Jaundice is a very common condition in newborn children, and under certain circumstances, circumcision would be considered dangerous for a jaundiced infant. The Halachic authorities discuss at length the question as to the precise level of jaundice required for a Berit Mila to be delayed, and when the Berit should be performed after it was delayed past the eighth day due to jaundice.
Rav Yosef Shalom Elyashiv (Israel, 1910-2012) maintained that if the infant’s bilirubin count is above 12, the circumcision should not be performed, and should be delayed. Some reports claim that Rav Elyashiv allowed a child to be circumcised even if the bilirubin count is 13, if the physicians discerned that the child was recovering and the bilirubin count was on its way down.
Halacha distinguishes between a case where a child is unfit for circumcision, and a case where a child is considered a "Holeh" (ill patient). In the first case, where the child is not ready for circumcision but does not have the status of "Holeh," the Berit Mila should be performed as soon as the child becomes fit for circumcision. In the second case, however, where the child is considered a "Holeh," the circumcision is not performed until seven days after he is deemed healthy enough to undergo circumcision.
Rav Elyashiv is cited as ruling that the infant has the status of "Holeh" if the bilirubin count reaches 18, and the doctors are considering the possibility of a blood transfusion. Rav Shlomo Miller of Toronto maintains that even if the bilirubin level is lower than 18, the child is considered "Holeh" if the doctors express concern about the child’s condition. Yet a third view is that of Rav Shlomo Zalman Auerbach (Israel, 1910-1995), who ruled that a child is considered a "Holeh" only if the level reaches 19, and the doctors determined that he is indeed ill. Rav Shlomo Zalman noted that modern medicine has found that jaundice does not necessarily signify an illness, and thus even at high bilirubin levels, an infant is not considered a "Holeh" with respect to Berit Mila unless the doctors determine that he is indeed ill. Of course, even if the infant is not considered ill, the Berit cannot be performed with a high bilirubin count, but in such a case, once the level goes down and reaches 11 or 12, the child may be circumcised immediately, without a seven-day waiting period.
In a case where a Berit Mila was delayed due to jaundice, how often must the parents bring the infant to have his bilirubin count checked? Must they go through the trouble of bringing the baby to be checked every day, in order to ensure that the Berit Mila is not delayed longer than necessary?
Rav Elyashiv ruled that once the parents see that the infant is recovering, and he looks healthy, he must be checked every day to determine the beginning of the seven-day waiting period. He explains that once the infant’s eighth day has arrived, the father is obligated to have him circumcised when he is ready for circumcision, and every day that passes on which the Berit can be performed but is not performed, the father is guilty of neglecting this important Misva. Therefore, once the child looks healthy, the parents must take him to be tested every day, despite the inconvenience entailed, and once the bilirubin level reaches the point which allows the child to safely undergo circumcision, the seven-day waiting period begins.
Interestingly, Rav Elyashiv maintained that if the infant is checked, and the doctor confidently presumes based on the results that the infant had already reached an acceptable bilirubin level the previous day, then the seven-day waiting period begins from the previous day. Even though the last time the infant was checked his level was still too high to allow for circumcision, nevertheless, if the doctor is fairly certain based on the results that the child was already healthy enough for circumcision the day before, the seven-day period begins from the previous day.
It must be emphasized that the guidelines relevant to the situation of a jaundiced infant are quite intricate, and subject to several disputes among the Halachic authorities, as we have seen. We are therefore not issuing definitive conclusions, and present this material merely for the purpose of familiarizing ourselves with the basic principles relevant to the subject. In any situation of a jaundiced child, it is imperative that the parents consult with an experienced Mohel and/or knowledgeable Rabbi to receive proper guidance.
Summary: Certain levels of jaundice necessitate delaying a Berit Mila past the child’s eighth day. When this happens, the child is to be circumcised either immediately upon being determined healthy enough to undergo the procedure, or seven days later, depending on whether his condition qualifies as a Halachic "illness" which requires waiting seven days after recovering from the illness. Given the difference of opinions among the Halachic authorities regarding these Halachot, it is imperative to consult with a knowledgeable Mohel and/or Rabbi for guidance when such a situation arises.
