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MONDAY, Oct. 20, 2014 (HealthDay News) -- Circumcision is typically done in the first days or weeks of life, but about 6 percent of U.S. boys have the procedure later, which increases the risk of complications and increases costs, according to new research.
The study analyzed insurance billing data that estimated circumcision rates in 2010 for babies up to 1 month (neonates) and older infants up to 1 year old.
Of more than 156,000 circumcisions, "94 percent were performed in neonates," said study researcher Dr. Karen Hoover, a researcher in the division of HIV/AIDS prevention of the U.S. Centers for Disease Control and Prevention.
The common but controversial procedure involves removing the skin covering the end of the penis. Some parents choose to have their sons circumcised for cultural, religious or health reasons.
Among the post-newborn circumcisions, almost half were done in boys younger than 1 year old, the study found.
Delaying circumcision beyond age 1 month increases costs, usually because older boys need general anesthesia to manage the pain, Hoover said.
For instance, early circumcision costs about $285 on average, compared to $1,885 later, according to the study, published online Oct. 20 in Pediatrics.
Dr. Colin Knight, a pediatric surgeon at Miami Children's Hospital in Florida, said he has noticed more parents asking for the procedure when their sons are older, at 3 or 4 months.
Knight, who wasn't involved in the study, said some of these delays are logistical -- either the preferred doctor wasn't available, the child wasn't yet on the insurance plan, or insurance didn't approve reimbursement.
"I tell parents the earlier, the better," he said. That's not just to save money. It's to spare the child general anesthesia. In his practice, Knight said, 3 or 4 months is the cutoff for using local anesthesia. Older boys need general anesthesia, which is riskier for the child, the study notes.
Hoover suggested that parents discuss circumcision and its risks and benefits with their doctor early in the pregnancy.
In a policy statement issued in 2012, the American Academy of Pediatrics said the benefits of newborn circumcision outweigh the risks but those benefits "are not great enough to recommend routine circumcision for all male newborns." The decision should be left to parents, the academy said.
The pediatricians' group did say the advantages of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant insurance coverage for circumcision of male newborns.
But groups such as Intact America and Doctors Opposing Circumcision oppose routine circumcision.
On its website, Doctors Opposing Circumcision states no one has the right to remove sexual body parts from someone else and cites pain associated with this "unnecessary procedure" as another objection.
Knight said he uses several methods to minimize a newborn's pain. "We give them acetaminophen before," he said. Also, while the local anesthetic is injected, the baby can suck on sugar water, he added. He said he also tries to distract the child during the procedure to reduce discomfort.
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SOURCES: Colin Knight, M.D., pediatric surgeon, Miami Children's Hospital, Miami, Fla.; Karen Hoover, M.D., M.P.H., researcher, U.S. Centers for Disease Control and Prevention, division of HIV/AIDS prevention; November 2014 Pediatrics