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

81 replies

Gracie123 · 15/03/2011 12:54

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. Sad

OP posts:
Are your children’s vaccines up to date?
leeloo1 · 16/03/2011 16:58

:) Glad the bear was a helpful idea. :) Re Pumba's sedation idea then I can recommend taking Teetha powders (maybe for both of you Grin), they're in Boots as teething powders, but are Camomila (spelling? Camomile's 'active' ingredient anyway) so very soothing/calming.

I'm just curious, but surely most religious circumsions would be in homes/places of worship rather than hospitals? So not sure why people see it as being so unusual to have it done at home?

Isn't it awful that mothers are too scared to post on here. :( Makes you wonder where 'having an opinion' verges on bullying. :( (not aimed at anyone on here, just general thought)

Gracie123 · 16/03/2011 17:05

I will talk to the GP about sedation. That is something I hadn't really thought of (beyond a glass of wine for me!)

My son does have some... Peculiarities shall we say, that make me think I may not need to restrain him physically (he's ASD and if you tell him he can get out of bed he will lie there weeping that his teddy is out of reach, but wouldn't dare get up to go get it). He doesn't like having the doctor attempt to retract his foreskin, but he does lie there and let him do it and I've never done more than stroke his hair for it.

DH has got time off work though, just in case (he's pretty strong and I don't delude myself that I could hold him on my own).

Like I said before, I do genuinely value everyones input, and you have all been lovely about a topic that is very emotional for all of us for various reasons, so thank you.

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Gracie123 · 16/03/2011 17:09

Ps on discussing DS ASD with the dr he has decided to order in a special anaesthesia that last 6-8 hours which he used on his own child when he circumcised him (he is down syndrome) and says that he always does it for children who may not understand the procedure.

He said the most difficult part of the aftercare will be ensuring DS doesn't play with it! Apparently he's known children this age to just pull it off Shock and had to come and put int back on again!

I shall be double taping his diapers on....

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MadameCastafiore · 16/03/2011 17:16

DS had his done when he was 4 - his foreskin was stuck to the glands at the top of his penis so we had no choice to have it done as he was getting continuous infections. DH also had to be done but not until he was 18 and it was quite a horrific experience as it was done as an emergency after it split - he should have spoken to his parents about it and had it done before then but they are not that kind of family.

Anyway - just told DS that as he had had these infections he would need a little operation on his winkie and it would involve staying overnoight in hospital - to be honest we kept everything kind of vague - we didn't want to scare him and he didn;t ask too many questions.

My friend had had to have her 3 boys done because their foreskins were just very tight and she said it was almost painless and really not a big issue - that wasn;t the case for DS - it was horifically painful and we spent about a week afterwards with him screaming everytime the bed moved or the wind blew on his exposed organ!!

Make sure you have lots of calpol and neurofen handy and a room where he will not be disturbed if he has the same problem as DS - if he just has a tight foreskin then it is something he will get over very quickly.

Good luck.

MadameCastafiore · 16/03/2011 17:25

Sorry can't understand why he needs it doing if he has enough excess skin to put this ring thing underneath?

Would also be pretty shocked that any professional would be willing to carry out a procedure at home on a small child without a general. If he is uncomfortable having his foreskin retracted how is he going to feel with this going on and although the way he acts with the teddy is giving you comfort that he won't move - the poor little mite maybe bloody dying with pain or angst inside.

Bit shocked really - woudl think it would be much easier to borrow a hig backed booster seat for his journey home and make sure he has a genneral so he doesn't have to go through this.

Gracie123 · 16/03/2011 17:53

The point of the local anaesthesia is to completely numb the area and the surgeon will spend some time stretching the skin until he can get the ring underneath it (apparently they come in lots of sizes). I told him the other doctor said it was too tight to retract, but he assures me that wig anaesthesia it won't be.

I've also spoken to several women now on PM who had their children done this way and the child chatted away quite happily during the procedure. It is completely numb.

I know that's hard to understand if your son had the stitches kind and it was traumatic. I'm sorry that happened. But that's what I'm trying to avoid and every (private) doctor I've spoken to has told me that this is the best way to do it.

