotional decision already.

What I'm hoping is that someone has been through something similar and can help/advise me on how to talk to him/prepare him for it.

The surgery is booked for 2 weeks time. Should we be discussing it now, or will that just make him scared for longer? Should we bring it up on the day for the first time?
How much detail would you go into?

He's my first baby and the only boy in our family (sister had all girls) so we've not really had anyone to talk it over with.

Anybody?

Do have a search - I know there are people on here who've had to do it too and so you could PM them? Poor all of you :(

Thanks.
Hadn't thought of searching, mostly because I don't know how to PM!
how do you do it?

Is the private doctor who will come to the house experienced in circumcisions? Are they a paediatric urologist?

On the right of someone's namebar above their post is Add message/Report/Message poster. Choose the last one

I've done a search for you and come up with this thread that might be useful:
www.mumsnet.com/Talk/behaviour_development/952844-DS-Circumcision-or-not

so you could PM the woman who started the thread and ask her :)

I would start talking now, no other advice as I have no experience sorry but I think that the sooner you start preparing him the better, you don't have to mention any pain or soreness yet but do explain whats going to happen and why he will feel better afterwards

Iskra - the doctor is a paediatric surgeon specialising in urology. He's one of the best in the country and we have paid a lot of money to get him.
It's not really a good time for us to pay for it, but I really didn't want to leave it longer for the sake of saving up money.
He's been extremely kind and explained everythin very clearly to us. I think going private was the right thing to do, but it's still a hard decision to make. I guess nobody wants to see their child in pain, even if it is small in proportion to the alternative.

I am not judging you, but I am struggling to visualise a surgery taking place in my house. Will he be anaesthetised too?

I'm with kreecher

I cant see how a surgical procedure can take place in your house

but I would do an inbetween thing with your ds, dont tell him right now but dont wait till the day

and be very matter of fact and give him the info he needs

Yes, he will be having a local anesthesia. It's one of the reasons we chose this particular surgeon was that he is willing (for a fee) to come to your home if your child is under 5 years old. He also returns in 24 hours for a check up and again in 4 weeks. We get his mobile phone number and can call anytime day or night in the first 48 hours if we have any problems.

He actually suggested doing it at home as we live quite a way from the clinic and it would be uncomfortable for DS to go in his 5 point harness car seat afterward.

Basically, it's classed as surgery, but what he is going to do is anesthetise the area with a spray, then give the local anasthesia injection. Then the foreskin will be stretched over a plastic ring, and a special thread (used for stitching) is tied around really tightly.

Apparently by the time the injection wears off (about 30 minutes) the circulation will have been cut off and he shouldn't feel anything in that area, but will be able to feel the plastic part touching him. He likened it to me wearing a bracelet with a tight jumper over it. I will feel the bracelet rubbing my wrist, but I have no nerves feeling the sleeve and wouldn't notice if it started to wear through.

So basically in the next 4-10 days with lots of salt baths the skin will just drop off (the the plastic with it) in the same manner that his umbilical cord did. There will be no open wound, therefore no dressings and no risk of infection (although all the equipment is disposable one time use stuff, just in case).

I still don't like it. He might not be in pain, but he really doesn't like people touching his willy (had a lot of it with doctors over the last year) and whether or not it hurts he will probably still be very distressed about it.

Christine Thanks for that. I have PM'd her now.

I certainly would not have this procedure done at home, it really should be done in a hospital. Who is assisting the surgeon? Does he have his own private team to come with him? Where is his NHS base - as all Drs practising privately have one. As your child will be awake here, he will need to be restrained - who is going to be doing that? I have worked in paediatrics for 20 years and I have never heard of this being done at home in a toddler. I think you should think very carefully about this again and have the procedure done properly in sterile conditions with correct support. Good luck.

Thank goodness for someone with sense. Well said sausage and mash. I honestly can't imagine a child (particularly one who dislikes his willy being touched) staying still enough for this procedure to take place.
OP, please rethink this.

I totally agree, I too work in peads and am horrified that a surgeon would consider it!! It is very difficult to restrain a three year old for a simple blood test let alone delicate surgery .. Even suturing a wound is difficult on a distressed child.... Please think very carefully before you go ahead, you obviously want what is best for your little boy and there may be better ways of going about it .. Xxx

Thanks for your input. We have talked about it a lot.
The surgeon will be bringing a nurse with him to assist, but, yes, my husband and/or I will probably have to restrain him.

I have spoken to another mother privately who said her son had this same procedure done at age 5 and happily chatted to the doctor about his holiday whilst it was being done. Apparently he didn't feel any discomfort until the anasthesia wore off later that day, but a spoonful of calpol sorted it and he was fine after that. I'm not naieve enough to think that my son will be that calm about it (like I said, he has already formed an opinion of doctors and willies!) but at least I know the distress will be mostly at loss of control and not pain.

The reason I am definitely not going with the NHS is that there is no would to suture. It is nothing like the NHS version of the circumcision, as nothing is going to be cut, so there is no suturing.

Again, all the equipment is sterile, I'm assuming you are referring to my house not being sterile? I'm not really sure what you think will happen as there is no open wound to become infected.

I took my babies home with their umbilical cords tied off and there was no infection risk. In fact plenty of people have home births in unsterile conditions and it's not questioned.

The surgeon does have an NHS base in London. Under the NHS though, he would be required to do the cutting/suturing/general anasthesia thing instead though. By going privately we are able to go with the less traumatic, faster healing, version.

