When Should I Pierce My Baby's Ears?

Parents of newborns often ask me what is the best time to pierce a baby's ears. My standard answer leaves many perplexed. Before I reveal what that reply is, let's briefly analyze the relevant issues surrounding ear piercing.

Earrings have been used since biblical times and it seems that the practice of piercing infants' ears dates back to that era. The most common reasons for ear piercing reported by parents are the following:

1. It is traditional in our culture.

2. It hurts less to have it done when they're babies, or at least, they won't remember the pain.

3. They look cute.

4. How else will people know that it's a girl?

The arguments against early piercing revolve around the potential risks of complications and issues of safety. There is the concern that babies have a higher risk for localized skin infections as well as for life-threatening generalized sepsis. The possibility of acquiring tetanus is quoted by those physicians who advocate waiting until six months of age (to complete three doses of tetanus vaccine) though it is hard to find any solid data on the actual incidence of this disease following ear piercing. Children are more likely to develop sensitivity to metals if exposed at an earlier age. And when the child grows into a toddler, the risks of suffocation and injuries to the ear lobe increase as the child becomes more active. Also, the studs of earrings have a propensity to become stuck or embedded under the skin on the back of the ear lobes of infants.

The weighing of risks and benefits in medicine incorporates two ethical prerogatives: the principle of beneficence (the desire to provide aid and relief) and the principle of non-maleficence (the desire not to harm). But, the issue of ear piercing should include yet another aspect of ethical consideration: the principle of autonomy - that an individual has the right to choose or refuse a treatment. The individual, in this case, is the baby, and though we can't ask her, there is no urgency that we can't wait until she is able to express her opinion.

Some may scoff at this notion, pointing out that parents routinely make medical decisions for their children, but they do so in situations where there is a clear health benefit to their child, where it's not feasible to wait a few years until the child is able to understand the choice and verbalize it. No such benefit can be surmised with ear piercing. Still, most children wouldn't make a big fuss about having had their ears pierced when they were infants, you may say. But what about baby girls who have multiple ear piercings? How about boys that have had their ears pierced as infants? Both of these are becoming more common trends. Are they not entitled to make that choice for themselves?

So this is what I tell parents. Jewelry is used in our society to connote social status (why else would someone drop thousands of dollars on a designer watch when they can use their cell phone to tell the time) and for cosmetic reasons. Babies don't care to flash bling and they are adorable without jewelry (in fact, jewelry on babies is a tad gaudy - what's next? Lipstick? High heels?). If it is absolutely crucial to you that people know the gender of your child, use the old pink/blue color scheme, pick names that are not ambivalent as to sex, or just tell people, "She's a girl!" or "He's a boy!"

As far as the pain issue, it is clear that infants feel pain just as acutely as older children and adults do. In fact, there is some evidence that early painful experiences might modulate the perception of pain later in life. If you think your child will not want to have her ears pierced when she's older out of fear of pain, think again. Teenagers hardly think twice about piercing their ears, noses, eye-brows, tongues, navels... and more sensitive parts.

What about the sense of culture and maintaining tradition? Traditions change. When I was an infant no one used infant car seats and few buckled up their seatbelts, smoking was rampant and there was no talk of "health foods". Bucking tradition is one of the great joys of life, particularly when you are making a rational choice for your child.

So when is the best time to pierce your baby's ears? Answer: when she (or he) requests to have it done. Now wasn't that simple?

Peter Palmieri, M.D., M.B.A. is a board certified pediatrician with 20 years of clinical experience.

He is the author of the acclaimed book, Suffer the Children: Flaws, Foibles, Fallacies and the Grave Shortcomings of Pediatric Care

http://www.amazon.com/Suffer-Children-Fallacies-Shortcomings-ebook/dp/B004R1QBCY/ref=sr_1_2?s=digital-text&ie=UTF8&qid=1368724299&sr=1-2&keywords=suffer+the+children

His blog analyzes controversial issues in pediatric care.

http://pediatricsincrisis.blogspot.com/

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