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sausagemashnpeas · 16/03/2011 19:53

Ok. I echo pumba's concerns in that restraining your DS really would be a task and a half. I have at times have had to have a colleague help me hold a baby in place for a lumbar puncture. I never involve parents in restraining if I can help it as if the child becomes distressed (which they usually do if they are being restrained) this usually upsets the parent and therefore leads to inadequate holding as they (quite rightly) want to comfort their child and probably need comforting themselves! I also think that comparing this procedure to a removal of a skin tag is a bit Hmm and also to a home birth??! Well for starters, the woman in labour has been involved in that choice and is a free and willing partner in the whole process, and certainly does not need to be restrained (one would hope).

I'm just concerned about:
1 - Restraining
2 - Emergency equipment back up in case anything goes wrong.

Also, as Madam states - why does he need it doing if the foreskin can be pulled back to get the ring underneath? Is a slit in the foreskin not needed? Sorry, I can understand if you don't wish to share your ds's details. If it is the Plastibell technique, then yes, it is offered on the NHS.

I'd just wish you'd have a bit of a re-think on this, if I were you.

Leeloo - I know circs are done at home for religious reasons - but I'm not really one that agrees with that either. Just my personal opinion on this, I really hope I'm not seen as bullying Blush

Tell you what. I'm at the Royal College of Nursing for a meeting tomorrow. Let me see if I can look something up about all this. It's just sitting with me a little uneasily, that's all...

sausagemashnpeas · 16/03/2011 19:54

Woops, too many words in bold there, sorry.

JessRabbit · 16/03/2011 19:56

Do NOT go ahead with this procedure at home.

Just don't, my son had it done aged 8 and he was in excruciating pain.

Why won't you go to a private hospital and have it done there?

Gracie123 · 16/03/2011 20:09

It is the plastibell, but my NHS paediatrician told me we couldn't have it on the NHS, so now I'm confused Confused

He said DS would almost certainly need it done by the time he reaches puberty, but it wasn't tight enough that the NHS would do it now. By 13 I'm told he would be too old for plastibell anyway. Does anyone know if this is true?

My friends 14yo son just had it done for similar reasons and 3 months on he still walks out the room when someone kisses on TV as he says it's too painful to get an erection Sad I don't want my son dealing with those issues at that age when he can have a plastibell now with anaesthesia that means he won't be in any pain.

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JessRabbit · 16/03/2011 20:13

Have it done in a private hospital then. Why does this surgeon want to carry it out at home?

peppapighastakenovermylife · 16/03/2011 20:27

I don't think anyone is really questioning why you are having it done...just where.

Remembering now - my DS was circumcised as part of a bigger op and had to have a catheter in for a few days. I had to hold him down just to have that taken out and it was horrific (and took about a minute). I can't imagine having to hold him in place for any longer. Sorry....that isn't meant to be scaremongering, just how I felt.

We took DS back home - 50 miles - in his 5 point seat when he had a much bigger op in that area. He had to be strapped in tightly (normally) as we were going down the motorway. He was fine.

sausagemashnpeas · 16/03/2011 20:32

Sorry - maybe I'm wrong. Still, as Jess says - a private hospital? They do it at The Portland...

iskra · 16/03/2011 20:40

They do Plastibell at GOSH (or at least did in 2007, which is when I worked in Paed Urology there).

JessRabbit · 16/03/2011 20:42

Operating theatres are sterile for a reason. I would question the legality of this operation.

PUMBA · 16/03/2011 20:49

GOSH definitely use plastibell technique as do other London hospitals, xx

MyLifeIsChaotic · 16/03/2011 21:17

This reply has been deleted

Message withdrawn

MadameCastafiore · 16/03/2011 21:19

If it isn't tight enough to need it done now do not have it done now and see how things go - this man seems like he is out to take your money - no surgeon can catagorically say how a child will grow and what will happen dpwn there in 10 years!

But you are happy to maybe have to hold him down whilst he goes through this?? I would rather be at an age where I can understand what is going on and why it is happeneing and I am sure your son would. And not be in any pain - do you really think he won't be in any pain or at least be uncomfortable?

