Wednesday, May 12, 2010

When Baby is Cranky - Is Tylenol a Solution?

The impetus for this posting comes from two incidents which took place in the last few weeks.


1. Tylenol, and other OTC baby pain medications had some kind of recall (the details did not concern me personally as my children don't use any of the items in question, and I never recommend any of them as a mohel)


2. Someone I know, who lives in New York, had his son circumcised by a local NY mohel, and called me that evening, after his baby had an unusually difficult day, to confirm that what his mohel had told him was "normal" in the post-op care of the baby. Details to follow.


I will not address the Tylenol recall directly, as it is not my area of expertise. But the issue which is raised often enough is whether there is room to give the baby tylenol if he seems cranky after the bris?


My answer is twofold. Firstly, let your pediatrician recommend tylenol or something to ease your baby's discomfort. Most mohels I know are not physicians, and while they can offer advice, they are not in charge of your baby's long-term care. Even if the mohel IS a physician, if he (or she - there are female Dr. physicians who are mohelets) is not your baby's physician, the questions about medications should be directed to the primary long-term caregiver.


Secondly, and this leads into the second impetus as mentioned above, your baby should not feel discomfort after the bris.


You may ask, how could a baby not feel discomfort after going through this surgery? I don't know the answer to this question, but I can report on what I've observed.


Post-bris, most babies who have a bandage placed on comfortably, who have their needs met (clean diaper and full belly), sleep nicely, eat nicely, wet their diapers consistently, etc. They cry under the same conditions they cried for before the bris: dirty diaper, hungry, tired... The main difference will be that baby might wince when he urinates - which would be directly impacted by the bris.


So what causes a baby to be cranky after the bris?

The number one item that causes a baby discomfort is an uncomfortable bandage. It could be the material does not agree with him. The bandage may also be on too tight, constricting what should otherwise be an easy urine-flow.


In my personal experience, when I fiddle (as necessary, after the bris) to get a new bandage on, the baby will usually cry as I am reapplying a gauze pad. Once I am finished and leave the baby alone, he is usually calm and comfortable, the crying stops, and he either eats or goes right to sleep.


Solutions


And so I asked the father of the baby three questions:

1. Is it bleeding? (usually indicative of either a case that requires attention or a bandage that fell off prematurely)

2. Has the baby urinated? (if not, there is too much constriction on account of the bandage, and it needs to either be loosened, removed, or replaced with a looser and softer bandage)

3. Will your mohel come and check it?


If the bandage is on too tightly - guess what - Tylenol or Motrin ain't gonna do a thing.

*************************



I mentioned in a different posting that it is normal to see swelling after the bris, particularly on the ventral side of the penis. In this case, that was not as much of a concern from my perspective (though the father did see swelling and was concerned about it).


In the end, the mohel did come and check, he removed the bandage (or loosened it) and baby was able to urinate more readily, easily and comfortably.


The point of this story is not to knock another mohel. It is to encourage you to avoid jumping to conclusions, to avoid worrying, and to realize there may be a very simple solution.


I have taken steps to avoid this problem. The bandage I leave on the baby is a softer one, which usually comes off on its own a few hours after the bris. I remind parents from the get-go that they need to report to me if the baby has not urinated a few hours after the bris. I consciously put the bandage on tight enough to constrict the bleeding, but not so tight to be uncomfortable for baby.

With the exception of babies who are extremely hungry after the bris, most babies I care for are calm when I finally leave them alone, and may even sleep comfortably for a few multi-hour stretches, waking up for feedings and diaper changes.


And I tell the baby's mother, "You see how he is now? That is how he should be throughout the rest of the day, except when he is telling you he is hungry or needs to be changed (which is when he normally cries anyway)."


Instead of Tylenol being the solution, let us return to appropriate TLC which will undoubtedly help ease the pain and make the ordeal so much easier for parents and baby.

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