Baby Sleep Positions

Andy at How To Be a Dad recently wrote about the blurry eyed, early morning (or late night!) wake up to a little one staring you back in the face. In his diagram (3rd below) he calls this the "Stalker" sleep position. Anyone who shares sleep with their baby knows that there comes a point, usually right around that first birthday party, when nighttime acrobatics become commonplace in the family bed. We've laughed about it, cried about it, and ultimately, come to truly treasure these fleeting moments with our children who quickly grow up to want a room of their own. Looking over these sleep positions, there may just be a couple you recognize as well.

For more on safe sleep sharing, visit the Safe CoSleeping page on Facebook, and look into research cataloged on the Baby Sleep Resource Page.

If you have a photo you'd like to contribute to the How CoSleeping Happens album, we'd love to hear from you. Write to DrMomma.org@gmail.com This can be a photo of your sleep sharing set up only, a photo of cosleeping 'in action', or both. The gallery will serve as a snapshot of how families around the world share sleep with their little ones - a sociological reflection of our present time in history.

Love is the Color of a Rainbow

How would you describe the colors of the rainbow to a child who was born without visual sight? If her eyes had never fixed on the colors of the world, or the contours of her momma’s face ~ if she had only seen the world through her many other senses, and as you splashed together in the puddles one rainy afternoon she asked you to please, “Tell me what the rainbow looks like…”

How would you respond?

In her beautiful new book, Love is the Color of a Rainbow, author, Kathy Parra, replies to this very question in a way that is both deeply involved and simple to understand ~ using our many senses to describe the blues, reds, greens, oranges, yellows and purples. Reading her words, if we close our eyes and imagine, or gaze upon the blissfully warm illustrations by Candace Keach, we can feel the rainbow’s colors coming alive around us.

Willow and her momma go out to splash barefoot in puddles and catch raindrops on their tongues (something my own son is thrilled to know other children do with their parents too!). The two of them hold a small snail, and feel the roundness of his shell to discover a rainbow’s shape. They stroll under the branches of a willow tree and feel the gentleness of green; and taste a fresh tomato off the vine to find that red is a color very much alive! Willow and her mom gather up wildflowers and breathe in the sweetness of orange and purple; and then feel the warmth that yellow brings with the summer’s sun, and the peace of the vast blue sky around us.

After their day’s adventures together, Willow wraps her arms around her momma, just as the rainbow wraps her arms around the earth, and Willow decides that a rainbow is colored very much like love.

The construction of Love is the Color of a Rainbow is softcover and printed by EcoFriendlyPrinter.com on recycled paper. I greatly appreciate this symmetry between the manner in which Parra presents herself and her story - her own respect for the earth and life around us - and the physical makeup of her book. A portion of the proceeds from Love is the Color of a Rainbow also go to support nature and environmental organizations.

The one aspect of this warm and colorful book that I wish were slightly different is the size of the text. Larger text in future editions would make it easier for parents and grandparents hard-of-sight themselves to read with their little ones, and easier for learning to read children to follow along.

Today was a rainy, cold, winter day here, but we did have a splendid time sharing Parra's book at the mall playground. Children gathered around and were eager to listen to all that Willow and her mother experienced on their own rainy day together. "Read it again!" came the requests, and in the words of my three year old, “This is The Beautiful Book!”

Read more about Love is the Color of a Rainbow and pick up a treasured copy of your own at KathyParra.com. Connect with Parra at her page on Facebook.

~ Give-Away Happening Now ~ 

Kathy Parra will be graciously giving away a signed copy of Love is the Color of a Rainbow to two peaceful parenting families who also have a heart for helping children connect with the natural world around them. If you take special moments to invest in a child's exploration of nature, to spend time outdoors, to talk with the plants and animals around you, to help little ones understand where their food comes from, or any number of other ways we come to understand love and compassion through the natural world, we'd love to hear from you.

To enter:

1) Skip over to Kathy Parra's Facebook page and say hi ~ tell her you came from peaceful parenting.

2) Send us your story (and a photo if you wish) of something you and your child(ren) enjoy doing together in the natural world, and how it meshes with gentle family living. Email to DrMomma.org@gmail.com If this is a previously posted article on another site, you may email the link.

