After a bris, I try to explain to parents what things will look like over the next few days, weeks, and months as the circumcision goes through its different stages of healing.
There is swelling, a reminder of what things look like before vs after, there are stages of healing, a couple of long-term reminders: the Chubby Baby Syndrome and the Fusion Challenge.
I often comment about the importance of using a marker to indicate where the edge of the foreskin is before circumcising. When this is done in advance of the bris, and when the mark is actually followed during the circumcision, the incision can be very even and beautiful (to quote a colleague who loves to use the word 'beautiful' to describe his work).
But what are we marking? Why can't a rough estimate be sufficient?
There is a very definite point where the foreskin ends, and that spot is where the skin of the shaft lies naturally beneath the outer edge of the glans/corona. A "beautiful" circumcision has all of the foreskin plus the membrane beneath it removed at exactly that spot.
However, owing to the reality that most circumcisions are not accompanied by a complete removal of the membrane beneath the foreskin, there is a benefit to removing a little more than just the foreskin, because leaving MORE skin plays a significant role in the Fusion Challenge, and especially in the Chubby Baby Syndrome (I get many questions from mothers who ask about the need to pull down the skin over the longer term. Depending on how the circumcision goes, this is an issue for some people, or may never be an issue at all.)
So let's say there is 100% shaft skin to leave behind. A good mohel will actually leave between 88-95% of the original shaft skin, since the remains of the membrane will make a proper fusion with the shaft skin and fill in the remaining 5-12 percent of the shaft as needed.
Without using the marker, the chances of removing 50% or more of original shaft skin are not unheard of. And the incision has a decent chance of being significantly unbalanced - one side having more skin removed than the other (a little uneven is not bad - these things have a tendency to heal nicely nonetheless). This form of operating is a tremendous disservice to any baby.
Being educated about circumcision takes a lot of guesswork out of the process. Best of luck to everyone!
Showing posts with label chubby. Show all posts
Showing posts with label chubby. Show all posts
Thursday, July 30, 2015
Sunday, September 2, 2012
Chubby Baby Syndrome
Thank God, most brisses I do look pretty nice after the bandage comes off. Even when there is some swelling and things don't look "amazing" immediately, time usually corrects things and within a week or two swelling goes down and the look "fills in" and "evens out."
In some cases, a few months down the road I'll get either a phone call, email, or chance encounter when the question of "why is his penis disappearing into the shaft?" comes up.
I've blogged about this before. Suffice it to say, my initial reaction is always, "Does your baby have a lot of baby fat?" 100% of the time the answer is, "Yes! His legs are nice big pulkies" (or some similar euphemism for 'quite large').
THIS is the reason behind the "look" which was not apparent when I finished with my care of the baby post bris. With the exception of some newborns who are born larger, most newborns are born between 6-8 pounds, perfectly apportioned with no significant baby fat.
But once they've been around for 2-6 months, and their bodies have discovered food, it deposits most of the baby fat quite significantly into the legs and groin area. Compound that with the constriction of the diaper, plus a lot of time on the back, and a chubby baby may very well have a tip of the penis (the glans) finding itself squashed with nowhere to go but to sink into the shaft, or, worse, to have the skin of the shaft climb up and adhere itself to the rim of the glans giving the penis a partially circumcised look. Parents will understandably be concerned.
This is why I try to remind everyone of what "may" happen in the event your baby becomes chubby.[Of course, some people never experience this at all.] Therefore - nip it in the bud! Be vigilant! Make sure the glans is always separate and distinct every time you open your baby's diaper. Sometimes the diaper is as much at fault as the baby fat. Neither of these are a "fault," per se, as both are really par for the course. But if parents are aware and know to keep the glans separate from the shaft, most of these "problems" will never come up.
Call if you have a question. I am always happy to come and take a look to tell you what you are seeing. And remember it is better to call earlier, when baby is 2-3 months old, than later, such as from 6-12 months old. In either case you can be shown what to do to train the skin the right direction. But the more it drags on, the more uncomfortable it can be for the baby.
In some cases, a few months down the road I'll get either a phone call, email, or chance encounter when the question of "why is his penis disappearing into the shaft?" comes up.
I've blogged about this before. Suffice it to say, my initial reaction is always, "Does your baby have a lot of baby fat?" 100% of the time the answer is, "Yes! His legs are nice big pulkies" (or some similar euphemism for 'quite large').
THIS is the reason behind the "look" which was not apparent when I finished with my care of the baby post bris. With the exception of some newborns who are born larger, most newborns are born between 6-8 pounds, perfectly apportioned with no significant baby fat.
But once they've been around for 2-6 months, and their bodies have discovered food, it deposits most of the baby fat quite significantly into the legs and groin area. Compound that with the constriction of the diaper, plus a lot of time on the back, and a chubby baby may very well have a tip of the penis (the glans) finding itself squashed with nowhere to go but to sink into the shaft, or, worse, to have the skin of the shaft climb up and adhere itself to the rim of the glans giving the penis a partially circumcised look. Parents will understandably be concerned.
This is why I try to remind everyone of what "may" happen in the event your baby becomes chubby.[Of course, some people never experience this at all.] Therefore - nip it in the bud! Be vigilant! Make sure the glans is always separate and distinct every time you open your baby's diaper. Sometimes the diaper is as much at fault as the baby fat. Neither of these are a "fault," per se, as both are really par for the course. But if parents are aware and know to keep the glans separate from the shaft, most of these "problems" will never come up.
Call if you have a question. I am always happy to come and take a look to tell you what you are seeing. And remember it is better to call earlier, when baby is 2-3 months old, than later, such as from 6-12 months old. In either case you can be shown what to do to train the skin the right direction. But the more it drags on, the more uncomfortable it can be for the baby.
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