Child Development

Potty Training 101

• Telling your child what you expect of him/her
• Your child telling you before he/she has to go pee or poop
• Undressing
• Going
• Wiping
• Dressing
• Flushing
• Hand washing

Potty Training 101
From Start to Finish

Potty training includes these steps:

• Telling your child what you expect of him/her
• Your child telling you before he/she has to go pee or poop
• Undressing
• Going
• Wiping
• Dressing
• Flushing
• Hand washing

Signs of Readiness

• Your child can follow simple instructions.
• Your child can walk to and from the bathroom and help undress.
• Your child seems uncomfortable with soiled diapers and wants to be changed.
• Facial expressions, posture or words reveal when your child is about to urinate or have a bowel movement.
• Your child asks to use the toilet or potty chair.
• Your child asks to wear grown up underwear.
• Your child stays dry at least 2 hours at a time during the day, or is dry after naps.
• Bowel movements become regular and predictable.

When Not to Potty Train
Do not try and potty train during stressful times in the family such as:

• Your family has just moved or will move in the near future.
• You are expecting a baby or you have recently had a new baby.
• There is a major illness, recent death, or some other family crisis.

Each Child is Different When it Comes to Toilet Training

• What works for one may not work for another.
• Keep different techniques available to keep your little one interested.
• Today there are a large amount of different products to help with potty training: potty chairs, dolls, videos, books, etc.
• The important thing is to begin potty training with the right training aids and knowledge, that the experience is positive from the start. Don’t wait until you and your child are frustrated to read the bedtime potty book or play with the fun musical potty. Make it positive from the start.

Once You Are Ready to Start

Take your child to the bathroom with you and talk about what you are doing.

Use consistent words associated with potty training. Whether you say “poop” and “pee” or “defecate” and “urinate,” choose words that are not offensive or embarrassing or that describe toileting functions in a negative way.

Encouraging Steps

• Provide your child with a potty chair that is low to the ground so that the feet touch the floor.
• Place your child on the potty seat at the same time each day so this becomes a regular part of his/her daily routine.
• Ask your child regularly to go to the bathroom, and encourage him/her to tell you when he/she needs to go.
• When your child goes to the potty, be sure to reward; should your child fail to go in the potty, don’t scold or punish him/her.

Potty Training Wrap-up

• This is not an easy step. Be prepared for frustrating days.
• Keep up your spirits and know that your child will not go to college in diapers!!
• Don’t let anyone push you into potty training just because their child was trained early doesn’t mean yours will.
• Keep an open mind on different techniques. The potty chair doesn’t have to be in the bathroom
• Always let your child know that you love him/her and will be right there with him/her.
• Expect many false starts and many accidents. when there is success REWARD!!
• Don’t expect dry nights for several weeks or months. They will need nighttime protection, but it is best not to use diapers!
• DON’T BEGIN TRAINING UNTIL YOUR CHILD IS CLEARLY READY—readiness does not just happen. It involves concepts and skills you can begin teaching your child at around 12-18 months.

• Your child can follow simple instructions.
• Your child can walk to and from the bathroom and help undress.
• Your child seems uncomfortable with soiled diapers and wants to be changed.
• Facial expressions, posture or words reveal when your child is about to urinate or have a bowel movement.
• Your child asks to use the toilet or potty chair.
• Your child asks to wear grown up underwear.
• Your child stays dry at least 2 hours at a time during the day, or is dry after naps.
• Bowel movements become regular and predictable.

• Your family has just moved or will move in the near future.
• You are expecting a baby or you have recently had a new baby.
• There is a major illness, recent death, or some other family crisis.

• What works for one may not work for another.
• Keep different techniques available to keep your little one interested.
• Today there are a large amount of different products to help with potty training: potty chairs, dolls, videos, books, etc.
• The important thing is to begin potty training with the right training aids and knowledge, that the experience is positive from the start. Don’t wait until you and your child are frustrated to read the bedtime potty book or play with the fun musical potty. Make it positive from the start.