Two winners will be chosen at random on Feb 28th by Random.org (numbers assigned in the order entries are received). All entries will be read by peaceful parenting editors and are eligible for potential publishing at DrMomma.org. Please include a brief author's bio if you wish.

We look forward to hearing from you, and as Kathy would say ~ Dolphin Love! 

~~~~

20 Ways to Bring Goodness Into Your Life

By The Dalai Lama
Read more from the revered and internationally known, Tenzin Gyatso, at his homepage: DalaiLama.com

Photo © 2012 peaceful parenting mom, Aliya Martinez, and her precious son, David. ❤

1) Take into account that great love and great achievements involve great risk.

2) When you lose, don’t lose the lesson.

3) Follow the three Rs:

- Respect for self,

- Respect for others

- Responsibility for all your actions.

4) Remember that not getting what you want is sometimes a wonderful stroke of luck.

5) Learn the rules so you know how to break them properly.

6) Don’t let a little dispute injure a great relationship.

7) When you realize you’ve made a mistake, take immediate steps to correct it.

8) Spend some time alone every day.

9) Open your arms to change, but don’t let go of your values.

10) Remember that silence is sometimes the best answer.

11) Live a good, honorable life. 

Then when you get older and think back, you’ll be able to enjoy it a second time.

12) A loving atmosphere in your home is the foundation for your life.

13) In disagreements with loved ones, deal only with the current situation.

Don’t bring up the past.

14) Share your knowledge. It is a way to achieve immortality.

15) Be gentle with the earth.

16) Once a year, go someplace you’ve never been before.

17) Remember that the best relationship is one in which your love for each other 

exceeds your need for each other.

18) Judge your success by what you had to give up in order to get it.

19) If you want others to be happy, practice compassion.

20) If you want to be happy, practice compassion.

~~~~

Finland Parents and Circumciser Charged with Assault and Battery and Fined for Sons' Circumcision

Helsinki, the capitol and largest city in Finland made news today when the District Court imposed a fine on the man who was convicted of assault and battery last Friday for circumcising two minor aged boys of Muslim parents. The parents of the boys have been convicted of incitement to assault and battery for encouraging the circumcision of their sons, and will pay out fines to their boys, but will not receive legal punishments.

Finland does not have specific legal guidelines for genital cutting of minors when cutting is performed for "religious reasons." In 2008, Finland's Supreme Court ruled that genital cutting for religious reasons is not specifically illegal if performed under proper medical procedure. However, after the Supreme Court's ruling, Finland signed the Convention on Human Rights and Biomedicine of the Council of Europe. Under this convention, any medical procedure impacting an individual's health must be performed according to professional obligations and requirements. Surgical procedures (including genital cutting and the amputation of the prepuce - 'foreskin' or 'clitoral hood') can only be performed on someone able to give informed consent. If they are unable to provide informed consent (because they are a minor child or infant, or for any other reason), they can only be put through surgical producers if there are immediate benefits. The court further ruled that circumcision is a procedure that should only be performed on those who consent to undergo such cutting of their own body. As an additional prerequisite, anyone performing genital cutting must be a medical or health care professional with a license in Finland or elsewhere in the European Union.

Last Friday, the Helsinki District Court stated that it would be a misinterpretation of the Supreme Court's earlier decision if they were to ignore or authorize these cases of non-medically justified circumcision.

The man who circumcised the boys said that he has performed the same surgical amputation of the prepuce upon thousands of boys in Turkey and Iran, but lacks the license required for such surgical procedures in Finland.

One of the two boys cut in Helsinki suffered infections as a result of circumcision. This boy was awarded 3,000 EUR (approximately $3,900 USD) to be paid to him by both his parents and the man who cut him. The other boy was awarded 500 EUR (approximately $650 U.S.) which will also be paid out by both his parents, and the circumcising man. In addition, the court issued a 60 day income-linked fine for the crime of circumcision without medical justification or qualification, which amounted to 360 EUR (approximately $470 USD).



