Neonatal circumcision is common in male infants in the United States. Despite evidence that circumcision causes intense pain, analgesia may or may not be used. There is a common belief that the effects of circumcision pain are short-lived and clinically insignificant. A recent study focuses on the effect of neonatal circumcision on pain response during subsequent routine vaccination (Taddio and others, 1997).
The sample consisted of 87 healthy, full-term male newborns who formed three groups--uncircumcised infants, circumcised infants who were treated with EMLA (eutectic mixture of local anesthetics), and infants circumcised with a placebo for pain control. Pain response was studied during routine vaccination at 4 or 6 months of age. Infant pain response was scored from a videotape by a research assistant who was unaware of both the purpose of the study and the treatment-group status of the infants. Three behavioral pain measures were used to assess pain: infant facial action, cry duration, and visual analogue scale scores. Infant facial action was a composite score from three specific facial actions--brow bulge, nasolabial furrow, and eyes squeezed shut.
The study found that there were increasing pain scores from the uncircumcised infants, to those circumcised with EMLA, to those circumcised with a placebo analgesic. Among the circumcised group, preoperative treatment with EMLA lessened the pain response to vaccination. The study postulates that circumcision may induce long-lasting changes in infant pain behavior because of alterations in the infant's central neural processing of painful stimuli.
Treatment to prevent neonatal circumcision pain is recommended. Nurses need to take an active role in ensuring that parents are adequately informed about the safe and effective use of analgesia during circumcision.
Taddio A and others: Effect of neonatal circumcision on pain response during subsequent routine vaccination, Lancet 349:599-603, 1997.
See Chapter 8 in Nursing Care of Infants and Children, 5th and 6th editions.
See Chapter 8 in Essentials of Pediatric Nursing, 5th edition.
March 15, 2002