After Care @Safecirc Circumcision Clinic

[More comprehAftercare instructions will be emailed before your appointment, and given to you in print at your visit, along with Dr. Pakes’ phone number. Below is are the main elements of aftercare.]

By the time you are reading this you will be comforted knowing that your son’s circumcision experience was positive and calm. Hopefully, he slept through it, but if he’s the kind of baby who gets upset with every diaper change, he may be a bit upset. Either way, most babies are a bit irritable after their circumcision. The freezing lasts about 15-30 minutes, so we encourage parents to head home as quickly as possible so you can get home before the freezing wears off – unless Dr. Pakes suggests you stick around.

 

Below is all the information you will need to care for your son following his circumcision. Most parents have found the FAQ format below most helpful, but the last page has some of the same information if you prefer the narrative format. There is quite a bit of duplication of information, just so you don’t miss anything if you read only some of the questions/answers.

 

If you need to get in touch with me anytime please text or call ((NUMBER GIVEN AT CLINIC)) for urgent issues, and email for non-urgent issues. I do my best to answer the phone at all hours 24/6. I cannot answer text/phone Friday evening (1hr before sunset) to Saturday night (1hr after sunset).

 

General Information

  1. What can I expect my baby to be like after the circumcision?
  • Every baby is different. Some babies will sleep more than usual after the procedure and to miss a feeding while others are very unhappy for up to a week. Generally, you should expect him to be irritable for the first 48-72 hours following the circumcision and be back to themselves within 2-3 days. Keep in mind that ‘normal’ can change every week for a newborn.

 

  1. What can I do to help?
  • Comfort your baby as you would normally. Some babies like to be held, others like to be left alone. Tylenol can help take the edge off, but he will still be irritable.

 

  1. How much Tylenol?
  • The dose for Infant Tylenol/Tempra Drops (Acetominophen 80mg/ml) is 15mg/kg. For example, a 3kg baby will need about 0.6ml, 4kg baby will need 0.75ml etc… You can give him Tylenol every 4-6 hours.

 

  1. What will feeding be like?
  • It is not unusual for baby to be a bit more fussy on the breast than usual for a few days. Continue feeding on-demand, but feeds may be shorter and more frequent. If he swallows air because of his fussy feeding he may get gassy and irritable. This should resolve in a few days.

 

  1. How should he sleep?
  • ‘Back to sleep’ is still the best advice (ie: on his back). He may sleep more than usual or be up every hour. Every baby is different.

 

  1. What kind of diapers should I use?
  • Disposable diapers, not reusable diapers, are strongly recommended for the first week since they tend to be less irritating, and they help keep the area dryer and cleaner. If you strongly prefer washable/cloth diapers you may find it takes a bit longer to heal.

 

  1. Should I hold or swaddle him differently following his circumcision?
  • Generally, the more he kicks his legs, the more likely the gauze will come loose. If he doesn’t mind, try keeping him swaddled – especially his legs. If he really doesn’t like being swaddled, that’s fine as well, but the less kicking and moving the better. For about three days following the circumcision you may want to restrict the handling of your baby to just a few people. Basically, avoid grabbing him near the circumcision site or passing him around at parties. Also, avoid unnecessary travel on unpaved road as bouncing around in a car seats can be irritating to the new circumcision.

 

  1. Does it hurt when the baby urinates?
    A: In my experience, he’s going to be somewhat irritable overall, but this doesn’t seem to be related to urination.

 

  1. When can I bathe my baby?
  • Do not bath baby for 2 days following the circumcision. If you want, you can sponge bathe him do not totally submerge the circumcision in water for at least 2 days after the procedure. It may irritate him. This is true unless you are having trouble getting the gauze off – see below regarding removal of gauze. In general, the less irritation for the first week, the better, so limit baths unless he really needs it.

 

The Dressing

Dr. Pakes will have shown you (or if you were not in the room, explained to you) the three layers of the post-circumcision dressing. The first (inner) layer is a non-stick yellow dissolving (Kaltostat) gauze. This will absorb some small amount of bleeding and unlike regular gauze it should not stick to the site. It will not dissolve completely, but with water/moisture/pee it will turn into jelly. This helps avoid pulling off a scab when it is removed. The second layer is a 10-15cm long ‘ribbon gauze. This is wrapped around the first layer to keep it on and prevent bleeding. The third layer is a tube gauze – like a sock, that keeps the first two layers in place and (mostly) clean.

