Recommendations"As Chair of the NYU School of Medicine Department of Surgery, I am happy to recommend Rabbi Moshe Chaim Friedman as a Mohel..."
NYU School of Medicine
The George David Stewart Professor and Chair
Department of Surgery
Part I | Circumcision - Its source in the Torah
It is written in Genesis, (17; 10-12): "This shall be the covenant that you shall keep between Me and you and your children after you: you shall circumcise all males. And you shall circumcise the flesh of your foreskin, and this shall be the sign of the covenant between Me and you. And at eight days old you shall circumcise all males for all generations..."
Circumcision was first performed some 3,800 years ago by our forefather, Abraham, on himself, at the age of 99. Only after having been circumcised was he fit to father the Jewish nation. When his son, Isaac, was born, Abraham circumcised him on the eighth day, in accordance with G-d’s commandment to do so.
Since then, bris Milah must be performed on all Jewish baby boys, on the eighth day after birth. It can, however, be carried out after the eighth day, should medical reasons warrant postponing it. However, it cannot be done earlier than the eighth day.
Part I | The reason for Bris Milah
The word Bris means "covenant" and the word Milah means "circumcision". Circumcision is that which permanently establishes a covenant between G-d and the Jew. (A Jewish female is born already circumcised, so to speak, possessing this holy sign within her from the moment of birth.)
G-d wanted to permanently affix a symbol on the bodies of the people He chose to be called by His name. Circumcision was designated as the symbol of this covenant, being that this is the source from which the perpetuation of the species emanates.
One might ask: If G-d desired that all males be circumcised, why then did He not simply create the human being already circumcised?
The answer to that is as follows: The reason G-d does not create the human being complete already in the mother’s womb, is in order to indicate that just as the physical aspects of the body can be perfected by human deeds (such as circumcision), so too is it within the person’s ability to perfect the soul by correcting oneself spiritually through the covenant of circumcision.
Part I | The Mitzvah that's always there
The story is told of King David that he was once standing, unclothed, in the bathhouse, and was, therefore, not wearing his yarmulke or tzitzis. He sighed, "woe is me that I stand here naked of mitzvos." He then saw his bris Milah and was comforted by the fact that even when the person has no other mitzvos upon him, the circumcision is always there.
Part I | Circumcision brings good news
At the time when the Jewish people fulfilled the commandment of circumcision, they were informed of the good tidings that the sanctuary will be built among them, as G-d says: "And they shall make for me a sanctuary and I will dwell in their midst."
Part I | Why specifically on the eighth day?
Kabbalah, (Jewish mysticism), explains the importance of the bris being carried out specifically on the eighth day, as follows:
The eight days between the birth of the child and the bris always include at least one Shabbos. Shabbos corresponds to the experience of perfect harmony with nature. The number 7, represents the natural order of the world, (i.e. there are seven days in a week; G-d created the world in six days and rested on the seventh day -- the Shabbos -- the holiest day of the week, the one which completes the order of the creation of the world.)
The bris takes place on the eighth day, indicating that the act of circumcision represents something that is higher than nature. After having attained perfection with nature during the first seven days, now, on the eighth day, the child reaches the level of the soul that is capable of connecting with the G-dly light that transcends nature.
Thus, through the act of circumcision, the Jew is given the power and ability throughout life, to overcome all obstacles in his service of G-d; he is able to rise above his own natural limitations.
Part I | Why not before the eighth day?
There are those who plan to have the circumcision take place on a Sunday, because of conveniences, though it may actually be before or after the eighth day. They fail to understand the importance of the eighth day:
Kabbalah explains that there are positive energies and negative energies in this world. These negative energies are called kelipot, shells, being that they obscure the light of G-dliness and do not allow it to shine in the world.
Negative energy, however, is only able to derive its strength from whatever positive energy it can capture. Thus, wherever holiness is present, unholy forces strive to dwell there as well.
Prior to the eighth day, the soul of the child is not yet fully within the child. Therefore, the negative energies have nothing on which to feed. On the eighth day, however, when body and soul unite, the total energy arrives.
The greatest concentration of the positive energies comes to rest upon the male organ, being that it possesses the potential to create life.
Since there is now an opening for positive energies to flow, the negative energy then comes and tries to attach itself to that opening. In this case, the concentration of the negative energies is in the foreskin, thus making it the embodiment of negative energy in the child.
This being so, only when the bris is done on the eighth day, is the greatest concentration of negative energy removed from the child forever.
