Wakefulness increased during circumcision, with percent crying showing the greatest increase. Thus, circumcision produced dramatic increases in behavioral state, primarily in the form of increased crying. The reasons for such a rapid return to apparent normality will be discussed below. Thus, infants who showed more behavioral distress during circumcision were also evidencing greater increases in adrenocortical activity. These data indicate that the close correspondance between pituitary-adrenal activity and behavioral state is not restricted to conditions of low or mild stimulation, but also is clearly evident under conditions of intense, traumatic stimulation in the neonate.
Neonatal circumcision is performed without anesthesia and it is clearly stressful for the infant.
Examination of techniques which may reduce stress thus is warranted. In this study some of the nurses in attendance attempted to calm the infants during circumcision by using a pacifier, while others did not do so. Although this was not a controlled aspect of the study, half of the infants received pacifiers while half did not. Use of the pacifier significantly reduced crying. This difference was not significant in this small sample.