"Anatomical, neurochemical, physiological and behavioural studies confirm that newborn responses to pain are 'similar to but greater than those in adult subjects' Infants circumcised with no anaesthesia (reflecting common practice) experience not only great pain, but also an increased risk of choking and difficulty in breathing. Increases in heart rate of 55 bpm have been recorded, i.e. 1.5 times the baseline rate. After circumcision, the level of blood cortisol increased by a factor of 3-4 times the level before circumcision. As a surgical procedure, circumcision has been described as 'among the most painful performed in neonatal medicine'. Investigators reported, 'This level of pain would not be tolerated by older patients' . Using a pacifier during circumcision reduced crying but did not affect the hormonal pain response. An infant may also go into a state of shock to escape the overwhelming pain. Therefore, while crying may be absent, other body signals show that severe pain is always present during circumcision.... From the perspective of the infant, all the elements in the DSM-IV description of traumatic events apply to circumcision; the procedure involves being forcibly restrained, having part of the penis cut off, and experiencing extreme pain. Based on the nature of the experience and considering the extreme physiological and behavioural responses, circumcision traumatizes the infant.