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Recent research reveals infant pain experiences closely resemble adults', challenging assumptions that infants have muted pain responses. fMRI data shows brain activation in emotional processing regions during invasive procedures without pain relief.1
Additionally, studies have demonstrated long-term impacts of unmanaged medical pain in babies. Circumcised infants exhibit heightened pain response to later vaccinations versus intact babies.2 Circumcision is also associated with breastfeeding difficulties,3 bonding deficits,4 and altered stress hormone levels.5
Notably, circumcision remains a common procedure lacking medical necessity that may cause lasting psychological damage.
One study using MRI and PET scans found it permanently changed reasoning, emotional, and perception areas of the brain.6 Additional research indicates circumcision can adversely affect men's sexual function7 and predisposes infants to UTIs.8-10
What is deeply concerning is that despite these findings, infants have long been considered incapable of experiencing pain intensely during routine medical procedures. Neonatal intensive care infants undergo 11.4 painful interventions daily, with only 36.6% receiving pain relief.11 A surprisingly wide range of common newborn procedures also lack research support for safety or benefits.
The revelation that infant pain processing closely resembles adults' raises ethical questions around consent for unsupported procedures lacking clinical indication. Male circumcision continues commonly without clear medical necessity and likely has psychological consequences.
Emerging research suggests circumcision permanently alters reasoning centers, emotional processing, and perception areas.12 Brain scans indicate the surgery most intensely affects regions associated with reasoning, emotions, and sensation interpretation. Follow-ups confirm these brain changes persist.13
Standards permitting aggressive, painful newborn procedures without managed pain relief or confirmed benefit deserve re-examination. All patients, including infants, deserve care abiding by "first, do no harm" and their holistic well-being.
The Imperative for Reform
There is an urgent need for reform when it comes to medical procedures performed on infants without pain management or clear clinical necessity. Both standards of care and parental consent procedures must better account for the current understanding that even newborns have complex neurological processing of painful stimuli.
The impacts of unmanaged medical pain extend far beyond the acute procedure, with demonstrable effects on physical development,1 behavior,2 stress reactivity,3 mother-child bonding,4 and potentially permanent changes in brain regions governing reasoning, emotions and interpretations of sensations.5
Ethically indefensible procedures lacking scientific validation of benefits versus harms, such as male infant circumcision, should be postponed until the patient can evaluate the evidence and risks vs benefits and consent as an informed, autonomous individual.
True reform requires abandoning paternalistic assumptions about infants as little more than passive bodies and recognizing the simultaneous vulnerability and complex personhood deserving of thoughtful protections. There exist better paths forward, guided by the motto "first, do no harm."
References
1. Slater R, et al. eLife. 2014.
2. Taddio A, Katz J. Lancet. 1997.
3. Graf Zepf B, et al. Z Geburtshilfe Neonatol. 2008.
4. Rhinehart J. Transactional Analysis Journal. 1999.
5. Gunnar MR, et al. Child Dev. 1995.
6. Tinari P. Circumcision Permanently Alters the Brain.
7. Kim D, Pang MG. BJU Int. 2007.
8. Goldman M, et al. Isr J Med Sci. 1996.
9. Prais D, et al. Arch Dis Child. 2009.
10. Amishai BZ, et al. IMAJ. 2009.
11. Carbajal R, et al. JAMA. 2008.
12. Tinari P. Circumcision Permanently Alters the Brain.
13. Rhinehart J. Transactional Analysis Journal. 1999.
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