NURSE DANI: If parents choose to have their son circumcised, does that usually happen
in the hospital, and if so, at what point? Or is it later in the office?
DR. AUSTIN BOWLES: So it can be either.
First off, most pediatricians fall about 50/50 on whether we recommend circumcisions or not.
We leave it up to the parents to decide, and that decision is based on
a lot of different factors that we leave to the parents.
And we’re happy to present the risks and benefits to them and help the decide,
but we don’t want to push them either way.
If they’ve decided to do a circumcision, it can happen either in the hospital or in the office.
In the hospital, we wait until they’re at least 24 hours old. We want them to
have a little time outside before we put them through a circumcision. (ND: Adjust a little bit, yeah.)
And we also want to make sure that they’re doing well, so any significant
health concerns, we might postpone the circumcision.
The most common ones are jaundice, and feeding issues, or weight loss in the baby.
So babies lose weight naturally at the beginning, but if they’ve lost more weight
than they should, we want to push feeding more.
As you can imagine, a baby that’s just been circumcised isn’t going to be as interested
in feeding, and it can set them back a little bit, at least for a half day or a full day.
And so if we’re focused more on feeding, we may defer or delay the circumcision
until later in the office when feeding is going well, weight gain is established,
and we don’t have any other concerns.
Jaundice is another concern that can come up that will delay circumcision.
So, same reasoning, a baby that’s jaundiced to the point that we’re more concerned,
we’re going to be encouraging feeding so that they can pee and poop more and get rid
of that jaundice, and we don’t want to set them back by doing a circumcision.
Whether it’s done in the hospital or in the office, it’s the same procedure.
It’s done with the pediatrician in the same manner.
It’s just that baby is a little older and has had a little more time to
establish feeding, that we aren’t going to set them back as much.
But at the same time, there’s also benefits to getting the circumcision done with while
babies are young and in the hospital to save some trouble for the parents when they’re in the office.
That can be a long appointment, getting the circumcision done in the office versus being in the
nursery where you’re already "held hostage" for a little bit and we can just get the circumcision done with. (ND: Mom’s already there. She’s not going anywhere.)
So those are some of the more common reasons we’ll do one versus the other.
Insurance can sometimes be an issue. Most commercial insurances cover circumcision.
Medicaid doesn’t cover circumcision. And to avoid associated hospital fees, sometimes
we’ll prefer to do it in the office to make it more affordable for the parents.
ND: Is there a point at which it’s too late to circumcise your son? Like, maybe you
were still kind-of making the decision in the hospital and a couple of weeks after.
At what point is it too late?
AB: It’s a question we get commonly. Some parents that either had a baby
that wasn’t able to be circumcised in the first few weeks of life, or
maybe were having a hard time deciding whether to do it and then decided later.
4 weeks is the typical cut-off that pediatricians will have in the office.
Beyond that, it becomes more of a surgery versus a procedure, and we’ll
refer you to the urologist for that procedure. But unfortunately,
then it’s hard because it becomes more expensive to see the specialist and
an anesthesiologist in the OR, and, a lot of times, won’t be covered as well by insurance.
So we try to get it done in those first 4 weeks.