WOrking in a hospital that is not involved in surgery we have such strict infection control procedures - your home is not appropriate for this to go on in and I would question whether this guy has insurance to undertake this in your home because I would think it would be rather hard to get insured to carryout what is a medical procedure in someone's front room!

Gracie123 · 16/03/2011 23:54

Of course it's legal!

If anyone took two seconds to google it you would find all kinds of companies offering the same service.

The peadiatric urologist (NHS) told me that it was not bad enough to et done on the NHS now (although my son I obviously in a lot of discomfort and repeatedly on medication for infections).

He is a specialist in this area and has many years experience and said that it was his opinion that when my son reached puberty it Wouk need doing. He works for the NHS and is making no money from this recommendation it is obviously our choice if we want to wait and see, but the operation is much more difficult with longer recovery times an higher risk of infection (due to open wounds) done at that age.

With that in mind, he suggeted we consider having the surgery done privately, and I researched it thoroughly and found one of the best surgeons who does it routinely and has a >1% complication rate from surgeries he has performed over the last 15 years.

He has kindly offered to bring an assistant and use a stronger anaesthesia than would normal be used to completely numb the area because my son is on the autistic spectrum.

People with no specialism in this area telling me that all the doctors are wrong and that my son will be in agony are not helpful. Of course you are entitled to your opinion, but why do you feel the need to force it on me?

I came on here asking for advice in preparing a toddler for something that he will probably find quite scary.
I did not come on here to have people slating the decision that my husband and I have come to after careful research.
If I wanted that I would have posted in am I being unreasonable.

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SingingSands · 17/03/2011 00:26

Quite right Gracie123. You have made a sensible and informed choice which is hard to do when considering circumcision, for whatever reason.

To answer your original question, I would wait until 3 days before the op to tell your ds that the doctor is coming to make him better. Long enough in a child's view to talk it over and quick enough to arrive that he is not worrying for too long. Be positive and calm in discussing it, use positive words. If he sees you are calm, this will reassure him.

Good luck. You sound like a very sensible mother, and I support your decision

Gracie123 · 17/03/2011 00:29

Thank you singing.

Feel a bit embarrassed about my outburst now Blush
You can see how I felt from all the typos!

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DoubleLifeIsALifeHalved · 17/03/2011 01:11

wow, the world of circumcision is a very difficult one isn't it! tempers run high and everyone has an opinion!

How crazy is it that I will post the most personal details and horrors of my life here, but was considering name changing for this post as I don't want to be flamed!

I had to get my DS circumcised, and found it a very disturbing experience - NOT the actual thing, but the misinformation, prejudice and conflicting views... I really had to dig around for information and spent a long time making my decision, as it seemed everyone had an agenda or a 'stance' rather than it being about my baby and his situation.

I ended up having it done in our house, by a very very experienced (and private) fully qualified consultant. It was the best decision and I am glad I did it that way, although initially the idea went against every bit of received wisdom about medical procedures.

In my search this is what I found out, which may explain why things are like they are today. You may or may not be interested, but here you go!

10 years plus ago, circumision was relatively easy to get on the NHS, for medical grounds, and even for religious grounds in many hospitals (not discussing the morals of this BTW!), as it didn;t have any stigma, and was regarded as an operation like many others, it just didn;t seem to be that big of an issue either way.

THEN due to an increasing muslim population, circumisions became very popular and the cultural side of it overwhelmed the medical side...so any debate around circumision seems to contain a debate around:

Religion
Otherness
Britishness
Identity
Fear of the unknown
Freedom of choice
Right to free healthcare/ role of NHS
Rights of the child
Body ownership and what parents can ethically decide for their child or not

... so basically, circumcision got driven underground. This was a terribly bad thing, as it meant whole communities turned to unqualified people to do circumcisions in the home, with unsterilised knives and no aftercare or information on what to do if something went wrong - in these conditions the risks are appalling.

As doctors now don't tend to perform many/any nowadays, this means that people within the NHS regard it as a tricky thing to do, and rate the risks as high (a bit like midwives not delivering breech babies). Places like the Portland do circumcision privately, BUT its not a very frequent operation for them (and yes they do give a general for it), and the doctors don't actually have that much experiences - they only do approx 20 a year, if that.

