To the Editor,
Many reading the Coroner’s Corner report “Circumcision: A minor procedure?” in the April 2007 edition of Paediatrics & Child Health (1) will compare it with a commentary in the May 2007 edition of Pediatrics (2) stating “very minor risks associated with the procedure”. They will be concerned with what information they should give to parents. The Canadian Paediatric Society (CPS) Web site for parents (3) provides information to assist parents’ decision and also provides an important section on pain relief – not as dramatic as the death reported in Paediatrics & Child Health, although a much more common consideration.
While the report of the Paediatric Death Review Committee: Office of the Chief Coroner of Ontario correctly addresses mortality in this little boy, an important issue for providers of newborn care appears to have been overlooked – “local anaesthetic was not used”. The CPS addressed the need for pain control during circumcision in their 1996 statement (4) (now under revision) and more recently in 2007 (5), but this may have limited effectiveness. With ample evidence for 20 years that newborns perceive and may be adversely affected by pain (6), it seems unconscionable that procedures of this nature are not accompanied by appropriate anesthesia.
In many parts of Canada, circumcision is no longer performed in hospitals where there may be a better degree of monitoring (and peer pressure) than in physicians’ offices. The CPS needs to enhance its advocacy for children through communication with the provincial Colleges of Physicians and Surgeons to provide a directive indicating that circumcision of a newborn without any consideration for pain relief is no different than circumcision of an older child (or adult) where such an occurrence would be deemed to not meet appropriate standards of professional practice.
History would suggest that male circumcision is going to continue to be performed (although the incidence may vary with time and location). Regardless of the indications or frequency of this procedure, we need to better address relief of pain when the procedure is performed.
REFERENCE
- 1.Paediatric Death Review Committee: Office of the Chief Coroner or Ontario. Circumcision: A minor procedure? Paediatr Child Health. 2007;12:311–2. [Google Scholar]
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