Putting on my asbestos suit before commenting.

I think circumcision (pro and con) is possibly even more controversial and
inspires more frothing at the mouth on the part of pediatricians, ob/gyns and
family practicioners (not to mention parents, babies and all sorts of
otherhealth providers).

This is my opinion as a "circumcision neutral" pediatrician--one who performs
circumcisions (with local anesthesia and pacifier in babes mouth) after
extended counseling of the parents.  Please also bear in mind that the
American Academy of Pediatrics is also circumcision neutral.

Circumcision (in boys--I'm not even going there with female circumcision--I
do not support that) is done mainly for religious and cultural reasons.  The
medical indications are very controversal (both sides will argue with studies
that suport their viewpoints--however I must note I have never treated a
circumcised infant male for Urinary Tract Infection in my 15 years of
experience).  In my experience if a family wants their boy circumcised and
have strong opinions about it-I have very little success changing their
minds.

As for painful procedures and breastfeeding.  Yes infants feel pain--that's
why I use local anesthetic when I do the procedure.  However they scream as
they are being put in the circ restraint board, as they are being cleaned and
draped.
The other thing I have noticed anecdotaly that these babies suck and feed
like there is no tomorrow after being "circ'ed."  I know from my post doc
days
studying infant taste and smell that sucking (of any kind nutritive and
non-nutritive ) is key for an infant's habituation, soothing and pain relief.

Having taken care of many infants who had to stay in NICU and had painful
procedures done eg spinal taps, IV's , multiple blood draws and the like, I
know that breastfeeding can be successfully done with the appropiate support.

What do I do in my clinical practice?  I prefer doing circumcisions in the
office when an infant is 3-5 days old.  That way I can spend more time
talking with the parents, and also have a better feel for whether or not the
babe has any medical problems.  However many insurers will pay for
circumcision ONLY if done in the hospital or the parents push to have it done
before discharge.  Under those
circumstances I will do a circ in hospital when the infant is about 24 hours
old.
In our hospital normal newborns are discharged at about 24 hours of age (and
yes this is another thread that will induce frothing at the mouth on the part
of many participants).

What did I do with my son?  Yes Josh had his circumcision at 4 days of age
under local anesthesia with a pacifier (sucrose soaked--analgesic per Dr.
Shoen's study).  He is half Ethiopian Coptic Christian--infant males are
circumcised per cultural and religious traditions as Coptic Christians have
similar traditions to Judaism.  His Buddhist (me) mommy had to flee the room
(my pedi partner thought  I would want to be there...NOT).  After the circ,
Josh breastfed like a champ!  In fact I was in the office an extra half an hou
r to finish feeding him.  Yes, I felt somewhat guilty but I also reminded
myself of the thousands of cath urines in full septic workups (blood, spinal
tap and urine cath with 48-72 hours of IM or IV antibiotics) I have done in
the past on febrile infants.

Yup, I'm a mean unfeeling pediatrician and mom!   I'm also pragmatic.

Enough for now!  Flamesuit will remain on for now:)!

Pierrette Mimi Poinsett MD FAAP
Modesto CA