Related Reading:

Faith Considerations on Circumcision (Islam, Judaism, Christianity)

Male Circumcision in the USA: A Human Rights Primer

Swedish Doctors Refuse to Circumcise 

Religious Reasons for Circumcision Could Breech Human Rights

~~~~

How the Grinch Stole Breastfeeding

By Chuck Dufano, WIC breastfeeding coordinator with the Johnson County Health Department in Iowa City, Iowa (with thanks to Dr. Seuss).

Above: Emilee S.'s son, Noah, 11 months old, enjoys some Christmas Milk ❤

Every Who down in Who-ville liked breastfeeding a lot
But the Grinch,
Who lived just north of Who-ville,
Did NOT!

The Grinch hated breastfeeding -- no matter what season,
Now, please don't ask why. No one quite knows the reason.
It could be, he thought, there wasn't enough nourishment.
It could be, perhaps, to see it caused him embarrassment.
But I think that the most likely reason above others
Was he thought the Who-kids would love only their mothers.

And the more the Grinch thought all about breastfeeding
The more the Grinch thought, "I must stop this whole thing!
Why for fifty three years I've put up with it. Now,
I must stop these Who-kids from breastfeeding...but how?"

Then he got an idea.
An awful idea!
The Grinch
Got a wonderful, awful idea!

"I know just what to do!" the Grinch laughed in his throat.
And made a quick Santy Claus hat and a coat.
And he grabbed a big briefcase with great Grinchy pep.
"In this get-up I look like a formula rep!"

All the Whos were dreaming sweet dreams without care
When he came to the first little house on the square.
He climbed down the chimney while the Whos still slept
Then off to the nursery on his belly he crept.

He took all the bra pads and breast shells.
He took all the bags for expressed milk as well.
He took the diaper log and breastfeeding diary.
He took the La Leche League book from the library.

In their place he put powdered Enfamil cans
And Prosobee concentrate for soy-formula fans.
Next to it all with a great heavy lug
He placed a gallon store-bought filtered water jug.

"And NOW," grinned the Grinch, "the last thing to dump
Is the electric double breastfeeding pump!"
And the Grinch grabbed the pump, and he started to shove.
When he heard the small sound like the coo of a dove.
He turned around fast and saw a small Who.
Little Cindy-Lou Who, who was not more than two.

She stared at the Grinch and said "Santy Claus, why,
Why are you taking our breastpump, why?"

But you know, that old Grinch was so smart and so slick
He thought up a lie, and he thought it up quick!
"Why my sweet little tot," the fake Santy Claus lied,
"There's something wrong with the wiring inside.
So I'm taking it home to my workshop, my dear,
I'll fix it up there. Then I'll bring it back here."

But Cindy-Lou Who started to fret.
"Oh, my Daddy's going to be awfully upset!
He feeds baby mommy's milk when she is away,
He does this at least two or three times every day!"

"You mean your Daddy can feed baby breastmilk?"
The Grinch asked Cindy-Lou.
"Oh, yes," she replied,
"And he changes diapers, too!
He gives the baby a bath and they play peek-a-boo.
When mommy's nursing he brings her a cup of water or two!"

Now the Grinch stood puzzling and puzzling 'til his puzzler was sore.
Then the Grinch thought of something he hadn't before.
"Maybe breastfeeding," he thought, shouldn't make me moan.
"Maybe breastfeeding...perhaps...isn't mother's job alone!"

And now that his heart was no longer bitter
He became the official Who-baby sitter.
And to all those who listened to his heeding

He...he HIMSELF!
The Grinch encouraged breastfeeding!

Katie O. tandem nurses her 4-month-old sons. ❤

~~~~

German Factory Uses Infant Foreskin to Grow Human Skin

By Danelle Frisbie

An employee at the Fraunhofer Institute holds a culture plate with foreskin-grown skin samples.

We've watched before as human foreskin is harvested from infant boys in the United States and sold for use in cosmetics nationally and overseas. We've seen foreskin taken from infant babies and used in skin grafting for burn victims. Now a laboratory dubbed the "Skin Factory" at the Fraunhofer Institute in Stuttgart, Germany is using vorhaut von kindern - children's foreskin - to grow new skin samples for testing cosmetics and other products.