• Provide your child with a potty chair that is low to the ground so that the feet touch the floor.
• Place your child on the potty seat at the same time each day so this becomes a regular part of his/her daily routine.
• Ask your child regularly to go to the bathroom, and encourage him/her to tell you when he/she needs to go.
• When your child goes to the potty, be sure to reward; should your child fail to go in the potty, don’t scold or punish him/her.

• This is not an easy step. Be prepared for frustrating days.
• Keep up your spirits and know that your child will not go to college in diapers!!
• Don’t let anyone push you into potty training just because their child was trained early doesn’t mean yours will.
• Keep an open mind on different techniques. The potty chair doesn’t have to be in the bathroom
• Always let your child know that you love him/her and will be right there with him/her.
• Expect many false starts and many accidents. when there is success REWARD!!
• Don’t expect dry nights for several weeks or months. They will need nighttime protection, but it is best not to use diapers!
• DON’T BEGIN TRAINING UNTIL YOUR CHILD IS CLEARLY READY—readiness does not just happen. It involves concepts and skills you can begin teaching your child at around 12-18 months.

BED WETTING

Toilet training a child takes a lot of patience, time, and understanding. Most children do not become fully toilet trained until they are between 2 and 4 years of age. While many children at this age are able to stay dry during the day, others may not be able to stay dry during the night until they are older.

Causes of bed-wetting

Although all of the causes of bed-wetting (enuresis) are not fully understood, following are some that are possible:

• Your child’s bladder is not yet developed enough to hold urine for a full night.
• Your child is not yet able to recognize when his bladder is full, wake up, and use the toilet.
• Your child is responding to changes or stresses going on at home such as a new baby, moving, or divorce.

All young children occasionally wet their beds while going through nighttime toilet training. Even after your preschooler is able to stay dry at night for a number of days or weeks, she may start wetting at night again. When this happens, don’t make an issue out of it. Simply put her back in training pants at night for a while until she is ready to try again. The problem will probably disappear as your child gets older.

Most school-aged children who wet their beds have primary enuresis. This means they have never developed nighttime bladder control. Instead, they have had this condition since birth and often have a family history of the problem. Children who are older when they develop nighttime bladder control often have at least one parent who had the same problem.

If you are concerned about your child’s bed-wetting, talk to your pediatrician. He or she may ask you the following questions in order to find the cause of your child’s bed-wetting:

• Is there a family history of bed-wetting?
• How often does your child urinate, and at what times of the day?
• When does your child wet the bed? Is your child very active, upset, or under unusual stress when it happens?
• Does your child tend to wet the bed after drinking carbonated beverages, caffeine, citrus juices, or a lot of water?
• Is there anything unusual about how your child urinates or the way his urine looks?

Signs of a problem
If your child has been completely toilet trained for 6 months or longer and suddenly begins wetting the bed again, talk to your pediatrician. It may be a sign of a medical problem such as:
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• Bladder or kidney infections
• Diabetes
• Defects in the child’s urinary system

However, keep in mind that less than 1% of bed-wetting cases are related to diseases or defects. If your child has a medical problem that is causing the bed-wetting, there are usually other signs including:

• Changes in how much and how often your child urinates during the day
• Discomfort while urinating
• Unusual straining during urination
• A very small or narrow stream of urine, or dribbling that is constant or happens just after urination
• Cloudy or pink urine, or bloodstains on underpants or nightclothes
• Daytime as well as nighttime wetting
• Burning during urination

If there are signs that wetting is due to more than just delayed development of bladder control, and your child is older than 5 years of age, your pediatrician may order additional tests, such as an ultrasound of the kidneys or bladder. If necessary, your pediatrician will recommend that your child see a pediatric urologist, who is specially trained to treat children’s urinary problems.

