Spring is finally giving way to summer, and with the lengthening days and warming temperatures come an increase in playground injuries among kids. Falls off the monkey bars that result in a bad bone break or ligaments torn during a game of tag increase in frequency this time of year. But other diseases and conditions such as life-threatening congenital deformities, cancer, hernias, appendicitis and a wide variety of other problems that can crop up any time may mean you’ll need to bring your child to a pediatric surgeon for help.
Pediatric surgery is a highly-specialized field of medicine. The American College of Surgeons reports that “pediatric surgeons are primarily concerned with the diagnosis, preoperative, operative and post-operative management of surgical problems in children, and they operate on children whose development ranges from the newborn stage through the teenage years.”
[See: 10 Questions Doctors Wish Their Patients Would Ask.]
This specialty field has several areas of focused expertise including prenatal (surgery while the baby is still in the womb), neonatal (surgery on newborns and infants), trauma (surgery to fix traumatic injuries) and pediatric oncology (surgery related to childhood cancers). Some surgeons may also focus their practice on particular parts of the body such as the bones and muscles ( pediatric orthopedic surgery), the brain ( pediatric neurosurgery) or the cardiovascular system ( pediatric cardiothoracic surgery), among others.
All of this specialization means additional training, which is important, says Dr. Meagan M. Fernandez, a pediatric orthopedic surgeon with Geisinger in Danville, Pennsylvania, because “children aren’t just small adults. That’s a common misconception. Their growing bones pose very different and unique challenges than the bones of adults. They get different variations on injuries than we do. And some of those things they’ll outgrow over time, but some require surgical intervention. And that’s when it’s really important to have someone with subspecialized training to treat your kids.”
Dr. Gail Besner, chief of pediatric surgery at Nationwide Children’s Hospital in Columbus, Ohio, says “most parents might not even recognize that you can’t just think of an adult and scale it down. They might think that going to an adult surgeon for their kid’s pediatrics problem is just fine, but it’s really not fine.” She notes that many of the conditions a pediatric surgeon treats would never show up in adults.
“For example, in the newborn period, children can be born with problems called congenital anomalies,” she says, such as a hole in the diaphragm that can cause the contents of the abdomen to move into the chest cavity and impede breathing or blockages in the esophagus that prevent babies from eating. Premature babies often have hernias or other abnormalities that would be relatively straightforward to repair in an adult. But in a preemie, such conditions are often much more challenging to treat because of the baby’s tiny size and delicate tissues.
Besner says many of these anomalies “are never seen in the adult population because you have to treat them in the newborn period in order for the patient to survive. So adult surgeons wouldn’t even learn about the care of these problems in an adult surgery training program,” she says. “That’s why that extra pediatric surgery training is really critical and crucial.”
[See: HIPAA: Protecting Your Health Information.]
To become a pediatric surgeon, the doctor must complete medical school followed by a five-year surgical residency. “Then, if your goal is to do pediatric surgery, you have to complete a two-year pediatric surgery fellowship,” Besner says. “But because pediatric surgery is so competitive and there are so few training positions in North America, you have to do something to distinguish yourself so that you’ll get one of those coveted spots.” She says this means many would-be pediatric surgeons take two to four years to do additional clinical fellowships or research before applying for a pediatric surgery fellowship to improve their chances. “It’s one of the most competitive fellowships out there.”
Your child’s pediatrician or your family doctor can likely make a referral to a good, local pediatric surgeon when you need one, but you may also want to do some additional research to review your options. Fernandez recommends checking the surgeon’s educational background and ensuring that any surgeons you’re considering are board certified and attended accredited training programs. “That’s the first step in finding the right person — finding someone who’s specialized in treating children.”
From there, she says you should meet with the doctor. “Even if it’s a minor surgery, you want to be comfortable with that person.” Fernandez notes that most pediatric surgeons are adept at putting parents and children at ease. “I think that’s sort of the special piece that we as pediatric orthopedic surgeons have,” she says.
Besner agrees, saying that “pediatric surgeons have to love children and you have to be good at dealing with families, because it’s not just the child — it’s the mother and the father and the grandparents.” Doctors who treat adults may not have to speak with anyone besides the patient, but pediatric surgeons must help families understand and cope with sometimes-complex diagnoses and treatment protocols. “In general, we spend a lot of time with the families so they understand the issues and the challenges, what the risks and the benefits are of what we’re proposing to do with their child,” Besner says.
But herein lies some of the appeal of becoming a pediatric surgeon, Besner says. “It’s an unbelievable honor that these families and parents are entrusting the lives of their most precious commodities — their children — to the pediatric surgeon. That is really something that we hold extraordinarily valuable.”
Beyond finding a doctor you can communicate well with, Besner says it’s also important to look at the hospital and other specialists who may be involved with your child’s surgery. “It’s not just the pediatric surgeon that’s important. It’s the hospital as well,” she says.
[See: 14 Things You Didn’t Know About Nurses.]
In addition to child-sized medical supplies, children’s hospitals also have another thing that most adult-oriented medical centers may not: a pediatric anesthesiologist. “If your child is being operated on in a community hospital or adult hospital, likely they won’t have a pediatric anesthesiologist. But the anesthesia part is as important or perhaps more important than the actual operative procedure itself. Pediatric anesthesiologists have taken extra time to learn how to administer anesthesia to children,” which again, is not just a smaller dose for a smaller body, but a highly-trained skill.
Once you’ve selected a surgeon, Fernandez says it’s important to come to your first appointment with the doctor armed with any test results or X-rays that have already been completed. “A big concern of mine is radiation. We try to limit X-rays and imaging as much as possible in kids when we can,” because growing bodies may be more susceptible to the damaging effects of radiation. “It’s a necessary evil and we need to have pictures to see what’s going on,” Fernandez says, but if your child has already had X-rays or other imaging done, “get the CD [of the images] before you leave that visit” so the pediatric surgeon doesn’t need to order more X-rays. In addition to limiting your child’s exposure to radiation, it can also hasten the initiation of appropriate treatment.
More from U.S. News
10 Questions Doctors Wish Their Patients Would Ask
HIPAA: Protecting Your Health Information
14 Things You Didn’t Know About Nurses
How Can I Find the Best Pediatric Surgeon for My Child? originally appeared on usnews.com
