Pain Management at the Bris
In short: In a traditional bris performed by a skilled mohel, the actual procedure is much briefer than the usual hospital circumcision. Rabbi Glantz manages pain in stages: LMX 4 numbing cream on arrival (with parents' permission), sweet kosher wine or grape juice during the ceremony, and a well-timed feeding right after — with additional options like Tylenol dosing or a dorsal penile block to discuss with your doctor in advance.
The majority of britot that Rabbi Glantz performs are done with the following pain-management methods, in this order.
What happens when Rabbi Glantz arrives?
With the parents' permission, Rabbi Glantz will apply a numbing cream, LMX 4. Plain triple antibiotic with lidocaine may be substituted if the family prefers a less aggressive ointment.
How is the baby comforted during the ceremony?
Sweet kosher grape wine or sweet kosher grape juice is put to baby's lips with a gauze pad by the sandek, on which he gladly sucks. Research has shown that the sugar content is a significant distraction for infants (another report here), who haven't the ability to focus on more than one thing at a time.
A development in recent years borrows from our Jewish tradition, making use of a sweet glucose product (Sweet-Ease made by Philips) put to baby's lips during hospital circumcisions and other minor invasive procedures.
What happens after the procedure?
Oftentimes, babies nod right off to sleep right after nursing or having a bottle — the energy an infant uses to eat is significant. Families are urged to time feedings on the day of the bris so that 1 hour before the bris ceremony is to begin, baby has stopped nursing or having bottles.
Being a little hungry will both increase his interest in the sweet wine or grape juice, and increase his motivation to nurse or take a bottle immediately after the procedure is complete and we continue with the naming ceremony.
Should we talk to our doctor about pain relief?
Yes — you are strongly urged to consult your doctor and consider additional options in pain management prior to the day of the bris. If you are giving Tylenol or Motrin, please obtain the exact product, dosage, and timing relative to the bris from your physician or prescriber.
Are other anesthetic options available?
If you are interested in any other form of anesthetic, including a dorsal penile block and/or your own earlier application of topical anesthetic, please call Rabbi Glantz to discuss. It is important that Rabbi Glantz have this information ahead of time because these procedures swell the tissue.
Common Questions
Is numbing cream used at the bris?
Yes, with the parents' permission Rabbi Glantz applies LMX 4 numbing cream upon arrival. Plain triple antibiotic with lidocaine may be substituted if the family prefers a less aggressive ointment.
Why is the baby given wine at a bris?
Sweet kosher grape wine or grape juice is put to the baby's lips on a gauze pad by the sandek. Research has shown the sugar content is a significant distraction for infants, who can't focus on more than one thing at a time — hospitals now use a similar glucose product, Sweet-Ease, for minor procedures.
When should the baby eat on the day of the bris?
Time feedings so baby has stopped nursing or having bottles one hour before the ceremony begins. Being a little hungry increases his interest in the sweet wine or grape juice and his motivation to feed immediately after the procedure, when babies often nod right off to sleep.