If, however, the bris is performed before the eighth day, when the body and soul are not yet completely united, all that is being accomplished is the removal of a useless piece of flesh. At that point, there is no great concentration of negative forces in the child that can be removed along with the foreskin. Then on the eighth day, when the negative forces do actually come, there is no longer a removable vessel to which they can attach themselves. The negative energy then remains in its potential state and gives its negative feedback to the child.
Part I | Circumcision as immunization against life's problems
When the foreskin is properly removed on the eighth day, all negative energy is annihilated and will never be able to have control over the person. On a metaphysical level, we cut off the ability for the potential of negative energy to become actualized in the child, thus giving him the extra strength necessary to overcome any problems he will experience throughout his life.
Kabbalah explains, that in this world there are many obstacles which conceal G-dliness. It is our job to remove these blocks, thus revealing the G-dly light. Circumcision is an act of removing unholiness. By physically removing the foreskin, we are spiritually removing and eliminating undesirable character traits, depressive tendencies and so on. We eliminate from the body of the child, forces which might try to cultivate overindulgence in physical pleasures, etc. In short, we give the child a boost and head start in fighting life’s battles; it can be compared to the concept of immunization.
The importance of the bris being carried out specifically on the eighth day can not be stressed enough. With no intention to dramatize the matter, it can be compared to detecting cancer. If cancer is caught during its early stages, it can be easily removed, and its potential to spread is thus eliminated. If, however, it is not detected early, even if it is later removed, it can still spread, G-d forbid, and the task of then challenging it, is much more complicated.
It is of interest to note that penile cancer is almost unheard of by Jewish men. Based on these observations, circumcision throughout the world has now become a routine medical practice.
Although circumcision by Jews is not performed because of health benefits, but rather solely because G-d commanded us to do so, we are nevertheless confident that whatever G-d commanded us to do, is ultimately for our benefit and will only contribute to the physical and spiritual well-being of the person. After all, G-d commands us in the Torah to maintain a healthy body and is called by the title, "Healer of all flesh."
Part II | The Shalom Zachar
It is a Jewish custom that on the first Friday evening after the birth of the child, we conduct a shalom zachar, during which we welcome the child to the world. The shalom zachar is held at that time, even in a case when the bris had been postponed. At this "party" it is customary to serve chickpeas, wine and cake. Those who attend, give blessings to the child and its parents.
Part II | "Vach Nacht"
The night before the bris, it is customary for the father of the child to remain awake the entire night and to recite special passages from the kabbalah and Psalms. This custom to stay awake is called "Vach Nacht" – wake night. The purpose of staying awake is to guard the baby from forces that seek to disrupt the observance of this important mitzvah.
Small children are invited to recite the "Shema" at the baby’s bedside. The passage 'HaMalach HaGoel' (The angel who redeems me..) is recited.
Part II | When the Bris should take place
The day on which the bris is to take place is a very festive occasion. It is mandatory that the bris take place during the daytime, and preferably in the early morning hours.
It is important that throughout each and every step of the bris ceremony there should be a minyan – a quorum of at least ten Jewish males above the age of thirteen – present. The reason for this is, because it is a greater honor for G-d and for the mitzvah when a large amount of people is present.
A bris may be carried out on Shabbos or even on Yom Kippur, providing that that is the eighth day from birth. If, however, the bris had to be postponed (due to medical reasons such as jaundice or sickness), then it can not be done on Shabbos or Jewish holidays. In addition, a baby that was delivered through an unnatural birth (such as a Caesarian section) has its bris done on the eighth day from birth, providing that it is not a Shabbos or Yom Tov.
Part II | The Mohel and the Sandek
The bris is performed by a specially trained "mohel". He must be an expert in the way he performs this important mitzvah because if it is not done correctly, the removal of the negative energies is not properly accomplished. It is, therefore, important to choose an Orthodox, G-d-fearing mohel in order to insure that the bris is done to perfection.
The sandek is the person given the honor of holding the child throughout the bris. According to Jewish mysticism, the sandek plays a special role in protecting the child from negative forces and in preserving positive energy. It is, therefore, important to choose a righteous person as the sandek. If the sandek is a righteous man, he can help in drawing down a holy soul for the child. In fact, the child takes the good character traits from the sandek and shares a spiritual connection with him.
Part II | Elijah's chair
A special chair is prepared at every bris in honor of Eliyohu HaNavi, Elijah the Prophet, which is located to the right of the sandek. The child is placed on this chair while the mohel recites certain blessings. The father then lifts the child and places it in the lap of the sandek.
