What is pediatric surgery?

Science and Profession

A pediatric
surgeon is a general surgeon who has received additional training in operating on infants and children. The full course of training includes four years of medical school, followed by five years of general surgery
residency and two years of pediatric surgery residency. Pediatric surgeons generally practice in large referral hospitals or children’s hospitals. The relatively small number of American training programs in this specialty are all located at major teaching hospitals.

Children are not simply small adults. They experience some different surgical disorders than adults, especially congenital defects. Their ability to withstand the stress of surgery is less than that of an older person. Also, many of their surgical problems require years of follow-up care by a surgeon who understands child growth and development.

In the first half of the twentieth century, when pediatric surgery was developing as a specialty, the pediatric surgeon was trained to operate on all parts of the child’s body. As the specialty matured, however, the pediatric surgeon came to perform only general surgical procedures on infants and children. This trend was made possible by the development of pediatric subspecialties in the other surgical fields, such as neurosurgery and cardiac surgery. In addition, pediatric surgeons work closely with pediatricians. As a team, they share in evaluating the patient and in providing preoperative and postoperative care.

To a degree, pediatric surgeons differ from general surgeons in their point of view. Infants and children change constantly as they grow, and common surgical diagnoses also change with the age of the patient. Additionally, the ability of a child’s body to cope with disease and with surgery alters with age. It is therefore necessary for the pediatric surgeon to understand child growth and development.

Although a disorder may be surgically corrected in infancy, the child may continue to have postoperative difficulty for many years. An example is the removal of a large amount of intestines, which must sometimes be done with premature infants. It takes considerable patience and expertise to follow this sort of patient for years, adjusting the child’s diet and treatment to achieve as nearly normal growth as possible. The pediatric surgeon is specially trained to provide this care.

The organs and tissues of an infant or child are much smaller than those of an adult. The pediatric surgeon must develop expert skills to perform surgery on these small structures. Also, the pediatric surgeon is trained to work rapidly when performing surgery. It is important to complete procedures quickly to minimize stress on the pediatric patient.

Congenital defects are, fortunately, relatively uncommon. The pediatric surgeon treats relatively more of these conditions than a general surgeon would and therefore has greater experience in caring for them. Examples of congenital defects treated by pediatric surgeons include defects of the abdominal wall and diaphragm and the obstruction or absence of a part of the intestinal tract.

Because the patient is a child, the pediatric surgeon must also deal with the patient’s family. This specialist is trained to build a supportive relationship with parents and to teach them about their child’s disorder so that they can be informed participants in decisions regarding the patient’s care. Especially with chronic diseases, the parents must be kept aware of their child’s progress and changing needs so that they can participate fully in the child’s recovery.

Diagnostic and Treatment Techniques

The pediatric surgeon’s day is split between the operating room and the clinic. This specialist spends relatively more time in the clinic than does a general surgeon. Surgical correction is only one step in pediatric surgery: careful evaluation and planning must precede any procedure. Afterward, extended follow-up care is often necessary, sometimes for years. This type of care requires patience and an interest in long-range planning on the surgeon’s part.

The pediatric surgeon relies heavily on history taking and physical examination of the patient. This information, plus knowledge of the incidence of specific disorders at different ages, leads the surgeon to the most likely diagnosis. Specific laboratory and radiographic tests are ordered to aid in the diagnostic process.

The pediatric surgeon works very closely with the anesthesiologist, the physician responsible for keeping the patient anesthetized and his or her vital functions stable during surgery. The needs of a child are different from those of an adult during surgery. Many hospitals with pediatric surgeons are also staffed with pediatric anesthesiologists.

Like other surgeons, the pediatric surgeon also performs minor surgery on children, often in the clinic. Examples of minor procedures are the suturing of lacerations, the drainage of small abscesses, and the excision of small benign growths under the skin.

Perspective and Prospects

Pediatric surgery began as an offshoot of general surgery in the first half of the twentieth century. For decades, the specialty met resistance from general surgeons. The American Academy of Pediatrics was the first medical group in the United States to recognize the value of pediatric surgeons and, following a meeting by the academy in 1948, established a surgical section. C. Everett Koop, the surgeon general under President Ronald Reagan, was a vigorous advocate of pediatric surgical education and a developer of new surgical techniques for children from 1946 through the 1990s. He was an important proponent in the eventual recognition of pediatric surgery as a surgical specialty. It was not until 1973, however, that the US Board of Pediatric Surgery certified the first specialists in the field. The number of training programs for pediatric surgeons has grown since then, although their limited number of graduates, in comparison to other specialities, means that pediatric surgeons will continue to be in great demand.

Bibliography

American Pediatric Surgical Association, 2013.

Azarow, Kenneth S., and Robert A. Cusick. Pediatric Surgery. Philadelphia: Saunders, 2012.

Cockburn, Forrester, et al. Children’s Medicine and Surgery. New York: Oxford University Press, 1996.

Coran, Arnold G., et al. Pediatric Surgery. 7th ed. Philadelphia: Elsevier Mosby, 2012.

Glick, Philip L., et al. Pediatric Surgery Secrets. New York: Hanley & Belfus, 2001.

Koop, C. Everett. “Pediatric Surgery: The Long Road to Recognition.” Pediatrics 92 (October, 1993): 618–21.

O’Neill, Jr., James A., et al., eds. Principles of Pediatric Surgery. 2d ed. St. Louis, Mo.: Mosby, 2004.