Tips to manage bed-wetting
It is important for parents to be sensitive to the child’s feelings about bed-wetting. For instance, children may not want to spend the night at a friend’s house or go to summer camp. They may be embarrassed or scared that their friends will find out they wet the bed.

Make sure your child understands that bed- wetting is not his fault and that it will get better in time. Remember, your child does not have control over the problem and would like it to stop, too! Until that happens, the following steps might help:

• Protect the bed. Until your child can stay dry during the night, put a rubber or plastic cover between the sheet and mattress. This protects the bed from getting wet and smelling like urine.
• Let your child help. Encourage your child to help change the wet sheets and covers. This teaches responsibility. At the same time it can relieve your child of any embarrassment from having family members know every time she wets the bed. If your child sees this as punishment, it is not recommended.
• Set a no-teasing rule in your family. Do not let family members, especially siblings, tease a child who wets the bed. Explain to them that their brother or sister does not wet the bed on purpose. Do not make an issue of the bed-wetting every time it occurs.
• Take steps before bedtime. Have your child use the toilet and avoid drinking large amounts of fluid just before bedtime.
• Try to wake him up to use the toilet again right before you go to bed if he’s been asleep for an hour or more.
• Reward him for “dry” nights, but do not punish him for “wet” ones.
• Use a bed-wetting alarm device. If your child is still not able to stay dry during the night after using the above steps for 1 to 3 months, your pediatrician may recommend using a bed-wetting alarm. When the device senses urine, it sets off an alarm so that the child can wake up to use the toilet. When used exactly as directed, it will detect the wetness right away and sound the alarm. Be sure your child resets the alarm before going back to sleep. These alarms are available at most pharmacies and cost about $50 to $70. They produce a 50% to 75% cure rate, although some children occasionally relapse once they stop using them. Alarms tend to be most helpful when children are starting to have some dry nights and already have some bladder control on their own.
• Medications. If the bed-wetting alarm does not solve the problem after 4 or 6 months, your pediatrician may prescribe an oral medication. Different medications are available. Medications usually are a last resort and are not recommended for preschool-aged children. Although it can be helpful for older children, some medications can have side effects. About four to five out of 10 children are helped by these medications. Your pediatrician will discuss medication options with you, if necessary.
• Avoid unproven treatments. Because bed- wetting is such a common problem, many mail-order treatment programs and devices advertise that they are the cure. Use caution; many of these products make false claims and promises and may be very expensive. Your pediatrician is the best source for advice, and you should ask for it before your child starts any treatment program.

If none of the treatments work
A small number of children who wet the bed do not respond to any treatment. Fortunately, as each year passes, bed-wetting will decrease as the child’s body matures. By the teen years almost all children will have outgrown the problem. Only 1 in 100 adults is troubled by persistent bed-wetting. Until your older child outgrows bed-wetting, he will need a lot of emotional support from the family. Support from a pediatrician or a mental health professional also can help.

Parents need to provide support
Try not to pressure your child to develop nighttime bladder control before his or her body is ready to do so. As hard as your child might try, the bed-wetting is beyond control, and your child may get frustrated or depressed because he or she cannot stop it.

If your child has enuresis, discussing it with your pediatrician can help you to understand it better. Your pediatrician can also reassure you that your child is normal, and will eventually outgrow bed-wetting.

Baby Bottle Tooth Decay—

How to Prevent It

Proper dental care is a lifelong commitment that starts even before your baby’s first tooth forms. While daily cleanings and fluoride are important, they alone may not prevent Baby Bottle Tooth Decay (BBTD), a major cause of tooth decay in infants. Baby Bottle Tooth Decay is costly to treat. If left untreated, however, it can quickly destroy the teeth involved. It also can lead to pain, infection, early loss of baby teeth, crooked permanent teeth, and an increased risk of decay in permanent teeth. When you consider the possible dental problems that can result from BBTD and the cost of treating those problems, it is best to prevent BBTD from developing in the first place.

How Does Baby Bottle Tooth Decay Develop?

