Infant circumcision often enters conversation when early trauma is discussed. And well it should since there are documentable effects of the harm it can cause physically and psychologically. However, often longitudinal datasets fail to analyze its relationships to child outcomes (see prior discussion of Schore’s 2017 review of baby boy health).

Studies show that the major reason that circumcision continues among non-religiously guided groups is father’s circumcision and perceptions that it is culturally normal (Rediger & Muller, 2013; Wang et al, 2010). (Of course, in the USA the medical establishment is guilty for condoning if not promoting circumcision to families based on cultural bias and shoddy research and perhaps because of profit making by doctors for the procedure--corporations use foreskins for costly products.) (See beginning of a series on circumcision here.)

Why worry about infant circumcision if it is common? As medical research gets more savvy and longitudinal data collected and analyzed, more studies are showing the harms of circumcision. For example, a recent longitudinal study from Denmark examined circumcision’s relation to autism. Over 300,000 boys were followed over an 8-year period. They observed a 106%  increased risk of early childhood autism associated with neonatal trauma (Frisch & Simonsen, 2015). This is a beginning. Other impairments, like ADHD and schizophrenia, are comorbidities (co-occur) of autism spectrum disorder, so the risk of these as consequences of infant circumcision need to be investigated as well.

It should be noted that infant circumcision, the most frequent neonatal procedure performed, results in traumatic brain injury manifested by central sensitization and multiple changes in the neurobiology (see details here: The consequences of pain in early life: injury-induced plasticity in developing pain pathways). Sensory processing disorder, which is associated with autism spectrum disorder, is likely etiologically due to central sensitization. It should be noted that newborns with multiple stressors seem more likely to succumb to Sudden Infant Death Syndrome (Elhaik, 2016).

Months after neonatal trauma there is increased pain responses to childhood immunization (Taddio et al, 1997). The accumulating facts about the harmful outcomes of circumcision raise the question as to whether neonatally traumatized boys comprises a neurodevelopmentally at-risk population that requires additional epidemiologic study (Taddio et al, 1997). Perhaps precautions in administration of the vaccine schedule should be examined along with the need for parental informed consent.

But there are more research questions to probe. Neonatal infants with decreased heart rate variability are more at risk, as heart rate variability is inversely related to severity of neonatal pain response (Porter et al., 1988). Decreased vagal tone, related to heart-rate variability, is observed in Autism Spectrum Disorder(ASD) /schizophrenia. Heart rate variability and vagal tone are shaped by parental responsiveness postnatally (Porges, 2011) and it is unclear what fetal experiences influence it.

In contrast to the Danish cohort study, ASD/ADHD/SCZ studies to date have not adequately evaluated the disparate male to female autism predominance  because of inadequate study design -- failure to control for confounding of outcomes with circumcision (which should be part of any future well-controlled neuroimaging/epidemiologic/epigenetic studies of ASD / comorbidities).

Notably In Hispanic countries where circumcision is a stigma, the male:female ratio of autism is closer to 1:1 (Fortea Sevilla et al., 2013). The ecologic association of prevalence of ASD with population rates of neonatal trauma is r=0.98, virtually 1 to 1 (Bauer & Kriebel, 2013).

It is clear that more co-active factors and child outcomes should be studied in relation to circumcision. Meanwhile, it seems reasonable to adopt a precautionary principle and “do no harm”—a medical ethics principle that should be employed not only by medical personnel towards infants but also by parents who want to optimize their child’s development.

ASD=Autism Spectrum Disorder

ADHD=Attention Deficit Hyperactivity Disorder

SCZ=Schizophrenia

Early trauma influences brain development and morality. See my book, Neurobiology and the Development of Human Morality: Evolution, Culture and Wisdom.

WHEN I WRITE ABOUT CHILD RAISING, I assume the importance of the evolved nest or evolved developmental niche (EDN) for raising human infants (which initially arose over 30 million years ago with the emergence of the social mammals and has been slightly altered among human groups based on anthropological research).

The EDN is the baseline I use to examine what fosters optimal human health, wellbeing and compassionate morality. The niche includes at least the following: infant-initiated breastfeeding for several years, nearly constant touch early, responsiveness to needs to avoid distressing a baby, playful companionship with multi-aged playmates, multiple adult caregivers, positive social support, and soothing perinatal experiences.