 

  1. What is the gauze dressing going to look like?
    • As shown to you by Dr. Pakes, the dressing is a little donut around the penis with the tip sticking out. When you open the diaper, it is normal for the covering gauze to have some crusted or fresh blood.

 

  1. How long does the dressing stay on?
    • The dressing should stay on for around 2 days (24-48 hours). If your circumcision was done on a Monday it should stay on until Wednesday morning. The purpose of the dressing is to protect the penis, prevent bleeding and to keep the foreskin from riding up to the tip. If the dressing comes off early – as long as there is no bleeding – that’s ok. There is no reason to worry.

 

  1. How do prevent the dressing from coming off? How do I change his diapers?
  • When you change diapers, do it slowly and carefully. The gauze dressing can stick to the diaper and when you open the diaper quickly it can get pulled off. The best approach is to hold the dressing on from outside the diaper, then open the diaper slowly on one side and as soon as you see the dressing, grab it and hold it down as you remove the rest of the diaper. Keep holding the dressing on while you clean him and apply the new diaper. You only need to be this careful for the first 2 days.

 

  1. What if the dressing comes off early?
    • If the dressing comes off in the first day or even at the first diaper change, there is no need to worry. This may be because baby has a large fat pad that pushes the dressing off. As long as there is no bleeding, or just a few drops, there is no need to worry. If you are concerned you can call or text Dr.Pakes at (NUMBER GIVEN AT CLINIC). Do your best to continue to gently push down the sides of the shaft to keep the skin away from the tip. If you are not comfortable doing this – no worries. Just wait a 2-3 weeks and we can take a look to make sure all is well. Email Dr. Pakes to find out when he is next in clinic to confirm a follow-up date.

 

  1. What do I do about poop?
    • The dressing will get messy with poo and pee. Do not attempt to aggressively clean it – certainly not in the first 24hours. Cleaning it will likely irritate him and risk dislodging the dressing or causing bleeding. Poop and pee will not cause infection, it just looks messy.

 

  1. What do I have to do in the first 12-36 hours?
    • All you have to do is put lots of Vaseline on the diaper. The purpose of this is to prevent the penis from sticking to the diaper as it heals.
  1. What if the dressing is riding up on the tip, or I cant see the penis head?
    • This can happen. Again, it’s often because baby has a large fat pad pushing up the dressing. If you can gently push it down thats great, but if it keeps slipping back up – no need to worry, it should heal just fine. If its already mostly off, you can just leave it in the diaper until it’s totally off or you can gently remove it.
    • If you are concerned you can call Dr. Pakes ((NUMBER GIVEN AT CLINIC))

 

Removing the Gauze Dressing

  1. When do I remove the dressing?
  • Unless you are instructed otherwise, leave the three-layer gauze dressing in place for between 24-36 hours. Ie: if your circumcision was done on a Monday evening, you can remove the gauze some time Wednesday morning. Nighttime is always a bit scarier so its always best to remove it during the day.

 

  1. How do I remove the dressing?
  • Remove the dressing layer by layer in reverse order from how it was put on. The tube gauze first, then the wrap-around ribbon gauze, then the yellow dissolving gauze. If the middle or inner layer is difficult to remove, you can just take off the outer layer first, then with the next diaper change you can try the middle gauze. The inner gauze may have turned to gel and can sometimes look like skin so if you’re unsure you can give me a call. If the gauze donut is in one piece and already moving up the shaft, you can gently remove it in one piece.

 

  1. What if I’m not sure all the gauze is off?
    • Sometimes the inner yellow gauze can look like skin. Even if you’ve left some of this gauze on longer than 2-3 days – no need to worry. Give him a soak for 5minutes and try to remove it. If its very stuck it may be skin or yellow granulation (healing) tissue.

