OXFORD, ENGLAND: Babies feel pain "like adults"

Science Daily
April 21, 2015

Babies feel pain 'like adults': Most babies not given pain meds for surgery

The brains of babies 'light up' in a very similar way to adults when exposed to the same painful stimulus, a pioneering Oxford University brain scanning study has discovered. It suggests that babies experience pain much like adults.

The study looked at 10 healthy infants aged between one and six days old and 10 healthy adults aged 23-36 years. Infants were recruited from the John Radcliffe Hospital, Oxford (UK) and adult volunteers were Oxford University staff or students.

During the research babies, accompanied by parents and clinical staff, were placed in a Magnetic Resonance Imaging (MRI) scanner where they usually fell asleep. MRI scans were then taken of the babies' brains as they were 'poked' on the bottom of their feet with a special retracting rod creating a sensation 'like being poked with a pencil' -- mild enough that it did not wake them up. These scans were then compared with brain scans of adults exposed to the same pain stimulus.

The researchers found that 18 of the 20 brain regions active in adults experiencing pain were active in babies. Scans also showed that babies' brains had the same response to a weak 'poke' (of force 128mN) as adults did to a stimulus four times as strong (512mN). The findings suggest that not only do babies experience pain much like adults but that they also have a much lower pain threshold.
The research was funded by the Wellcome Trust and is reported in the journal eLife.

'Up until recently people didn't think it was possible to study pain in babies using MRI because, unlike adults, they don't keep still in the scanner!' said Dr Rebeccah Slater of Oxford University's Department of Paediatrics, lead author of the report. 'However, as babies that are less than a week old are more docile than older babies, we found that their parents were able to get them to fall asleep inside a scanner so that, for the first time, we could study pain in the infant brain using MRI.

'This is particularly important when it comes to pain: obviously babies can't tell us about their experience of pain and it is difficult to infer pain from visual observations. In fact some people have argued that babies' brains are not developed enough for them to really 'feel' pain, any reaction being just a reflex -- our study provides the first really strong evidence that this is not the case.'

The researchers say that it is now possible to see pain 'happening' inside the infant brain and it looks a lot like pain in adults.

As recently as the 1980s it was common practice for babies to be given neuromuscular blocks but no pain relief medication during surgery. In 2014 a review of neonatal pain management practice in intensive care highlighted that although such infants experience an average of 11 painful procedures per day 60% of babies do not receive any kind of pain medication.

'Thousands of babies across the UK undergo painful procedures every day but there are often no local pain management guidelines to help clinicians. Our study suggests that not only do babies experience pain but they may be more sensitive to it than adults,' said Dr Slater. 'We have to think that if we would provide pain relief for an older child undergoing a procedure then we should look at giving pain relief to an infant undergoing a similar procedure.'

Dr Slater added: 'Recent studies in adults have shown that it is possible to detect a neurological signature of pain using MRI. In the future we hope to develop similar systems to detect the 'pain signature' in babies' brains: this could enable us to test different pain relief treatments and see what would be most effective for this vulnerable population who can't speak for themselves.'
...

COPENHAGEN: Infant male genital cutting may increase autism risk

Daily Mail
January 9, 2015

Circumcised boys may be more likely to develop autism and ADHD by the age of 10, study claims  

• The findings hold regardless of cultural background, say researchers
• They suggest the pain caused by circumcision may be partly to blame
• This may in turn affect how the brain develops and reacts to stress
• Study looked at 340,000 boys born in Denmark between 1994 and 2003 
• But experts have urged caution over the 'extremely speculative findings'

by Anna Hodgekiss 
Circumcision before the age of five can double a boy's risk of developing autism, controversial research suggests.
 
Scientists believe the finding may be linked to stress caused by the pain of the procedure.
 
The study of more than 340,000 boys in Denmark found that circumcision raised the overall chances of an autism spectrum disorder before the age of 10 by 46 per cent.
 
But if circumcision took place before the age of five it doubled the risk.
Circumcision also appeared to increase the likelihood of boys from non-Muslim families developing hyperactivity disorder. 
 

Regardless of cultural background, circumcised boys may run a greater risk of developing autism and ADHD, a study has claimed

 

The research, published in the Journal of the Royal Society of Medicine, examined more than 340,000 boys born in Denmark between 1994 and 2003.
 
At the age of nine, their health was tracked - and almost 5,000 cases of ASD were diagnosed.
 
Professor Morten Frisch of the Statens Serum Institut, Copenhagen, who led the research, said: 'Our investigation was prompted by the combination of recent animal findings linking a single painful injury to lifelong deficits in stress response...and a study showing a strong, positive correlation between a country's neonatal male circumcision rate and its prevalence of ASD in boys.
 
He added: 'Today it is considered unacceptable practice to circumcise boys without proper pain relief.
 
'But none of the most common interventions used to reduce circumcision pain completely eliminates it and some boys will endure strongly painful circumcisions.'
 