Elijah serves a spiritual purpose at the bris: He is a positive energy force coming to take the place of the Evil Prosecutor. As mentioned earlier, the greater the mitzvah, the more the unholy forces attempt to place accusations upon the Jew, and, ultimately to prevent him from fulfilling the mitzvah. Elijah transforms the prosecutor into a defense attorney, so to speak. The purpose of his arrival is to remove all negative energy.
However, in order for Elijah to be present, we must physically summon and announce his presence and designate a special chair for him.
Part II | The Bris ceremony
The people chosen as "Godfather" and "Godmother" are usually a husband and wife. The child’s mother hands the baby to the Godmother, thus signifying her consent to entrust the child to G-d’s care. The Godfather then takes the child and hands him to a designated individual whose honor it is to place the infant on the Chair of Elijah.
When the child is brought in to the area in which the bris will take place, all present should rise and remain standing throughout the duration of the bris. Only the sandek will remain sitting throughout the bris, while holding the infant on his lap.
After having placed the child on the sandek’s lap, the father then designates the mohel as his emissary to perform the circumcision on his son. (The reason for this is that according to the Torah, the father himself is responsible to perform the circumcision on his son. However, since most fathers are illiterate in these areas, they are permitted to appoint an emissary to take his place. A concept in Jewish law pertaining to many areas, is that "a man’s emissary is considered to be the sender of that emissary himself.) After the father recites the appropriate blessings, everyone present says: "Just as he (the child) has entered into this covenant, so may he enter the covenant of Torah learning, marriage, and of good deeds."
Part II | The issue of pain during circumcision
As far as pain is concerned, Jewish law does not permit the use of a Gomco clamp or the like -- instruments used in most hospitals – being that it is too traumatic, as it crushes all of the flesh and veins in the area. A mohel, on the other hand, uses much simpler instruments – some using no other instrument than the knife used for the actual cutting of the skin! The mohel’s method is the least painful and the most skillful as it is done with an extremely sharp knife and takes less than half a minute to complete.
According to kabbalah, the few drops of blood that are discharged during the bris, remove any remaining impurities and completes the task of removing the negative energy to its maximum.
It is interesting to note that Crown Prince Charles, son of Queen Elizabeth and heir to the British throne, was circumcised by a mohel, rather than by a doctor. Apparently, the Royal Family had asked for a mohel, trusting his expertise over that of the Royal physician.
Part II | Naming the baby
Once the bris is finished, certain prayers are recited and the official naming of the baby takes place. We do not name the child before the bris, being that the Divine soul begins to shine its light only from the moment of the bris when the body and soul are fully united. Therefore, since the Jewish name is connected to the soul, the bris is the most appropriate time to give the child its Jewish name. It is customary to name the child after a righteous person, as the name influences the character of a child.
Part II | Ceremony following the Bris
After the bris is completed, the food – kosher, of course – is served. This meal is called a seudas mitzvah, a meal honoring a Divine commandment, and everybody should, therefore, wash appropriately for the consumption of bread and partake of the meal. If the circumcision is performed on a fast day, the meal is put off until the evening when the fast is broken.
After the meal, the participants recite a special series of prayers, including a prayer asking that as a reward for properly fulfilling the mitzvah of circumcision, we should merit to speedily see the coming of the Messiah and the end of human strife.
After the circumcision, the foreskin must be buried. The reason for this is that since the foreskin contains within it the maximum concentration of negative energy, this energy must be transformed into positivity. Earth causes things to grow; when a seed is buried, it ultimately produces good fruit. Therefore, when the foreskin is buried, it can then be transformed into positivity. (It is for this reason that the Jewish religion forbids cremation: In ashes there is no potential for positivity as nothing can grow from it.)
Part III | On which day must the circumcision take place?
A bris is performed on the eighth day following the birth of the child. If he was born before the twilight period, then the day on which he was born is included in the eight days. If he was born after the twilight period, the next day begins the eight-day counting.
A circumcision carried out prior to the eighth day is invalid.
A bris that had been postponed until after the eighth day, for any reason whatsoever, may not take place on Shabbos or Jewish Holidays. Only the bris of a baby born by normal delivery overrides Shabbos or Holidays. Therefore, a child born by Caesarian section may not have his bris performed on Shabbos or Holidays. (In such an instance, it would be postponed until Sunday.)
