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Re: Honey in neonates

This was an interesting and useful article on birth customs from a religion and culture dfferent from my own, and should be compulsory reading for those invloved in obstetrics and neonates.

There is, however, one practice which I would like to comment on. The use of honey in young children (under 6 months) is not usually recommended because of the (rare) risk of botulism. Honey is the one dietary resevoir of C botulinum spores that has been definitively linked to infant botulism. Spores have been found in honey from US, Canada, China, Japan and Central America, but interestingly not the UK! The AAP (American Academy of Pediatrics) recommends that honey should not be fed to infants unless it is certified free from C botulinum.

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Re: Muslim birth customs

This article on Muslim birth customs[1] makes good and very useful reading not only to non-Muslim professionals who work with children but also to Muslims, like me, who are not familiar with these practices which are seen basically in Muslims from the Indian subcontinent and are, many times, cultural rather than based on clear religious directions.

Many of these practices are not known to Muslim Arabs in the Middle East and North Africa who, I am sure, have their own very different practices. The paper should probably be better labelled Birth customs in Muslim families of Indian subcontinent origin.

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Re: Pediatric ethics in the Holy Quran

I read with interest Gatrad and Sheikh’s articles on “Muslim birth customs”(2001;84:F6-F8) and “Medical ethics and Islam” (2001;84:72-75). It quite interesting to find some more references (presented as sura: verse) related to pediatric ethics in the Holy Quran.

On organ transplantation
“Whoever killed a human being … should be looked upon as though he had killed all mankind; and that whoever saved a human life should be regarded as though he had saved all mankind” (5: 32).
On the basis of this Quranic text, organ transplantation is encountered in may Islamic countries.

On motherhood
According to the Holy Quran, the mothers of infants born after in vitro fertilization and embryo transfer are the women who give birth, not the women who give ovum: “Their mothers are those only gave birth to them” (58: 2).

On termination of pregnancy
According to the Holy Quran, if a mother’s health is treated by continuation of a pregnancy, then termination of pregnancy is allowed. “None should be charged with more than one can bear. A mother should not be allowed to suffer on account of her child, nor should a father on account of his child” (2: 233; see also 2: 185 and 2: 195).

On breast-feeding
According to the Holy Quran “The mothers shall give suck to their offsprings for two complete years” (2: 233). However, “If they both (mother and father) decide on weaning, by mutual consent and after due consultation, there is no blame on them” (2: 233).
The mother who cannot and is not able to breast-feed her infant, can give her baby to a wet-nurse to breast-feed, after mutual consent between the father and mother: “If you support financially the wet-nurse, there is no blame on you” (2: 233).
The father should protect the lactating mother from any conditions which might affect the breast-feeding and Islam forces fathers to provide finances for breast-feeding mothers who are divorced: “To provide food and clothing is an obligation of the father” (2: 233).

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Re: Beliefs versus facts

Those who believe that urine stained clothes will diminish the power of prayer and that circumcision will prevent such staining, are entitled to their opinion. The assertions that male circumcision decreases the incidence of cancer of the penis cannot however go unchallenged.

It is quite clear that circumcision does not prevent cancer of the penis.[1-13] Moreover, it appears to be ineffective in reducing the incidence of cancer of the penis.[14-15] In men who have been circumcised, cancer of the penis would appear to affect the circumcision scar and be less amenable to conservative treatment.[16] Thus what may be a religious belief, would also seem to be a medical myth.

There is universal freedom to manifest religious beliefs, but this may be limited to protect the rights and freedoms of others. Religious customs should be practiced by officers of a religion in a religious context and not be medical practitioners who are not qualified to deliver religious ritual. Medical practice should be evidence based.

Male circumcision causes a high rate of complications.[17] This would appear to be the case even when done in hospital by a medical practitioner.[18] It also removes normal specialised, functional tissue.[19-20] In view of these facts, and the fact that Islam does not require the hygienic purposes attributed to circumcision until the child matures and begins to offer prayers, it would seem appropriate to leave it until the child is of sufficient age and maturity to consent in his own right.

References

1. Maden C, Sherman KJ, Beckmann AM, Hislop TG, Teh CZ, Ashley RL, Daling JR. History of circumcision, medical conditions, and sexual activity and risk of penile cancer. J Natl Cancer Inst 1993;85:19-24.
2. Pec J Jr, Pec J Sr, Plank L, Plank J, Lazarova Z, Kliment J. Squamous cell carcinoma of the penis. Analysis of 24 cases. Int Urol Nephrol 1992;24:193-200.
3. Aynaud O, Ionesco M; Barrasso R. Penile intraepithelial neoplasia. Specific clinical features correlate with histologic and virologic findings. Cancer 1994;74:1762-7.
4. Rogus BJ. Squamous cell carcinoma in a young circumcised man. J Urol 1987;138:861-2.
5. Windahl T, Hellsten S. Laser treatment of localized squamous cell carcinoma of the penis. J Urol 1995;154:1020-3.
6. Cupp MR, Malek RS, Goellner JR, Smith TF, Espy MJ. The detection of human papillomavirus deoxyribonucleic acid in intraepithelial, in situ, verrucous and invasive carcinoma of the penis. J Urol 1995;154:1024-9.
7. Boczko S, Freed S. Penile carcinoma in circumcised males. N Y State J Med 1979;79:1903-4.
8. Leiter E, Lefkovitis AM. Circumcision and penile carcinoma. N Y State J Med 1975;75:1520-2.
9. Onuigbo WI. Carcinoma of skin of penis. Br J Urol 1985;57:465-6.
10. Korczak D, Siegel Y, Lindner A. [Verrucous carcinoma of the penis] Harefuah 1989;117:436-7.
11. Girgis AS, Bergman H, Rosenthal H, Solomon L. Unusual penile malignancies in circumcised Jewish men. J Urol 1973;110:696-702.
12. Koriech OM. Penile Shaft Carcinoma In Pubic Circumcision. Br J Urol 1987;60:77.
13. Cold C, Storms MR and Van Howe RS Carcinoma in situ of the penis in a 76-year-old circumcised man. J Fam Pract 1997;44:407-10.
14. Frisch M, Friis S, Kjær SK and Melbye M. Falling Incidence of Penis Cancer in an Uncircumcised Population. BMJ 1995;311:1471.
15. Fleiss PM and Hodges F. Neonatal Circumcision Does not protect Against Penile Cancer [letter]. BMJ 1996;312:779-90.
16. Bissasda NK, Morcos RR and El-Senoussi. Post-Circumcision Carcinoma of the Penis I. Clinical Aspects. J Urol 1985;135:283-5.
17. Williams N, Kapila L. Complications of Circumcision. Br J Surg 1993;80:1231-6.
18. de la Hunt MN. Paediatric Day Care surgery: a hidden burden for primary care? Ann Royal Coll Surg Engl 1999;81:179-82.
19. Taylor JR, Lockwood AP, Taylor AJ. The prepuce: Specialized mucosa of the penis and its loss to circumcision. Br J Urol 1996;77:291-5.
20. Cold CJ, Taylor JR. The prepuce. Br J Urol 1999;83(Suppl 1):34-44.