Project spokesperson, Andreas Traube, says researchers hope that this use of human foreskin could replace animal testing, and eventually be used in developing treatments for cancer, pigmentation diseases, and certain skin allergies.

The process itself takes six weeks to complete, and during this time 10 million skin cells are grown from one single boy's foreskin - to make new skin up to five millimeters thick. A machine is used to heat the foreskin to 98.6 degrees Fahrenheit (the temperature of the human body), and robotic hands extract cells from the organ. Scientists then take the extracted cells, mix them with collagen and connective tissue, and incubate them inside a petri dish lined tube, where they multiply at the same regulated temperature. This tube, approximately 22 feet long, 10 feet wide and 10 feet high, fosters the growth of the foreskin's cells into an epidermis layer of skin (the outermost skin on the human body). Three layers of this new skin are finally put together to create the end sample. In regards to the month and a half long time frame, Traube says, "We can't use the machine to speed up the process; biology needs time to take its course."

While European authorities have yet to authorize the Skin Factory for official use in product testing, new skin swatches from young human foreskin is begin produced at a rate of 5,000 samples per month and authorities are examining the factory to determine if the skin can be used commercially. "It's logical that we'd want to take the operation to a bigger scale," said Traube. And at least one German organization has already expressed interest in the machine. "I think the idea is a good one. I believe cells from artificially cultivated skin are indeed comparable with real skin," says Rolf Homke, spokesman for the German Association of Research-based Pharmaceutical Companies. "I do think it might take a few years to get up and running though. There are complicated international safety standards -- these procedures can't just be changed overnight."

One ethical problem in all of this? These harvested foreskins belong to babies and toddlers who are not yet able to consent to the organ's amputation from their own bodies. The Skin Factory uses foreskin only from newborn baby boys up to four years of age, and the goal is to gather as many infant foreskins as possible. "The older the foreskin is, the worse it performs," says Traube. And this foreskin (the prepuce organ) is one that all mammals are born with, male and female alike. It is on the human body for a purpose - it serves many important developmental, immunological, and sexual functions. Just as the foreskin is valuable to researchers when amputated from babies and toddlers, it is of even more value when it remains on the body to which it belongs.

Fraunhofer Institute for Interfacial Engineering and Biotechnology

Related Reading:

Huffington Post report on the skin factory:
http://www.huffingtonpost.com/2011/12/20/german-skin-factory-uses-baby-foreskin_n_1161384.html

New York Daily News report on the skin factory:
http://www.nydailynews.com/life-style/health/german-scientists-grow-artificial-skin-cells-baby-foreskins-article-1.994464

The Foreskins in Oprah's Face Cream
http://www.drmomma.org/2009/10/foreskins-in-oprahs-facecream.html

Article Asks, "Are Infant Foreskins the New Botox?"
http://www.drmomma.org/2010/04/article-asks-are-infant-foreskins-new.html