Baby Bottle Tooth Decay can develop if your child’s teeth and gums are in prolonged contact with almost any liquid other than water. This can happen from putting your child to bed with a bottle of formula, milk, juice, soft drinks, sugar water, sugared drinks, etc. Allowing your baby to suck on a bottle or breastfeed for longer than a mealtime, either when awake or asleep, also can cause BBTD.

When liquid from a baby bottle builds up in the mouth, the natural or added sugars found in the liquid are changed to acid by germs in the mouth. This acid then starts to dissolve the teeth (mainly the upper front teeth), causing them to decay. Baby Bottle Tooth Decay can lead to severe damage to your child’s baby teeth and also can cause dental problems that affect your child’s permanent teeth.

Why Are Baby Teeth Important?

Many parents assume that decay does not matter in baby teeth because the teeth will fall out anyway, but decay in baby teeth poses risks. If your child loses his baby teeth too early because of decay or infection, the permanent teeth will not be ready to replace them yet. Baby teeth act as a guide for the permanent teeth. If baby teeth are lost too early, the teeth that are left may shift position to fill in the gaps. This may not leave any room for the permanent teeth to come in.

What Can I Do to Prevent Baby Bottle Tooth Decay?

Take the following steps to prevent Baby Bottle Tooth Decay:

• Never put your child to bed with a bottle. By 7 or 8 months of age, most children no longer need feedings during the night. Children who drink bottles while lying down also may be more prone to getting ear infections.
• Only give your baby a bottle during meals. Do not use the bottle as a pacifier; do not allow your child to walk around with it or to drink it for extended periods. These practices not only may lead to BBTD, but children can suffer tooth injuries if they fall while sucking on a bottle.
• Teach your child to drink from a cup as soon as possible, usually by 1 year of age. Drinking from a cup does not cause the liquid to collect around the teeth, and a cup cannot be taken to bed. If you are concerned that a cup may be messier than a bottle, especially when you are away from home, use one that has a snap-on lid with a straw or a special valve to prevent spilling.
• If your child must have a bottle for long periods, fill it only with water.

Keeping your baby’s mouth clean is also important in preventing tooth decay. After feedings, gently brush your baby’s gums and any baby teeth with a soft infant toothbrush.

Start using water and a soft child-sized toothbrush for daily cleanings once your child has seven to eight teeth. By the time your toddler is 2 years of age, you should be brushing her teeth once or twice a day, prefer-ably after breakfast and before bedtime.

Begin using a fluoride toothpaste when you are sure the toothpaste will not be swallowed (usually when your child is around 3 years of age). Use a pea-sized amount of toothpaste to limit the amount your child can swallow.

Too much fluoride can be harmful to a child.

Detect Decay Early

Baby Bottle Tooth Decay first shows up as white spots on the upper front teeth.

These spots are hard to see at first—even for a pediatrician or dentist—without proper equipment. A child with tooth decay needs to get treatment early to stop the decay from spreading and to prevent lasting damage to the teeth.

If you are concerned that your child may have BBTD, your pediatrician can refer you to a pediatric dentist who will carefully examine your child’s teeth for signs of decay.

With the right balance of proper home and professional dental care, your child can grow up to have healthy teeth for a lifetime of smiles.

Is Your One-Year Old Communicating With You?

“Dada.”  “Mama.”  “Ball.”  What will your baby’s first words be?

Whatever the word is, when you hear it, it’s an exciting moment in your child’s language development.

However, language skills begin long before the first spoken word.  Your child starts to communicate with you during the first year of life.  Children respond to you and the world around them with eye gazes, smiles, gestures or sounds.  Later on, you’ll notice more obvious “speech” skills or milestones.

Read more to learn about early language and social milestones and possible signs of language delay.

If you have any questions about your baby’s development, share them with your pediatrician–the sooner, the better.

Milestones

Remember, children develop at different rates, but they usually are able to do certain things at certain ages.  The following developmental milestones are only guidelines.