The study goes on to discuss how painful experiences in babies have been shown - both in animal and human studies - to have a long-term effect on pain perception.
 
This is a characteristic often encountered among children with autism, they add.  
 
Professor Frisch said: 'Given the widespread practice of circumcision in infancy and childhood around the world, our findings should prompt other researchers to examine the possibility that circumcision trauma in infancy or early childhood might carry an increased risk of serious neurodevelopmental and psychological consequences.
[The paper goes on to spend  more space on critique and rebuttal than the detail of the study. This never happens with pro-circumcision studies, which are reported uncritically, with benefits often exaggerated and caveats ignored.}
 
However experts have urged caution over the findings.
 
Professor Jeremy Turk, Consultant Child & Adolescent Psychiatrist at Southwark Child & Adolescent Mental Health Neurodevelopmental Service, said: 'The findings of this research, while interesting, need to be considered carefully - one cannot draw very strong conclusions from the data. 
 
'This is not a causal study, but instead compares data sets and looks for correlations. 
 
'While this is a valid way of doing a study, it means that we must be careful about any implications.
 
'For example, many cases of autism are missed until children are older and as there are relatively few cases of autism this could easily skew the data.
 
'Furthermore, there are many potentially confounding variables which could explain raised ASD rates, which the authors do not explore or account for.
 
'Finally, I have some issues with the premise in that their speculations regarding early pain as a cause of autism are, to say the least, highly speculative. 
 
And Dr Rosa Hoekstra, lecturer in psychology at the Open University, said: 'I think this is an extremely speculative study. 
 
'The study is purely based on register data and takes a registered autism diagnosis at face value, without considering cultural or social factors affecting the likelihood of an (early) autism diagnosis. 
 

The researchers suggest the pain caused by circumcision may be partly to blame, in turn affecting how the brain develops and reacts to stress

 

'Even in a high income country like Denmark not all children with autism are detected and given a suitable autism diagnosis at an early age (the age under study in this paper). 
 
She added: 'An entirely different but in my view much more plausible explanation is as follows: Boys with symptoms of autism who undergo circumcision by a medical professional may have their symptoms recognised as autism more often, and at an earlier age, than boys who are not circumcised and who may therefore fly under the radar of medical professionals.
 
'In other words: the detection rate of autism (rather than the risk of autism per se) may be higher in boys seeing a medical professional for circumcision.
 
Professor David Katz, from University College London, who chairs Milah UK, a body that speaks for the Jewish community on issues related to circumcision, said: 'This report is far from convincing: correlation does not equal causation.
 
'There is a long history of attempts to link autistic spectrum disorders to unrelated practices, such as the measles/mumps/rubella association, which proved to be fraudulent.
 
He added: 'There is general agreement that in people suffering from an ASD there are abnormalities that can be identified in brain structure and/or function. 
'There is a strong genetic component, which may be a factor within the faith communities studied here, and which does not appear to have been explored amongst them.
 
'Some contemporary research does indicate that factors besides the genetic component are contributing to the increasing occurrence of ASD.
 
'For example, a variety of environmental toxins have been invoked to explain why these conditions are more prevalent today than they may have been in the past - but again proof of causation is lacking, and these factors are only likely to be relevant in those who are already vulnerable to them.'
 
Applied statistician Professor Kevin McConway, from the Open University, said: 'This study raises an interesting question, but one that cannot be fully answered with these data.'

ZIMBABWE: Pain haunts circumcison poster-boy

AllAfrica.com
February 25, 2014

Zimbabwe: Circumcision Pain Haunts Jah Prayzah

by Tawanda Marwizi
Man of the moment Mukudzei Mukombe aka Jah Prayzah has revealed he is having a hard time on stage due fresh circumcision wounds.

The musician was circumcised last week but did not take a break from shows and continues with energetic dances against post-circumcision medical instructions.

Speaking at the sidelines of the 21st February Movement Gala in Marondera on Sunday the musician said he is performing for the love of his fans but he is still in pain.

"I could not abandon my shows that had already been booked and we are going on with stage work but I am in pain," said Jah Prayzah.

The musician was involved in non-surgical PrePex male circumcision and it takes up to two weeks for the initial painful stages to subside.

[All circumcision is surgical. The PrePex method crushes instead of cutting and causes significant pain.]

"I can't divulge the stage of the process is now but what I can say is I am feeling the pain but this should not stop people from getting circumcised. I am braving the pain for the love of my fans," he said.

A health expert from a local circumcision clinic however said people should not be engaged in vigorous activities before circumcision wounds heal.

"People are just encouraged not to get involved vigorous activities because the healing process might be disturbed."

Meanwhile the musician has encouraged men to get circumcised.

"People should just take the responsibility. I might be in pain for this short while but I now know I did this for my healthy safety and for the safety of my partner."

GERMANY: Circumcision law has failed

Deutche Welle
December 12, 2013

German circumcision law still under fire

A year ago Germany, after a long and heated debate, passed a controversial new circumcision law. It was meant to be a Solomonic solution, but critics say that the new rules do not guarantee children's well-being.