Stealing Foreskins: The Science of Skin Grafting
http://www.drmomma.org/2009/12/stealing-foreskins-science-of-skin.html

~~~~

Urine Samples and Catheter Insertion for Intact Boys

By Danelle Frisbie © 2011

We receive two common types of forced retraction reports from parents: those that happen at well-baby checkups in the United States, often before a parent even knows what is happening, and those that happen when a parent ends up in the hospital with a baby who is catheterized (due to illness or surgery).

Before we address catheterization specifically, and the correct way to catheterize an intact male baby or child, it should be noted that frequently there is truly not a need for catheterization in the first place. With some surgeries, and post-op recovery, it is going to be necessary. However, often, in surgical cases for babies and toddlers, simply wearing a diaper and having another couple ready for change during and/or post-OR, is another option, especially if the toddler will be under general anesthesia for less than 4 hours.

Urinary Tract Infection

Besides surgery, the most common reason for catheterization is to check for the existence of a urinary tract infection (UTI). UTIs occur with much more frequency in girls than they do in boys due to the short urethra and proximity to the anus (contamination with fecal matter or bacteria from the hands of a care-taker are the two biggest causes of UTIs). UTIs are easily treated with antibiotics, but they should not be ignored or left untreated because bacteria can quickly spread up the urinary tract, through the bladder, into the kidneys, and do serious or permanent damage. UTIs are bacterial infections and once they have taken hold, merely drinking cranberry juice will not kill off bacteria, as some pop parenting reports suggest. Regularly consuming 100% cranberry extract capsules (a much higher concentration than you would get from cranberry juice) for older children and adults can reduce the likelihood of UTIs in the future by priming the health of the urinary tract, but it cannot 'cure' an already established bacterial infection. Even if symptoms disappear, the strongest bacterial strains may remain, causing future kidney problems. Therefore, if you suspect UTI, do not wait, and do not mess around with treatment if a UTI is confirmed. If antibiotics are prescribed for a UTI, be sure your baby or child takes the full does, on time, and does not miss any days or stop early (which can also lead to the most powerful bacteria lingering on when the child is asymptomatic).

There are some children (girls especially) who seem overly susceptible to contracting UTIs and may have a bout with several each year until they are older, out of diapers, without parents' hands helping them to wipe, and always wiping themselves 'front to back.' While it is not a subject regularly brought up at the physician's office, self-touching or exploration of the genitals (masturbation) with hands that have not yet been washed and have fecal particles on them is another way that UTIs can be contracted - again, especially among girls whose urethra is shorter and less protected. This does not make masturbation 'wrong' or 'dirty' -- it merely is a reality that we need to wash our hands before and after changing or wiping babies or toddlers, and encourage them to do the same before they touch their own bodies. This is also one of the reasons masturbation and circumcision became intertwined in U.S. history in the first place -- it was theorized that if we remove the prepuce (which houses the most nerves of any male body part, and a relatively equal number to the female clitoris) we would thereby diminish boy's and men's sexual desire to masturbate, and in turn, we'd also see fewer UTIs (among other illnesses previously blamed on masturbation).

In reality, when forced retraction is not part of the picture, UTIs are no more common in intact baby boys (boys who have their full, intact prepuce and penis) than in circumcised boys. The prepuce, in fact, serves to protect against UTIs. Additionally, breastfeeding reduces the rate of urinary tract infection for both male and female babies, as human milk is powerfully charged with antibodies and white blood cells, among other protective, immunological features.

Urine Sampling

Today, the two most commonly used methods of collecting a urine sample from non-toilet using babies and children in U.S. emergency rooms are the "clean catch" and "bag specimen." Neither method is done without contamination of sample, but research suggests that between the two, clean catch is the way to go. (1, 2) Note: Studies do show that there is no significant variation between clean catch versus a standard urine sample obtained through other means for older children and adults who can urinate into a sterile cup on their own. (3, 4, 5, 6, 7)

A clean catch receptacle designed by UriAid especially for use with children, women, or little ones who may be laying down during urine sample collection. 

A clean catch works by wiping down the genitals of an infant or child with sanitizing wipes (provided by the clinic), and holding a sterile specimen bottle under the stream of urine - after the baby/child has started to urinate. This is considered to be the 'gold standard' of non-invasive urine sampling, but is more difficult to time with babies. Breastfeeding may help to fill and release the bladder.