Part III | Medical reasons for postponement
A bris may not be performed on an ill child until he is fully recovered. The slightest ailment or the least pain, as determined by a Mohel, doctor or rabbi may be reason enough to postpone the bris until the child is healed.
The above applies only to an ailment affecting the entire body, in which case we must wait seven days before doing the bris. However, if the disease is one that affects only a certain part of the body, there is no waiting period and the bris can be carried out immediately upon full recovery.
The most common cause for delaying circumcision is a condition known as jaundice, in which the child’s skin is a shade of yellow. The generally accepted view is that as soon as this clears up, the circumcision can be carried out. However, if the condition is serious enough to warrant a blood transfusion, the bris then can only be carried out after seven full days after recovery.
An underweight child cannot be circumcised. However, once the necessary weight is achieved, the bris can be performed immediately without a waiting period.
A bris may not be postponed simply for the sake of convenience.
If a bris must be postponed, the Hebrew name is given to the baby when the bris does actually take place.
Part III | What time of day should the bris take place?
The bris may be performed any time of the day until sunset. However, since it is preferable to fulfill a mitzvah as quickly as possible, it should better be done in the morning. One should, at least, not postpone a bris later than midday.
One should not use a less-qualified Mohel in order to have the bris take place earlier in the morning. Rather, he can delay the bris to later in the afternoon when a more-qualified Mohel will be available.
Part III | The Shalom Zachar
On the first Friday night after the child is born, it is customary to gather in the house of the baby to celebrate in honor of the newborn. This is called the "Shalom Zachar" – welcoming the male newborn. At this celebration – which, incidentally, is a seudas mitzvah, (a meal honoring the fulfillment of a Divine commandment) -- it is customary to serve lentils along with other beans (such as chickpeas), as well as nuts and wine.
If the child is born Friday after sundown, thereby causing there to be two Fridays between birth and the bris, most people follow the opinion which holds that the shalom zachar should take place on the second Friday night. The practical reason for this is that there is not enough time before the first Friday night to inform people of the shalom zachar.
In addition, the second Friday night, in this case, would be "vach nacht" (see below) which, in most communities, is customarily a night for celebration.
Even if it is definite that the bris will not be held that week (for reasons such as premature birth, or the like), the shalom zachar is nevertheless held.
Part III | "Vach Nacht" – The night before the bris
The Midrash states that the merit of bris milah is so great that it safeguards Jews from Gehinom (hell). The Satan, therefore, attempts to see to it that the bris is not performed. For this reason, the custom is that the men of the family and some colleagues should remain awake in the child’s home to recite various portions of Torah and discuss the laws of milah throughout the night. Thus, they watch over the baby and ward off anything that may attempt to interfere with the bris.
Children are brought to the crib of the child to recite the Shema and the verse "Hamalach HaGo’el" ("The angel who redeems me..."). They are given sweets in reward for their blessing the baby.
Part III | Kvatter and Kvatterin (Godparents)
Two people – one male, the other female -- usually a married couple -- are customarily given the honor of bringing the child to the room in which the bris will be taking place, and then returning it to the mother after the bris. They are called the Kvatter and Kvatterin.
Some do not allow a pregnant woman to be the kavatterin as she might become frightened by the bris, and cause harm to her unborn child.
Part III | The Chair of Elijah
Elijah the Prophet, according to Jewish tradition, attends all circumcisions in order to protect and bless the child. It is customary to honor him by preparing a chair for him to the right of the sandek’s chair. The reason the sandek’s chair is to the left of Elijah’s is based on the Talmudic saying that a student walks on his teacher’s left.
One of the assembled is honored with placing the child upon Elijah’s chair, so that Elijah should bless the child.
Elijah does not attend a bris unless he is summoned. For that reason, there are various prayers and blessings to summon and acknowledge his presence.
Part III | The Mohel
A male should perform the bris. Similarly, it must be performed by a G-d-fearing, observant Jew. If a non-Jew performs the circumcision, the bris is rendered invalid. The reason for this, is that since the bris is to imprint the "act of the covenant", it, therefore, must be performed by a member of the covenant.
The way to rectify an invalid circumcision is to do hatafas dam bris – releasing a speck of blood.
Once a Mohel has been appointed to perform a bris, one should not afterwards reject him and hire a second Mohel in his place. However, if the second Mohel is a close friend of the family or if he is an exceptionally righteous person, (and it is, therefore, obvious that he would have been chosen in the first place had the family known that he was available), the family may then go ahead and reject its original choice.