By 12 months your baby should:

• Look for and be able to find the source of sounds.
• Respond to her/his name most of the time when you call it.
• Wave goodbye.
• Look where you point when you say, “Look at the ____________.”
• Change from monotone babble to babble with inflection, as if telling a story in a foreign language.
• Take turns “talking” with you–listens to you when you speak, and then resumes babbling when you stop.
• Say “dada” to dad and “mama” to mom.
• Say at least one or more words in addition to “mama” and “dada.”
• Point to items she/he wants that are out of reach or make sounds while pointing.

Between 15 and 24 months, your baby should:

• Follow simple commands with, and then later without, gestures.
• Get objects from another room when asked.
• Point to a few body parts when asked.
• Point to interesting objects or events to get you to look at them too.
• Bring things to you to “show you.”
• Point to objects so you will name them.
• Name a few common objects and pictures when asked.
• Enjoy pretending (for example, has a tea party).  She/he will use gestures and words with you, or a favorite stuffed animal.
• Learn about 1 new word per week as she/he approaches her/his 2nd birthday.

By 24 months, your toddler should:

• Point to many body parts and common objects.
• Point to some pictures in books
• Follow 2-step commands.
• Say about 50 words or more.
• Say several 2-word phrases, like “daddy go,” “doll mine,” and “all gone.”
• May say a few 3-word sentences, like “I want juice” or “Me go bye-bye.”
• Be understood about 50% of the time.

About developmental language delay
Delays in language are the most common types of developmental delay.  One in 5 children will show a developmental delay in the speech or language area.  Some children will also show behavioral challenges because they are frustrated when they can’t express everyday needs, desires or interests.

Simple speech delays are sometimes temporary.  They may resolve on their own, or with a little extra help from family.  Sometimes formal speech therapy is needed.

It’s important to encourage your baby to “talk” to you with gestures and/or sounds before filling a need.  In some cases, your baby will need more help from a trained professional.

Sometimes delays may be a warning sing of a more serious disorder that could include hearing loss, global developmental delays or autism.  Delays also could be a sign of a possible learning problem you may not notice until the school years.  It’s important to have your child evaluated if you are concerned about you child’s language development.

Not typical behaviors
Sometimes language delays are associated with behaviors that may concern you, like if your baby:

• Doesn’t cuddle like other babies.
• Doesn’t return a happy smile back at you.
• Doesn’t seem to notice if you are in the room.
• Doesn’t seem to notice certain noises (for example, seems to hear a car horn or a cat’s meow, but not when you call her/his name).
• Acts as if he is in his own world.
• Prefers to play alone; seems to “tune others out.”
• Doesn’t seem interested in or play with toys, but likes to play with objects in the house.
• Shows a strange attachment to hard objects (would rather carry around a flashlight or ballpoint pen than a stuffed animal or favorite blanket).
• Can say the ABCs, numbers or words to TV jingles, but can’t ask for things she/he wants.
• Doesn’t seem to have any fear.
• Doesn’t seem to feel pain.
• Laughs for no clear reason.
• Uses words or phrases that are inappropriate for the occasion.

If your child seems delayed or shows any of the above behaviors, tell you pediatrician.  Also, tell your pediatrician if your baby stops talking or doing things that she/he used to do.

When autism is the reason for language delays, the child will also show some or all of the above-listed behaviors.  Most likely, your child will then be referred to a specialist or a team of specialists knowledgeable about autism and its many related disorders.  The specialist(s) may then recommend speech therapy, but also specific interventions to improve social skills, behavior and the “desire” to communicate.

What Your Pediatrician Might Do
After you share your concerns with your pediatrician, he or she may:

• Ask you some questions, or ask you to fill out a questionnaire.
• Evaluate certain aspects of your child’s development by interacting with your child in various ways.
• Order a hearing test and refer you to a speech and language therapist for testing.  The therapist will evaluate your child’s speech (expressive language) and ability to understand speech and gestures (receptive language).