For older children who can tell you when they need to go, a clean catch can be done at home. Wipe down the outside of the genitals and the perineum (between the urethra and rectum) with a wet cloth. Have your child drink a lot of liquid or nurse, and stand by or sit on the toilet with the faucet water running (this helps to psychologically induce 'flow'). Your child may also want to stand over a cup in the bathtub if he is more comfortable with this. Write your child's name, date of birth, and the date and time the sample was taken on the outside of the cup. Take it to your local urgent care or emergency room within 2 hours of the time it was taken (if more time has passed, it is likely they will ask you to repeat the sample). If your child truly has a UTI, it may be difficult for them to push out urine even when they feel the intense urge to 'go.' This urgency and frequency, coupled with being unable to eliminate urine, is a key indicating factor that there is indeed a UTI present, and a full round of antibiotics are justified. Babies who cannot tell you that they desperately need to go, but cannot, and that it constantly hurts, and stings when they try, are those who we are especially concerned with - their cry of discomfort, fever to fight infection, and possible reduction in wet diapers, are the only indications we often have of a UTI.

Urine collection pad kit.

The National Institute for Health and Clinical Excellence (NICE) suggests that the use of urine collection pads is the next best method of urine collection in a non-toilet using baby or child. This is a special pad made specifically for collecting urine that is placed into a baby's diaper after a wipe-down with a sanitizing wipe. The pad needs to be changed every 30-40 minutes (whether the child wets or not) so as to reduce the rate of contamination. (8) One reason that we see higher rates of UTIs in the first place during the first year of life is due to the diapering of our babies - a situation that helps to move fecal bacteria from the anus to the meatus (urethral opening). The same is true for collection pads - it is merely contact with the perineal area that increases contamination of sample - so change often. (9) 

Pediatric urine collection bag. 

Another form of urine collection (which sees no less contamination of sample than the urine collection pad, and is more cumbersome, so may not be the method of choice) is the urine collection bag. The bag has a U shaped sticky area (similar to a bandaid, but with less adhesive) on the round opening that is placed over the genitals after they are wiped down. The bag lays out of the way (to the top or bottom of baby's genitals) as urine is collected. A diaper can be put on over the the collection bag. If being used at home, the urine from the collection bag can then be transferred to a sterile collection cup and submitted to your local urgent care or emergency room within 2 hours, just as it would be with a clean catch. A 2009 study published in the Journal of Pediatrics found that bag-obtained specimens produced a significantly higher number of false-positive results (parents were told their child had a UTI, when in fact, he did not). In addition, there was a higher number of false-negatives (parents were told their child did not have a UTI, when he in fact did). (10) 

 Infant with urine collection bag in place. 

Neither pads or bags may be left on a baby for more than 40 minutes or it will increase the likelihood of a bacterial infection even if your baby does not already have an infection. Leaving babies in diapers all day also increases infection potential - so give your little one some 'diaper free' time whenever you are able. Babies who are not yet crawling can do tummy time on a waterproof mat with a towel or cloth diaper laid out under him/her. Many parents today incorporate 'elimination communication' into their routine as well, which also reduces time in diapers.

Catheters

Occasionally, medical staff will suggest they need to collect an uncontaminated sample, or verify the results of a sample previously obtained through non-invasive means, with catheterization.

Adult intact male with Foley catheter in place to demonstrate how the catheter would appear inside your son. Infants and children have a shorter urethra (and shorter penis) which is one reason they have a tendency to get more UTIs. Therefore, the catheter itself will be smaller and shorter, without as far to go to reach the bladder. The balloon you see here (for the Foley) would be present if your son is catheterized for a surgery, but not present for a brief urine sample. The catheter goes directly from the urethra to the bladder - above the prostate gland that you see pictured here between the penis and bladder.

There are two types of catheters that are most commonly used with infant or young boys: the Foley catheter and the intermittent or Robinson catheter. The Foley catheter is used most often during surgery when the instrument needs to stay in place. This is done with a small balloon at the tip of the catheter that is inflated with sterile water once inside the bladder.  The intermittent/Robinson catheter is a flexible catheter that is used most often when medical staff are checking for urinary tract infection. It is designed for the brief drainage of urine - to obtain a quick sample - and cannot stay in place without being held.

When an intact male baby or child is catheterized, retraction of the prepuce (foreskin) is not necessary or indicated.

In the United States there is quite a well founded concern that forced retraction will come into play when an intact male child is catheterized. However, it is the female patient for whom catheterization is actually more diverse and confounding. Age, weight, childbirth, past surgeries, female genital cutting, and many natural variations in the female body make catheterization of a girl or woman much more complex than catheterization of a boy or man, intact or otherwise. In general (unless hypospadias is a factor) the meatus (urinary opening) is going to be somewhat centrally located directly behind the opening to the prepuce, and fairly easy to 'hit on feel.'