It is important to stress that bris milah is a religious observance and not a medical procedure. For this reason, one should not use a doctor who is a qualified Mohel to do the bris. Some hold, however, that if the doctor’s expertise as a Mohel is apart from his being a doctor, then it would be okay. There are those authorities, however, who have expressed the view that religious doctors should refrain from performing bris milah.
Part III | The Izmail knife
The metal knife used to perform the circumcision is usually referred to as izmail. The traditional izmail is sharp on both edges in order to eliminate the possibility of hurting the child by cutting with a blunt edge.
Part III | The father’s role
Being that the actual mitzvah of bris milah is incumbent upon the father, it is, therefore, customary for the father should stand near the Mohel and to verbally appoint him to act in his behalf in performing the bris. The father, for this reason, also hands the knife to the Mohel.
Part III | The others present
It is preferable, though not mandatory, that there be a minyan (ten males above the age of 13) present at the bris milah. The reason for this is because it is more respectful for G-d – as it is for a king – when there is a large presence of people at a religious ceremony.
Part III | The Milah
The milah itself involves three parts: a) cutting away the foreskin, b) Revealing the glans, and c) Extracting the blood from the wound.
The excised foreskin is customarily covered with sand or earth.
Candles are lit during the bris.
Part III | Twins
When twins are being circumcised in one ceremony, each child is brought in separately to insure that each one receives the honor due to it. Hamalach Hago’el is recited between the two circumcisions to make an obvious separation between the two. Because of this separation, the blessings from the first circumcision are not valid for the second and must, therefore, be repeated.
Part III | The Circumcision Meal
It is customary to make a festive meal after the circumcision, at which bread and wine should be served, being that this is a seudas mitzvah.
It is customary not to explicitly invite people to this meal, rather to publicize when and where the meal will be held, leaving the invitation unspoken.
Various liturgical poems are recited at this meal.
Part IV | In the merit of Milah
The heavens and the earth and all that is found in them exist and are preserved in the merit of the great mitzvah of bris milah, as it is written (Jeremiah, 33:25): "If not for my covenant, I would not have put in place the day and night and the laws of heaven and earth."
Part IV | The blood of milah suppresses Hashem's anger
The Zohar states (parshas pikuday, p. 225b): When the child is circumcised at eight days of age, the blood shed is laid by the angels before G-d’s palace. When the power of severe judgment is aroused in the world, the Holy One, blessed is He, looks at that blood and does not allow evil influences to do any harm.
Part IV | "You won't leave home without it!"
King David felt bereft of Mitzvos whenever he had to bathe, for in the bath he could neither wear tzitzit, do Mitzvos, nor study Torah. When he thought of the bris Milah, he realized that he has one mitzvah embedded in his body at every moment of his life.
Part IV | Better safe than sorry
A Mohel must be very precautions about the child’s health before performing the circumcision. Things such as low birth weight and the appearance of mild jaundice – a condition dismissed by contemporary medical opinions as insignificant – are regarded by mohalim as reason for delaying the bris, since they are mentioned in the Talmud as signs of danger.
Another precaution observed by mohalim, over and above medical guidelines, is to postpone a bris for seven days after an infection, despite the fact that the child may now appear healthy.
As the Rambam puts it: "It is possible to perform a bris milah after its time, but it is impossible to restore a lost life."
Part IV | Dispose of properly
The severed foreskin is buried for the reason that this enables it to "grow", i.e. produce positivity, rather than the negativity it presently represents. Being that the earth is the source of growth of good things, it should, therefore, be covered with earth. Any other method of disposing it would disable it from accomplishing this transformation.
Part IV | Eat dirt!
Another reason for this practice is as follows: The severed foreskin is regarded as the portion of the evil influences which have now been removed from the child. The serpent – which was punished in Genesis to feed off the dust of the earth – is an incarnation of evil. It is, therefore, appropriate to have the portion of evil become part of the food of the partner of evil.
Part IV | Uninvited guests
A special seriousness is attached to the meal following the circumcision. It is considered so holy, that one who refuses an invitation is regarded as excommunicated in heaven. So that people should not have the opportunity to spurn such a holy gathering, one does not invite guests, but rather notifies them as to when and where the festive meal will be held, leaving the invitation unspoken.
Part IV | Great is the Mitzvah of Milah...
The Mishnah teaches (Nedarim 31b): Rabbi Yishmael said: "Great is the mitzvah of milah for thirteen covenants were made over it. (The word "covenant" appears 13 times in connection with circumcision.)"