If your pediatrician doesn’t seem to be concerned and instead tries to reassure you that children develop at different rates and that your child will “catch up in time,” it’s OK to say you are still concerned.  You might also ask you pediatrician if a referral to a developmental specialist might be appropriate.

If any of the steps above lead to the conclusion that expressive language ONLY is delayed, you may be given suggestions to help your child at home.  Formal speech therapy may also be recommended.

If Both receptive and expressive language are delayed, and the hearing is normal, your child will need further evaluation.  This will determine whether the delays are due to a true communication disorder, global developmental delays, autism or some other developmental problem.

Programs
Regardless of the cause of your child’s delays, your pediatrician may refer you to a local developmental or school program that provides intervention services to children with various delays.  The staff there might do an independent evaluation.  You may be reassured that your child’s development is, indeed, within normal limits, or the staff might feel that she/he would benefit from some type of intervention.

If your child is younger than 3 years, the referral may be to an Early Intervention Program (EIP) in your area.  This is a federal- and state-funded program that helps children with delays or behavioral challenges.  You may also contact the EIP directly.

If your child is eligible for services, a team of specialists will, with your input, develop an Individualized Family Service Plan (IFSP).  This plan becomes a guide for the services that will be provided until your child turns 3 years of age.  It may include parent training and support, direct therapy, respite, and special equipment.  Other services may be offered if they benefit your child and/or your family.  If your child needs help after 3 years of age, the EIP staff will refer your child to the local school district.

If your child is 3 years of age or older at the time of a concern, the referral may be to your local public school.  You may also contact the local public school directly.  If your child is eligible, the school district staff will, with your input, develop an Individualized Education Plan (IEP).  This plan provides many of the same services as the IFSP, but the focus is different: school services are mainly for the child.  The level of services may also be different.  If your child continues to need special education and services, the IEP will be reviewed and revised from time to time.  The IEP should be revised to meet your child’s changing needs as she/he grows older and develops new skills.

Resources

American Academy of Pediatrics
National Center of Medical Home Initiatives for Children with Special Needs
www.medicalhomeinfo.org

Remember
Your instincts as a parent should be followed.  If you continue to have concerns about your child’s development, ask for a reevaluation or referral for more formal testing.

Circumcision:

Information for Parents

Circumcision is a surgical procedure in which the skin covering the end of the penis is removed. Scientific studies show some medical benefits of circumcision. However, these benefits are not sufficient for the American Academy of Pediatrics to recommend that all infant boys be circumcised. Parents may want their sons circumcised for religious, social, and cultural reasons. Since circumcision is not essential to a child’s health, parents should choose what is best for their child by looking at the benefits and risks. This brochure answers common questions you may have about circumcision. Use this as a guide to help you decide what is best for your baby boy.

What is Circumcision?

At birth, boys have skin that covers the end of the penis, called the foreskin. Circumcision surgically removes the foreskin, exposing the tip of the penis. Circumcision is usually performed by a doctor in the first few days of life. An infant must be stable and healthy to safely be circumcised. Many parents choose to have their sons circumcised because “all the other men in the family were circumcised” or because they do not want their sons to feel “different.” Others feel that circumcision is unnecessary and choose not to have it done. Some groups such as followers of the Jewish and Islamic faiths, practice circumcision for religious and cultural reasons. Since circumcision may be more risky if done later in life, parents may want to decide before or soon after their son is born if they want their son circumcised.

Common Questions About Circumcision

Is circumcision painful?

When done without pain medicine, circumcision is painful. There are pain medicines available that are safe and effective. The American Academy of Pediatrics recommends that they be used to reduce pain from circumcision. Local anesthetics can be injected into the penis to lower pain and stress in infants. There are also topical creams that can help. Talk to your pediatrician about which pain medicine is best for your son. Problems with using pain medicine are rare and usually not serious.