The prepuce will typically be tightly adhered to the glans (penis head) of a baby or young toddler with little slack or room for movement, as seen in the photograph below. Even in boys as old as 10 years, many will still not have a retractible prepuce. In Pediatrics, Rudolph and Hoffman note, "The prepuce, foreskin, is normally not retractile at birth. The ventral surface of the foreskin is naturally fused to the glans of the penis. At age 6 years, 80 percent of boys still do not have a fully retractile foreskin. By age 17 years, however, 97 to 99 percent of uncircumcised males have a fully retractile foreskin." The average age of retraction is 10 1/2 years -- some will retract naturally, on their own, sooner, and some later. Each is within the range of normal, but no one should retract a baby or child except for the boy himself when he chooses to do so.

In their bulletin, Care of the Uncircumcised Penis, the American Academy of Pediatrics stresses, "...foreskin retraction should never be forced. Until natural separation occurs, do not try to pull the foreskin back - especially an infant's. Forcing the foreskin to retract before it is ready may severely harm the penis and cause pain, bleeding and tears in the skin."

Simply put, there is never a reason to forcibly retract the prepuce. Writes Doctors Opposing Circumcision in their article, Forced Retraction of Intact Boys: An Epidemic:

Only in the instance of significant hypospadias or epispadias (congenital malposition of the urethral opening) might retraction be necessary, and even then only if it is unavoidable collateral damage for which there should be specific follow-up care.

If your son has already been the victim of forced retraction, see Forced Retraction: Now What? for more information on how to handle things from here on out.

Intact baby boy and where the catheter will go. 

If retraction of intact boys is not going to take place for catheterization, how then should it be done? By feel alone.

Nurse K. at Johns Hopkins Hospital in Baltimore, Maryland (top ranked urology hospital in the nation), writes,

I know for certain as a result of working with many intact boys that the catheter can be inserted without retracting the foreskin. There is no reason whatsoever that the foreskin would need to be retracted for a simple catheter insertion procedure. The catheter used on an infant will be tiny and should be easily slipped into the small opening at the tip of the foreskin, right into the meatus. Parents: be firm and tell others that retracting the foreskin is not acceptable! Not even 'just a little.' If you must, you be the one to hold your son's penis and slide the catheter into place. They can take it from there. Or, specifically ask for someone who has catheterized an intact baby without retraction.

Just as the skilled hand of a midwife can determine a baby's position by feel alone, without need for seeing or intervention, so can a nurse or practitioner catheterizing an intact boy without laying eyes on the meatus itself. There is simply no need to see the meatus in order to 'hit' it with a catheter. With one hand on the penis for steadying, the small tube can gently be moved into the prepuce, and pressed against the glans, so it will either hit the spongy tissue of the glans, indicating the need for ever-so-slight readjustment, or it will glide smoothly into the urethra. With a small amount of patience and practice, nurses can become skilled in catheterizing an intact boy so that it rarely takes more than the first try to get it.

Because the prepuce on an infant boy is typically quite stationary and non-mobile, there is not much prepuce slack, and there are not many places to 'go' with the catheter. If the first try does not work, a mere glance to the right or left, up or down, will. In an older, retracting child, after separation from the glans has started to occur naturally, he may wish to retract his foreskin enough on his own for a catheter to be inserted directly into the meatus (if he is awake during the procedure). But even for older children, simply holding the penis steady with one hand, while gliding the catheter into the prepuce opening, until it touches the glans where it can be pressed into the urethra, works quite well and uneventfully. If your practitioner is not willing to take the extra moment to catheterize without forced retraction, ask to see another staff member, or request a set of sterile gloves, while you take your son's penis, and his health, into your own hands.


For additional resources on raising intact boys see: How to Care for Your Intact Son

References

1) Hardy JD, Furnell PM & Brumfitt W. Comparison of sterile bag, clean catch and suprapubic aspiration in the diagnosis of urinary tract infection in early childhood. British Journal of Urology1976;48(4):279-83.

2) Alam MT, Coulter JB, Pacheco J, Correia JB, Ribeiro MG, Coelho MF & Bunn JE. Comparison of urine contamination rates using three different methods of collection: clean-catch, cotton wool pad and urine bag. Annals of Tropical Paediatrics. 25(1):29-34, 2005 Mar.

3) Lohr JA, Donowitz LG & Dudley SM. Bacterial contamination rates for non-clean-catch and clean-catch midstream urine collections in boys. Journal of Pediatrics 1986; 109:659-660.

4) Lohr JA, Donowitz LG & Dudley SM. Bacterial contamination rates in voided urine collections in girls. Journal of Pediatrics 1989;114:91-93

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