*Wound - not would

I'm sorry to keep harping on about it Gracie, but this just doesn't sit comfortably with me at all.
I don't think that anyone is questioning the cleanliness of your house, rather the bizarre notion that you are having a surgery, that isn't 'normal' in your house without any back up.
Surely if the surgery is less traumatic and faster healing it would cost less for the NHS to do it that way.

Or at a private hospital. Not at home.

We could have it done at the private hospital, but then he would have to drive home with the seatbelt of his 5 point harness car seat between his legs, and I'd prefer he didn't have to.

He is also scared of hospitals having spent plenty of time there in the last year, and I'm hoping it will be less stressful for him at home.

The back up is that we live around the corner from A&E, although the dr assures me that if there are any complications we can ring him day or night and he will come straight back out to check up for us.

I'm not sure why the NHS do it differently. I guess because it only works on small children and as an older boy would need the other type of surgery, maybe it makes sense to only offer one kind? I don't know. I don't make the NHS decisions It certainly does seem like it would be cheaper for them this way, but apparently they don't do it.

Also, the NHS want us to wait until he reaches puberty for the surgery. I am 100% against waiting for this as I think it will be much worse to put a teenager through the stitches type of surgery (sorry can't remember the real names for the two different types ) and at an age where he will remember it. And he will have to go through the next 10 years crying about peeing and on cycles of antibiotics and creams that never really work.

So the decision was to go private and get it done now. Every private doctor we spoke to insisted that this other type of surgery is a much better way to do it, and the younger the child the better.

The surgeon we have chosen does this everyday. This surgery is 'normal' for him. There are no open wounds. There is less risk of infection than a hospital (my son lives in our home every day and doesn't catch anything. The hospital may have MRSA or any other bugs lurking in the waiting room for him).

I really don't understand why people think it would be better to have a very simple (but unpleasant) procedure done in a hospital

Is this the plasiibell method then?

Its sounds really odd to do it at home but there are places that do this at a clinic which is set up like a typical GP surgery, like this one so i suppose due to the seat belt thing it isnt a totally bizarre choice

I would probably prefer there to be 'crash' equipment there just incase he had a terrible reaction to the local anaesthetic, unlikely though. But if there is a nurse there maybe he will have that kind of equipment too.

OP, I don't get the hard time you're getting. You've explained the procedure (sounds rather like how they used to doc lamb tails, or tying a thread around a skin tag) and it seems very sensible to do this in a home situation rather than a hospital.

I think the home birth comparison is very apt (except that circumcision is obviously well down the danger scale compared to birth)

I can't offer much help though, except that it seems to me that preparing him in advance with casual mentions seems like a better idea to me than just having the doctor arrive and do it one day... unless your child is a worrier?

It sounds like cutting off a skin-tag (read a thread about it on here a few days ago) - i.e. cut off blood supply and surplus skin falls off.

I think its great that the surgeon will come to your house, much less traumatic all round! Lucky you to have the money to pay for it and the wherewithal to arrange it rather than waiting 10 years to have a less ideal surgery done through the NHS. It sounds like it'll be briefly unpleasant but soon be a distant memory for your son. My friend had her toddler circumcised (for religious reasons) and she said she was very very upset by it all, as hated him being upset, whereas her DC was fine 20 mins later! I'm pretty sure that took place in their house too?!

Re talking to your son about it, can you explain that this is a very special doctor who can 'make him better', so he won't need to take the yucky medicine, use the owwy creams (or whatever he usually says about the medications). Maybe practise putting a piece of kitchen roll tube on and off a teddy bear's arm/leg (most similar thing I can think of to the procedure) and have bear say 'oh that feels better'. Tell him Mummy and Daddy will be with him all the time and won't leave him. Also, maybe promise him some treat for being a brave boy.

Thanks. I hadn't thought of using teddy to practise on. That is a great idea, exactly the sort of response I was hoping for in fact!

I don't think he's a worrier, haven't usually had so long to prepare him for something before.

chunky it is very similar to the skin tag procedure. It is a plastibell that they will be using. Apparently if the child is over 3 months old there is no need to do the cutting to place the ring, so there is really no wound to get infected.

I think I will probably be like leeloo 's friend though, making a much bigger deal of it than he is

What's interesting is the number of mother's who have PM'd me about this thread that won't post on here because they have had such abusive message on MN over these issues. Personally I think you have all been very lovely considering what some of these other mother are saying they experienced

We had to have DS circumcised for medical reasons but he was a bit younger than two and it was part of a bigger GA operation.

Just to say though we drove him home from the hospital in his 5 point car sear without any problems and this was the day after the Op.

I think I worried about it more than needed - mainly because I had preconceived ideas about circumcision and all the negative opinions I had read about it on mumsnet, facebook etc. In real life I have met several men / partners of men who have been circumcised and they seem very confused when I said I was worried about DS when he grew up [that makes it sound like I go round discussing foreskins all day but no ]

I havent said much to DS - he is now 4.5. We just say he looks different because he had to have a bit of skin that was making him poorly removed and now he is all better.

I don't want to give you a hard time at all as making decisions reguarding our children is hard enough, I just wanted to give you
My opinion as I have worked in peads for a long time my biggest concern would be restraining him for the procedure .. Are you prepared to physically hold him down which is far from easy with a wriggling toddler . As a professional I would question how ethical that was with a child of this age without sedation, there aren't many three year olds that tolerate procedures well hence the need for a GA for simple things in kids .....

Forgot to add that if you do go ahead I would ask your gp to prescribe some light sedation for your son to make it easier on all of you....