Rabbi Yosi said: "Great is the mitzvah of milah for it supercedes the severity of Shabbos, (i.e. when the eighth day after birth is Shabbos we perform the milah on that day, despite its necessitating many types of work that would otherwise be forbidden)."
Rabbi Yehoshua said: "Great is the mitzvah of milah for Moses was not given even an hour to delay it."
Rabbi Yehoshua ben Korcha said: "Great is the mitzvah of milah for all the good deeds of Moses did not protect him when he delayed the milah (of his son Eliezer), as it says (Exodus, 4:24): ‘And G-d encountered him and sought to put him to death.’"
Rabbi Nechemia said: "Great is the mitzvah of milah for it overrides the laws of "Nega’im". (Nega’im are spiritual blemishes that are manifest in skin defects. Although it is strictly forbidden to remove such skin, if the effected skin is on the sight of the milah, we perform the milah despite the fact that it is resulting in the removal of the blemish.)
And Rebbi said: "Great is the mitzvah of milah because despite all of our forefather Abraham’s good deeds, he was still not called a complete person until he performed milah upon himself, as it says, only after his circumcision: ‘Walk before Me and be complete.’"
Part IV | Despite the parent's love for their child
When we examine all the mitzvos, we find no mitzvah that the Jews fulfilled with as much sacrifice as they did by milah. When a child is born, his parents caress and kiss him; everything is done to protect him from harm. They ensure his ideal environment with controlled room temperature and ventilation. They feed him as much as he requires and worry about his every need. When he cries, they rush to calm him. Their wish is to see that nothing unpleasant happens to him.
And yet, since G-d has commanded us (Genesis, 17:12): "When eight days old, every male among you is to be circumcised," we do not hesitate to perform this mitzvah. If not for G-d’s commanding us to do so, no parent would allow the slightest scratch on their baby, let alone unnecessary surgery and the removal of the foreskin.
But since G-d commanded us: "Have every male among you circumcised," we perform the mitzvah with wholehearted joy. Clearly, it is the special power of this mitzvah that gives the parents both the courage and joy to fulfill it.
Part IV | The self-sacrifice involved
Another form of sacrifice by circumcision is the self-sacrifice involved. Many mitzvosh require sacrifice, sometimes even fasting and abstinence from food and drink, or great financial loss. The greatest loss, however, is that of a part of the body. Yet, when it came down to it, when given the opportunity, those older Russian Jews who had not yet been circumcised, were jumping onto the operating table, offering their bodies for circumcision.
Part IV | Underground circumcision
Yet another form of self-sacrifice endured by Jews for the mitzvah of milah, is this that they carried out this mitzvah even in times when it was forbidden by the government. There are many stories of people who risked their life in performing circumcisions during the Holocaust.
The Mechilta comments on the verse (Parshas Yisro; on the verse 20:3): "...To those who love Me, and guard my commandments" -- these are the Jews who lived in Israel at the time when the occupying nations forbade circumcision and lost their lives in the fulfillment of this mitzvah.
Part IV | Fatalities are rare, despite child's tender age
The Chasam Sofer (Rabbi Moshe Sofer, the Rabbi of Pressburg, often referred to by the title of his major published work), mentions in his Responsa (Yoreh De’ah, Ch.245) that the rarity of fatal complications due to bris, in spite of the child’s delicacy at such a tender age, is clearly because the mitzvah exerts a protective power over the newly-circumcised child. From his words it is evident that only the fulfillment of the mitzvah exactly as ordained for all generations has this special protective power.
Jaundice is a condition characterized by yellowing of the skin and eyes that is caused by an excess of bilirubin in the blood. Bilirubin is a normal waste product resulting from the breakdown of red blood cells and is removed from the body by the liver. Prior to birth, bilirubin in an infant is processed by the mother’s liver and excreted. After birth, an infant must eliminate bilirubin without the mother’s help. It may take the infant’s system several days to begin eliminating bilirubin from the blood faster than it is produced. Infants who are born prematurely, who are underfed, or who belong to certain ethnic groups are at increased risk of developing jaundice. The initial screening of jaundice is the observation of yellow skin. This is a subjective determination prone to errors due to differing skin colors and gestational ages. Bilirubin levels normally peak in full-term infants 4 to 5 days after birth and may peak later in premature infants. If the infant’s serum bilirubin levels continue to rise the infant is at risk for kernicterus (the deposit of bilirubin in the brain at toxic levels which can cause permanent neurologic impairment).