So going against convention are a number of private doctors, who believe that whatever the rights or wrongs of circumcision culturally, people will do it/ have a need to do it, so for a few doctors, it almost seems like their mission to provide this service.

I ended up getting a consultant who had done 1000s of circumcisions a year, and was an absolute expert. He provided a proper service before and after, which is crucial, and talked us through exactly what we should expect and how best to minimise our babies discomfort.

AS you/ someone mentioned, in babies they have to cut the foreskin a bit before using the plastibell so that the foreskin can stretch, so it makes it slightly more invasive than in children, as they dont have to cut it - that should make your and his experience so much better as that was the only bit i had trouble with really.

Top tips I can pass on:

  • he suggested we take photos at 12 hrs, 24 hrs and 36, and beyond if we felt the need, and send to him, so he could immediately see if there was a problem (this was such a reassurance, i wonder if you could suggest doing the same?)
  • he described in detail what a circumsised baby penis would look like, as i had no idea and didn't know what was normal or not! he also showed us pictures of the plastibell in action as it did its thing, so we could see what it should look like so we didn't feel uncertain
  • he also gave us a recommendation of which hospital to go to, what to say and what to demand/ watch for, just incase of an emergency - he said alot of damage is done by outraged doctors trying to take off the plastibell and not knowing what they are doing! no idea if thats true or not but it was good to be prepared! he said to go to a hospital which has a paediatric surgeon in house and permanently on call, as many dont and a normal paediatrician or A&E doctor just wont know what to do. Anyway, the risks are tiny tiny tiny, but it pays to have a plan for all eventualities.

So, just wanted to give my support and offer advice from someone you'd been through that journey from NHS to the idea of doing it in home, and i can understand how odd that seems to anyone who hasn't had to thread that path themselves!

Your and your DS experience will be different as he's 3, but if he wont move, then it should be over quickly, and i hope he wont remember the loss of control too much after a little while. I was thinking that the fear/ loss of control would be very traumatic, but then I realised that he would experience that in a hospital too, as they knock him out, and so it cant be avoided poor chap.

Good luck, and let us know how it goes,

DoubleLifeIsALifeHalved · 17/03/2011 01:15

forgot to answer original question... what about preparing him with something vague like 'the doctor will come and make it better, and he's coming to our house so its not as scary, and he'll give you a tiny scratch and thats all you will feel.' i think they always tell children having a general that they'll feel a tiny scratch (as the needle goes in)... scratch sounds more surfacey and familiar?

And then can you get the doctor to show him the plastibell on a teddy or something? and let him touch and play with a plastibell and see its just a plastic ring before it gets put in, so he knows its not needles/ knives or anything else v scary?

SpringchickenGoldBrass · 17/03/2011 01:27

I am concerned about the fact that the only doctor who will do it is one who will do it in the home, as well. This suggests to me that it might not actually need to be done at all. Pardon me OP but is there any family/cultural pressure going on in the background here eg have you originally refused to do it and now been convinced that a few minor infections mean it is necessary when the NHS doctors don't think that it is?

differentnameforthis · 17/03/2011 07:10

I told him the other doctor said it was too tight to retract, but he assures me that wig anaesthesia it won't be

No, it won't be because an the penis is cut to begin with, then an instrument is driven under the foreskin to separate it from the penis.

It is then clamped and they do what they have to.

The local is also never adequate enough.

Your house will NOT be as sterile as a theatre. I don't care how clean it is!

PLEASE do not delude yourself that he will just lie there, because the chances are, he won't! Having a circumcision is more than having a dr attempt to retract your foreskin.

People with no specialism in this area telling me that all the doctors are wrong and that my son will be in agony are not helpful. Of course you are entitled to your opinion, but why do you feel the need to force it on me?

I know you are having to do this for medical reasons, so I am not trying to tell you not to do it, but you have either been feed duff info (doesn't hurt, child chats throughout, no cutting, etc) or your are being naive. Of course it will hurt. We are just trying to make you see the patient's side of it. Goggle it, look at the images of children screaming while having it done.

Taking your son to the hospital & having to travel home in a 5 point will be nothing compared to what he goes through while having it done.

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