 

  1. What if the gauze wont come off?
  • If the gauze doesn’t come off on its own you can gently remove it on day 2-3. Remove it layer by layer as described above. If it still seems a bit stuck, remove what you can and cut off the excess. Try giving him a soak for 5 minutes and try again. If the gauze is still stuck, you can give him a soak each day and try again gently. Keep up with daily soaks. This is not an emergency. Worst case, you can leave it on until the next clinic day (usually the next Monday) and I can remove it for you. There is no harm in leaving on gauze for a bit longer than usual. If you have questions call Dr. Pakes ((NUMBER GIVEN AT CLINIC)).

 

  1. The gauze is off, what do I do now?
  • After the gauze is off, you simply need to use Vaseline on the diaper to prevent the healing tissue from sticking to the diaper. Some babies are sticky and need Vaseline for a week or more, others are not sticky and don’t need any Vaseline past day 3. Every baby is different.
  • The other thing you may need to do is make sure the skin on the shaft of the penis does not stick to the tip (the glans). In most cases, there is little risk of this happening, however if your baby has a large fat pad or a ‘short shaft’ the skin at the side may move up a bit and touch the glans. If this has happened, and you are comfortable doing this, you should push the skin down off the head of the penis to ensure it heals properly just behind the back rim of the head. If the skin is very swollen from the procedure do not use excessive force to push it down.

Appearance

  1. What should it look like now?
  • Every baby is different. Some baby’s penis will look like a normal penis within a few days, while others will be quite swollen – sometimes more on one side than the other – and can look unusual if one hasn’t seen a post-circumcision penis before. This swelling may last for days or weeks, but will always go down over time. As long as the swelling is not bright red and not obscuring the tip (glans) the is no need to worry.
  • If there was bleeding during the procedure, Dr. Pakes may have used either a yellow powder to help stop the bleeding and promote clotting, or silver nitrate sticks which cause a blackened appearance to the penis. Dr. Pakes will have discussed this with you if these additional measures were taken. Things may take a few weeks longer to look normal if the yellow powder or silver nitrate were used.

 

  1. I’m not sure if it looks normal. What should I do?
  • After a circumcision, things can look anywhere from normal to quite unusual. If you have concerns about how things look, its best to wait until most of the swelling is gone, which will be around week 3. At that time, if you have concerns about the appearance of your son’s penis, you can email safecirc@gmail.com to find out when Dr. Pakes will next be in clinic. On a clinic day, you are (usually) welcome to come by between 8am and 6pm. Just let the clerk know you are there for a circumcision followup and they will put you right thru.

 

  1. There is a small nub of skin at the base of the penis, what is that?
    • Mogen clamp method avoids cutting the blood vessels at the base of the penis and as a result there may appear to be a small tag of skin at the base. This skin is larger in larger babies or those with longer foreskins. It can also appear larger right after the circumcision when there is swelling in the surrounding area that makes it ‘stick out’. This area of skin is normal and will open up, flatten and stick to the base of the penis and disappear. Sometimes it can take a few weeks for this to happen.

Bleeding

The only complication that is important to be aware of in the first few days is bleeding. Significant bleeding is very rare, but if baby has a bit more bleeding than ideal it can cause alarm. Excessive bleeding is often because of a combination of a baby’s clotting system being are immature, and baby having a large fat pad, pushing off the dressing.

  1. What if the dressing comes off and there is bleeding?
  • If the dressing comes off within a few hours (<12hrs) of the procedure it may begin to bleed. If there are just a few drops of blood, or a bit of blood mixed with pee, there is no need to work. If there is more than a twonie spot of blood you may want to give me a call or text – (NUMBER GIVEN AT CLINIC). If it is before 6pm it is best call and then come back in to have him re-dressed.

 

  1. How much is too much bleeding?
  • A twonie size spot of blood in the diaper is normal. More than this may indicate active bleeding. If you see what you feel is ‘too much’ blood or if you can see active bleeding (dripping blood) call Dr. Pakes immediately ((NUMBER GIVEN AT CLINIC)).
  • Sometimes the normal initial bleeding covers or soaks the gauze dressing. When this happens, every time he pees, the pee will dissolve and mix with blood and make it look like lots of blood. This blood will be light colour not dark, and is not a cause for concern. If you are worried about this you can take a picture of the diaper and send it to Dr. Pakes (with name and question/issue) (NUMBER GIVEN AT CLINIC).