The one instruction

The American Academy of Pediatrics: "At birth, the foreskin is attached to the head of the penis and cannot be pulled back." And: "Remember that foreskin retraction should never be forced. Until the foreskin fully separates, it shouldn't be pulled back. Forcing the foreskin to retract before it is ready can cause severe pain, bleeding and tears in the skin."

The NHS says the same thing in its list of things not to do: "do not pull back the foreskin of a baby or young boy that is still attached to the end of the penis because it could be painful and damage it, leading to problems in later life."

The tears that result can heal with scarring, and scarring is one of the routes to a foreskin that genuinely will not retract later. So the well-meant advice some parents are still given — to retract a little each bath to "keep it free" — is the thing most likely to cause the problem it claims to prevent.

When it separates

Later than most people assume, and on no fixed schedule.

The AAP: "The age at which the foreskin separates differs for each child. Rarely, this process takes a few weeks, but more often it takes months or years."
The NHS: "A tight foreskin is normal in babies and young boys. Most boys' foreskins do not pull back (retract) before the age of 5, but sometimes it's not possible until they're 10 or older."
The AAP again, in its account of how newborns look: "Without a circumcision, the foreskin will separate from the glans naturally during the first few years."

The NHS also notes something that alarms parents and is not a problem in itself: "The end of a boy's penis may bulge or balloon when they pee, particularly if their foreskin is tight." Ballooning without pain, difficulty passing urine or infection does not need treatment.

How to clean it

The AAP's instruction for the period before separation is short: "In the first few months, clean your baby's foreskin and penis with warm water. Cotton swabs or antiseptics are not needed. Do not pull back the foreskin."

In practice, at every nappy change:

Wash your hands before and after — the HSE lists this first in its nappy changing guidance.
Wipe the outside only, with warm water and cotton wool. The NHS advises cleaning the whole nappy area gently and drying it before the clean nappy goes on.
Do not use perfumed soap, talcum powder or deodorants — the NHS's own list — because they cause irritation.
Do not use cotton buds or antiseptic, and do not try to clean underneath.
Dry the creases at the top of the thighs, where moisture collects.
Nappy-off time each day, which is standard advice for keeping the whole area healthy.

Once the foreskin has separated by itself, which will be years rather than months, the AAP's routine is: pull it back gently, rinse underneath with warm water, pull it forwards again, and clean the penis with warm water and if needed mild soap, avoiding the opening and rinsing well. That is a skill for later childhood, taught rather than done for them.

Smegma

The AAP describes it so you do not mistake it for infection or dirt: "White, pearl-like lumps under the foreskin are typical. It's also typical to see a thick, white or yellowish substance under the foreskin and near the penis. This substance is called smegma." It is a collection of dead cells, oils and fluids, produced as the foreskin separates from the glans underneath. It works its way out on its own. You do not need to retract anything to get at it. The AAP's advice is simply to rinse it off with warm water, or wipe it gently with warm water and a cloth, once it appears at the edge.

The signs that something is wrong

The AAP names three specific triggers to call, all about urine flow: "If the hole in the foreskin is not large enough for your baby to urinate as expected", meaning the urine stream is never more than a trickle; if your baby seems uncomfortable while urinating; or if the foreskin is red or swollen.

The NHS's list for a tight foreskin overlaps and extends it: swelling and tenderness; pain when passing urine or a weak flow; blood in the urine; frequent urinary tract infections; and bleeding or a thick discharge from under the foreskin or an unpleasant smell. It notes that swelling, tenderness, bleeding or discharge can also be signs of balanitis, an inflammation of the head of the penis.

None of these describe a foreskin that simply will not pull back. That, on its own, in a baby who is passing urine normally, is expected.

If your baby has been circumcised

Aftercare instructions come from whoever performed the procedure and vary with the technique used, so follow those in preference to anything general. Contact them promptly if there is bleeding that does not stop with gentle pressure, spreading redness, swelling, pus, a foul smell, a fever, or if your baby has not passed urine in the expected time.

When to call

Call your local emergency number (999 in the UK and Ireland, 911 in the US and Canada, 000 in Australia, 111 in New Zealand) if your baby: has not passed urine for an unusually long time and is unwell with it; has a temperature of 38C (100.4F) or above or below 36C (96.8F); looks pale, ashen, mottled or blue; is unresponsive or unrousable; has a weak, abnormally high-pitched or continuous cry; is grunting or breathing over 60 breaths a minute; has a bulging fontanelle, neck stiffness or a seizure; or has a rash that does not fade under a pressed glass. Those are NICE's red flags for serious illness in young babies, from NG194. A fever in a baby under three months is an emergency in its own right, and a urinary infection is one of the things it can mean.

Speak to your midwife, health visitor, public health nurse or GP if: the urine stream is never more than a trickle; your baby seems uncomfortable passing urine; the foreskin or tip is red, swollen or tender; there is a thick discharge, bleeding or an unpleasant smell; or the foreskin has been pulled back and will not come forward again — that last one needs same-day attention.

What to let go of

There is nothing to do here, and that is the difficult part. No stretching, no daily retraction, no cleaning underneath, no cotton buds, no antiseptic. A foreskin that does not move is doing exactly what a newborn's foreskin does. The only active care a newborn needs is warm water on the outside and a clean, dry nappy area — and the only real risk on this page comes from intervening.

Newborn Foreskin Care