A systematic review of 1,984 babies concludes that injectable or topical pain medicines significantly, but not totally, lower a baby's heart rate and reduce crying time -- two expressions of pain. Giving oral pain relievers or sugar solutions to the baby or playing comforting music had little apparent effect on pain sensations, says lead author Barbara Brady-Fryer, R.N., the Child Health Program at Stollery Children's Hospital-Capital Health in Edmonton, Alberta.

"None of the studied interventions completely eliminated the pain response to circumcision," Brady-Fryer says.

The review, which includes data from 35 separate randomized controlled studies, appears in the October issue of the Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

There are possible medical benefits to circumcision, says the American Academy of Pediatrics, but they are not sufficient to recommend the procedure routinely for all newborn boys. Parents who want their sons circumcised for religious, cultural or personal reasons should talk to their physicians about anesthetics that can lower pain and stress, the Academy says.

"When done without pain medicine, circumcision is painful," says an Academy policy statement. Researchers have found that circumcision pain can increase the infant's heart and breathing rates, decrease blood oxygen levels, increase crying, cause skin flushing and vomiting, and alter sleep/wakes states. It can also increase sensitivity to other painful procedures.

"Infants circumcised without anesthesia exhibit stronger pain responses to routine immunizations during
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Contact: Barbara Brady-Fryer
barbbradyfryer@cha.ab.ca
780-491-5537
Center for the Advancement of Health
17-Oct-2004