What should I expect for my son after circumcision?

After the circumcision, the tip of the penis may seem raw or yellowish. If there is a bandage, it should be changed with each diapering to reduce the risk of the penis becoming infected. Petroleum jelly should be used to keep the bandage from sticking. Sometimes a plastic ring is used instead of a bandage. The plastic ring that is left on the tip of the penis usually drops off within 5 to 8 days. It takes about 1 week to 10 days for the penis to fully heal after circumcision.

Are there any problems that can happen after circumcision?

Problems after a circumcision are very rare. However, call your pediatrician right away if:

• Your baby does not urinate normally within 6 to 8 hours after the circumcision.
• There is persistent bleeding.
• There is redness around the tip of the penis that gets worse after 3 to 5 days.

It is normal to have a little yellow discharge or coating around the head of the penis, but this should not last longer than a week

Reasons Parents May Choose Circumcision

Research studies suggest that there may be some medical benefits to circumcision. These include the following:

• A slightly lower risk of urinary tract infections (UTIs). A circumcised infant boy has about a 1 in 1,000 chance of developing a UTI in the first year of life; an uncircumcised infant boy has about a 1 in 100 chance of developing a UTI in the first year of life.
• A lower risk of getting cancer of the penis. However, this type of cancer is very rare in both circumcised and uncircumcised males.
• A slightly lower risk of getting sexually transmitted diseases (STDs), including HIV, the AIDS virus.
• Prevention of foreskin infections.
• Prevention of phimosis, a condition in uncircumcised males that makes foreskin retraction impossible.
• Easier genital hygiene.

Reasons Parents May Choose Not to Circumcise

• The following are reasons why parents may choose NOT to have their son circumcised:
• Possible risks. As with any surgery, circumcision has some risks. Complications from circumcision are rare and usually minor. They may include bleeding, infection, cutting the foreskin too short or too long, and improper healing.
• The belief that the foreskin is necessary to protect the tip of the penis. When removed, the tip of the penis may become irritated and cause the opening of the penis to become too small. This can cause urination problems that may need to be surgically corrected.
• The belief that circumcision makes the tip of the penis less sensitive, causing a decrease in sexual pleasure later in life.
• Almost all uncircumcised boys can be taught proper hygiene that can lower their chances of getting infections, cancer of the penis, and sexually transmitted diseases.

What If I Choose Not to Have My Son Circumcised?

If you choose not to have your son circumcised, talk to your pediatrician about how to keep your son’s penis clean. When your son is old enough, he can learn how to keep his penis clean just as he will learn to keep other parts of his body clean.

The foreskin usually does not fully retract for several years and should never be forced. The uncircumcised penis is easy to keep clean by gently washing the genital area while bathing. You do not need to do any special cleansing, such as with cotton swabs or antiseptics.

Later, when the foreskin fully retracts, boys should be taught how to wash underneath the foreskin every day.

Teach your son to clean his foreskin by:

• Gently pulling it back away from the head of the penis
• Rinsing the head of the penis and inside fold of the foreskin with soap and warm water
• Pulling the foreskin back over the head of the penis

See the AAP brochure Newborns: Care of the Uncircumcised Penis for more details. See your pediatrician if you notice any signs of infection such as redness, swelling, or foul-smelling drainage.

Female “Circumcision”

Female genital mutilation, sometimes called female circumcision, is common in many cultures. It involves removing part or all of a female’s clitoris.

It may also involve sewing up the opening of the vagina. It is often done without any pain medicine. The purpose of this practice is to prove that a female is a virgin before she gets married, reduce her ability to experience sexual pleasure after marriage, and promote marital fidelity.

There are many serious side effects, including the following:

• Pelvic and urinary tract infections
• Negative effects on self-esteem and sexuality
• Inability to deliver a baby vaginally

The Academy is absolutely opposed to this practice in all forms as it is disfiguring and has no medical benefits.