A ruling by a Cologne regional court in the spring of 2012 set off a fierce debate over the Jewish and Muslim ritual of circumcision. The court decided that non-medical circumcision amounted to bodily harm. Both supporters and critics of the practice discussed the issue at length on television and op-ed pages, employing both medical and ethical arguments. The main question remained: how to reconcile freedom of religion and parents' rights to choose how to raise their children on the one hand, with the children's well-being on the other.

A law was passed that was meant to answer that question. Paragraph 1631d of the code of civil law declared that the circumcision of a male child is legal and must be done in accordance with "the rules of the medical profession" - as safely as possible and with appropriate and effective pain relief. Parents need to be informed of the procedure's potential risks, it must not pose a danger to the child's well-being, and the wishes of children old enough to express them also need to be taken into account. Representatives of Germany's Jewish and Muslim communities said they were satisfied with these conditions.

Justice Minister Sabine Leutheusser-Schnarrenberger, who introduced the bill, said the regulation re-established what was regarded as the status quo before the Cologne court's ruling.

But a year after coming into effect, the law is now a complete failure - at least according to critics, who say circumcision represents a violation of a child's physical integrity. Boys, critics said, often do not undergo the procedure under safe conditions and without appropriate pain relief.

"This law has legalized many questionable means of children's foreskin amputation," said Christian Bahls, head of the Mogis association, which advocates the physical integrity and sexual self-determination of children.

Bahls refers to a case in Berlin in which the Jewish method of Metzitzah B'Peh was carried out - where the circumciser sucks the wound with his mouth, and not with a pipette or a small tube. Because of the danger of infection, the Israel Ambulatory Pediatric Association (IAPA), among other associations, has already rejected the practice.

Mogis pressed charges against the boy's father, a rabbi, as well as his wife and the circumciser. But prosecutors dropped the case because no criminal responsibility could be proven against the parents, and the circumciser lived abroad and so was outside German jurisdiction.

Bahls says this outcome shows that the new law does not protect children's well-being properly. Prosecutors, he claims, dropped the case on the grounds that applying a painkilling bandage after the circumcision was enough to ensure medical safety. "So clearly it is permissible to amputate a child's foreskin without an adequate anesthetic," said Bahls. "That is what the law allows."

Wolfgang Gahr, general secretary of Germany's academy for children and young people's medicine (DAKJ), has also heard reports of circumcisions being carried out under hygienically questionable conditions and without anesthetic. "They are individual cases," he said. "We don't have any figures." The DAKJ is against non-medical circumcisions in general, but if they can't be avoided, "they should at least take place under medical supervision and be painless."

But this last condition is certainly not stipulated by the law, according to which children under six months are allowed to be circumcised by someone nominated by the religious community - in other words, a circumciser, who in most cases is not a doctor. That means he is not qualified to administer an anesthetic, says Gahr.

The Justice Ministry, on the other hand, cites what it claims is evidence that the law protects children's well-being - for instance a ruling made by a Higher Regional Court in September, which forbade a Kenyan woman from circumcising her six-year-old son because parents and doctors had not consulted the child, and because the parents had failed to properly inform themselves.

Germany's Constitutional Court has also had to address the law, after a man brought a lawsuit because he had been circumcised by someone without medical training, in 1991, when he was aged six. The judges dismissed his case because he was not currently directly affected by the new law. In other words, the court avoided addressing the new law itself.

GEORGIA: Early pain changes the brain

Science News
October 30, 2013

Early pain changes the brain

A new study has found that rats subjected to pain soon after birth undergo changes in their brains.
This may permanently alter their reaction to stress and pain in adulthood, Dr Anne Murphy of Georgia State University has found

More

DELAWARE: Spanking ruled "physical injury"

HSLDA
September 21, 2012

Child Welfare Legislation Outlaws Spanking

When Governor Jack Markell signed into law Senate Bill 234 on September 12, 2012, Delaware became the first state in the in the nation to effectively outlaw corporal discipline of children by their parents.

Sponsored by Senate Majority Leader Patricia M. Blevins (District 7), the legislation creates a definition of the term “physical injury” in the child abuse and neglect laws to include “pain.” Currently the law permits a parent to use force to punish a child for misconduct, but it prohibits any act that is likely to cause or does cause physical injury. By defining “physical injury” to include the infliction of pain on a child, spanking has become a crime in Delaware punishable by imprisonment.
Under the new law, a parent causing “physical injury” (e.g., pain) to a child under age 18 would be guilty of a class A misdemeanor and subject to one year in prison. A parent causing pain to a child who was 3 years of age or younger would be guilty of a class G felony and subject to two years in prison.

Home School Legal Defense Association opposed this bill as a violation of the right of parents to direct the upbringing of their children, including the long-recognized right to administer reasonable corporal discipline. HSLDA worked with the Delaware Home Education Association and the Delaware Family Policy Council in an effort to bring about a defeat of this legislation.

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