Post-Bris Care Instructions

1. Prepare for a fussy baby. Primary healing time is 24-48 hours.
2. There are risks, benefits and alternatives to this or any other surgical procedure. They are (bleeding, infection and/or damage to the penis), benefits (spiritual and physical), changes (appearance and sensitivity) and alternatives (not to circumcise). Be aware that cosmetic results will vary from child to child and cannot be guaranteed (i.e. adhesions, scar tissue, curvature, asymmetry, etc.).
3. There may be some swelling of the area (on one side or both) and you may notice a thickness on the underside of the penis where the skin was bunched together. Over time, this will decrease in size.
4. After each diaper change, apply a sterile gauze pad treated with a healthy amount of ointment for 3-5 days. If the gauze pad sticks, leave it alone until it comes off by itself. Put the new gauze pad with ointment on top of the old one, and after a few diaper changes, both should come off. If the gauze pad sticks, soak the baby in a shallow tub of warm water to remove it.
5. Any bleeding will stain the gauze pad and the diaper. The size and intensity of the stain will decrease after each diaper change. If bleeding persists, apply direct pressure with a sterile gauze pad for 15-20 minutes. This should stop the bleeding. Call the mohel or pediatrician immediately.
6. If there is a bandage (which is not the same as the gauze pad – the gauze pad covers the bandaged penis), the nurse or the parents may remove it after 24 hours. The bandage may come off by itself at anytime, which is fine; if you accidentally remove it, don’t worry. You may re-wrap the bandage if it unravels. Should the bandage stick, soak the baby in a shallow tub of warm water to remove it. After the bandage comes off, continue applying gauze pad and ointment for a few more days. Your baby should have a wet diaper within a few hours of the circumcision.
7. If there is no bandage (not to be confused with the gauze pad), no follow-up visit is needed. Parents may wish to schedule the first pediatrician’s visit within a week of the circumcision. A follow-up visit by the mohel may be requested at any time. Most pre- and post-circumcision questions can be addressed by emailing one or two digital photos of the area in question. There is a $150.00 charge for a separate follow-up in-home visit.
8. Following the circumcision, resume the baby’s regular routine and treat him normally.
9. Sponge bathe the baby until the penis is healed. When the penis is sufficiently healed (about one week) you may immerse the baby in the bath (assuming the umbilical cord is healed, as well).

Longer Term Care

No further bandaging is necessary. One may continue to apply ointment as needed to enhance further healing.

Each child is unique and the techniques of performing circumcisions vary. Cosmetic results will vary from child to child and are not guaranteed (i.e., adhesions, scar tissue, asymmetry, etc.). The circumcision area is not a perfect circle and skin is elastic. There may be some unevenness or asymmetry which will become a non-issue after the baby has healed completely. Even siblings or twins may not look the same even if the Bris was done by the same mohel with the same technique with the same instruments. During the healing process, the head (glans and corona) should remain completely revealed.

Be prepared for a fussy baby. If he’s fussy, it may be for an hour or two. If you’d like, you can blame me any time he cries on the day of and the day after the Bris.

New parents love to micro-analyze the circumcision site. If you have any questions about the healing process or you’re not sure what you are seeing, contact me right away – within a week or two of the Bris. DO NOT WAIT! You can call me or e-mail me one or two digital photos. (I don’t need an album!) If you call me in three months to tell me there is a problem, there is nothing I can do at that point. It is too late.

Normal things that you you may see during the healing process include:

1. The tip will be red or deep red in color. The redness may last for several weeks. During the healing process, the tip may turn blue or bluish/ purple in color. This is normal.
2. Sometimes a whitish or yellowish waxy-like coating, a yellow crusty-like coating or white spots or dots may occur on the tip or around the circumcision site. This is called granulation. It is normal and part of the healing process; it is not pus or an infection. Pus can be wiped off and will recur; granulation cannot. An infection would mean that the tip is red and swollen and hot to the touch. The baby would most likely have a fever and cry inconsolably. Granulation is more like a scab.
3. A few weeks into the healing process, a blister may develop along the circumcision line — this, too, is normal. It is often due to friction against the diaper which creates displaced lymphatic fluid (a blister). Apply ointment.
4. I will often get a phone call from parents 3-4 months or 6-8 months after the Bris telling me that it has disappeared. For babies who gain weight quickly, the fat of the thighs and abdominal fat pad may cover the circumcision. It retracts inside like the head of a turtle. Gently push the skin back to reveal the head and coronal ridge. Use ointment to avoid adhesions and allow for the free movement of the skin. If it gets stuck in the “in” position, that is called an adhesion. Call me right away. I will suggest several ways to solve the problem. This is very common. If your child continues to gain weight, it may happen again and it may get worse before it gets better. Once we know that the circumcision has healed properly (usually within a week or two of the Bris), it is safe to say that it is a fat problem and not a circumcision problem.
5. If the gauze pad sticks, DO NOT REMOVE IT! Put the second gauze with ointment on top of the stuck gauze pad. Eventually, both will fall off. Or, you may soak the baby in a shallow tub of warm water for ten to fifteen minutes to remove a stuck gauze pad. It may take two or three soakings.
6. Once you have stopped using the gauze and ointment, the skin may be dry and separate causing a blood spot on the diaper. Do not worry. It is usually a one time event. Apply ointment.

Please read and follow all instructions. If there is any question about the healing process or appearance of the circumcision, DO NOT WAIT — call or email me immediately.

Some General Guidelines

1. Once again – please read and follow all instructions.
2. In the event of an emergency, call or text me immediately at 212-316-4784 and leave a voice message.
3. For all other non-emergency questions regarding the Brit Milah ceremony, please email me at imohel@imohel.com​.
4. If a question or emergency arises on Shabbat or a Jewish holiday, you will not be able to reach me. Please call your pediatrician immediately. After the Shabbat or holiday has concluded, please call to apprise me of the situation. If I am unavailable at any other time, and you need assistance, please call your pediatrician.