All EDN characteristics are linked to health in mammalian and human studies (for reviews, see Narvaez, Panksepp, Schore & Gleason, 2013; Narvaez, Valentino, Fuentes, McKenna & Gray, 2014; Narvaez, 2014) Thus, shifts away from the EDN baseline are risky and must be supported with lifelong longitudinal data looking at multiple aspects of psychosocial and neurobiological wellbeing in children and adults. My comments and posts stem from these basic assumptions.

My research laboratory has documented the importance of the EDN for child wellbeing and moral development with more papers in the works (see my Website to download papers):

Narvaez, D., Gleason, T., Wang, L., Brooks, J., Lefever, J., Cheng, A., & Centers for the Prevention of Child Neglect (2013). The Evolved Development Niche: Longitudinal Effects of Caregiving Practices on Early Childhood Psychosocial Development. Early Childhood Research Quarterly, 28 (4), 759–773. Doi: 10.1016/j.ecresq.2013.07.003

Narvaez, D., Wang, L., Gleason, T., Cheng, A., Lefever, J., & Deng, L.  (2013). The Evolved Developmental Niche and sociomoral outcomes in Chinese three-year-olds. European Journal of Developmental Psychology, 10(2), 106-127.

We also have a recent paper look at adult effects:

Narvaez, D., Wang, L, & Cheng, A. (2016). Evolved Developmental Niche History: Relation to adult psychopathology and morality. Applied Developmental Science, 4, 294-309. http://dx.doi.org/10.1080/10888691.2015.1128835

See these for theoretical reviews:

Narvaez, D., Gettler, L., Braungart-Rieker, J., Miller-Graff, L., & Hastings, P.  (2016). The flourishing of young Children: Evolutionary baselines. In Narvaez, D., Braungart-Rieker, J., Miller, L., Gettler, L., & Harris, P. (Eds.), Contexts for young child flourishing: Evolution, family and society (pp. 3-27). New York, NY: Oxford University Press.

Narvaez, D., Hastings, P., Braungart-Rieker, J., Miller, L., & Gettler, L. (2016). Young child flourishing as an aim for society. In Narvaez, D., Braungart-Rieker, J., Miller, L., Gettler, L., & Hastings, P. (Eds.), Contexts for young child flourishing: Evolution, family and society (pp. 347-359). New York, NY: Oxford University Press.

Also see these books:

Evolution, Early Experience and Human Development (Oxford University Press)

Ancestral Landscapes in Human Evolution (Oxford University Press)

Contexts for Young Child Flourishing: Evolution, Family and Society (ed. with Braungart-Rieker, Miller-Graff, Gettler, Hastings; OUP, 2016)

Neurobiology and the Development of Human Morality (W.W. Norton)

References

Bauer, A.Z., & Kriebel, D. (2013). Prenatal and perinatal analgesic exposure and autism: an ecological link. Environmental Health, 12:41. doi: 10.1186/1476-069X-12-41.

Elhaik, E. (2016). A "Wear and Tear" Hypothesis to Explain Sudden Infant Death Syndrome. Frontiers of Neurology, 7,180.

Fortea Sevilla, M.S., Escandell Bermúdez, M.O., Castro Sánchez, J.J. (2013). Estimación de la prevalencia de los trastornos del espectro autista en Canarias [Estimated prevalence of autism spectrum disorders in the Canary Islands]. Anales Pediatricas (Barc), 79(6), 352-9. doi: 10.1016/j.anpedi.2013.04.022. Epub 2013 Jun 6.

Frisch, M., Simonsen, J. (2015). Ritual circumcision and risk of autism spectrum disorder in 0- to 9-year-old boys: national cohort study in Denmark Journal of the Royal Society of Medicine, Vol 108, Issue 7.doi: 10.1177/0141076814565942

Porter, F.L., Porges, S.W., Marshall, R.E. (1988). Newborn pain cries and vagal tone: parallel changes in response to circumcision. Child Development, 59(2),495-505.

Rediger, C., Muller AJ. (2013). Parents' rationale for male circumcision. Canadian Family Physician, 59(2), e110-5.

Schwaller, F., & Fitzgerald M. (2014). The consequences of pain in early life: injury-induced plasticity in developing pain pathways. European Journal of Neuroscience, 39(3), 344-352. doi: 10.1111/ejn.12414

Taddio, A., Katz, J., Ilersich, A.L., Koren, G. (1997). Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet, 349(9052), 599-603.

Wang, M.L., Macklin, E.A., Tracy, E., Nadel, H., & Catlin, E.A. (2010). Updated parental viewpoints on male neonatal circumcision in the United States. Clinical Pediatrics (Phila), 49(2), 130-136. doi: 10.1177/0009922809346569

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