Do medical doctors use better equipment or techniques for bris milah than Mohelim use?

Familiarity with the customary religious ceremony makes the traditional Mohel the choice of many families, but parents are still concerned about getting the best care for their newborn and minimizing his discomfort after his bris milah.

The New York Times and Connecticut Post reported in August, 1997 that Mohelim “inflict less pain on their newborn subjects than most doctors do”. The article explains that different tools are used by the medical doctor and the Mohel. The shield used by Mohelim during a bris milah was found to be much quicker to use and less painful that the one used by most doctors. The report quotes a study involving 48 newborn boys in Hartford by Dr. Hema N. DeSilva, director of neonatology at St. Francis Hospital and Medical Center. Babies circumcised with the Mogen clamp used by Mohelim suffered less stress, showing only half the heart rate increase and total crying time of infants circumcised with a Gomco, the choice of most physicians. Oxygen levels were higher in the Mogen infants as well. Circumcision typically takes 20 to 30 seconds when a Mohel is using the Mogen clamp. A doctor using the Gomco clamp averaged 3 1/2 minutes for the procedure in the study. Click here for the full text of the Post article.

A Mohel is used to handling the circumcision in front of a crowd and is a specialist in the procedure. Doctors usually use different tools and techniques for circumcision than a Mohel would, but in my own opinion and that of many parents the shorter time and lower stress level are key advantages in choosing a Mohel to perform the bris milah.

Should my baby have anesthesia or pain medication for the circumcision?

Among the methods of reducing pain during and after circumcision are topical anesthetics, oral analgesics, and the Mohel’s traditional choice of sweet wine. The benefits of anesthetics and pain medication are well understood.

I personally strongly urge parents to use local topical anesthetic on the condition they are shown how to apply it by me as well as the proper dosage so as not to sensitize the baby or overdose.

Acetaminophen is often used to reduce pain, but research shows a disturbing level of risk associated with Tylenol and other medicines containing acetaminophen. Please discuss the dosage or other pain relief options with your Pediatrician

The wine itself is a potent pain relief medicine for the children. Read the article below for information corroborating what mohalim always knew.

British Medical Journal- Pain Relief After Bris Milah

Sugar: an effective pain killer for babies

[The analgesic effect of sucrose in full term infants: a randomized controlled trial]

Ordinary white sugar is an effective pain killer for young babies, according to a paper in this week’s BMJ. The authors of the paper gave sugar in the form of 2 mls of 50 per cent sucrose syrup by mouth to 30 babies just before they had a routine blood test to detect jaundice.

Thirty babies got only plain water. After the test, which involves a painful prick in the foot, the babies in the group who had the sugar cried less and their heart rate returned to normal more quickly than the controls. The authors conclude that sugar syrup is a safe,

BMJ No 6993 Volume 310
10 June 1995
Embargo 00.01 hrs 9 June 1995

effective pain-killer for young babies.

Contact:

Prof. Malcolm Levene
University Division of Pediatrics & Child Health
D Floor
Clarendon Wing
Leeds General Infirmary
Leeds LS2 9NS