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Pediatric Surgery

Frequently Asked Questions

What is a pediatric surgeon?

A pediatric surgeon usually devotes of his or her practice to the surgical care of children. He or she must have graduated from medical school, and completed five years of postgraduate General Surgery training in an accredited training program. Pediatric surgeons must then complete an additional accredited two-year fellowship program in Pediatric Surgery.

Pediatric surgeons concentrate on the special surgical problems of children. We care for infants, children, and adolescents, and also help to counsel parents expecting a baby who may have been diagnosed before birth with a surgical problem. Pediatric surgeons are experienced in caring for the wide variety of problems children may have, ranging from hernias or appendicitis to cancer or serious congenital anomalies.

What sort of credentials should a pediatric surgeon have?

A pediatric surgeon should be Board-Eligible or Board-Certified in General Surgery (board certification is granted when a fully trained surgeon has taken and passed first a written, then an oral examination). Once the General Surgery Boards have been passed, a fellowship-trained pediatric surgeon becomes eligible to take the Pediatric Surgery examination (this also involves both written and oral examinations).

Other credentials that a pediatric surgeon may have include fellowship in the American College of Surgeons, in the American Pediatric Surgical Association, or in the American Academy of Pediatrics. Each of these organizations requires that Fellows meet well-established standards of training, clinical knowledge, and professional conduct.

How is a children's hospital different from an adult hospital?

A children's hospital is planned around the special needs of children and their families. All of the doctors have special training in pediatrics, whether they're pediatric surgeons or pediatric anesthesiologists or pediatric radiologists; all of the nurses are experienced in caring for children. This concentration allows us to develop specific expertise in pediatric problems, and to develop special programs for children (such as Minimal Access Surgery, pediatric trauma care, etc.)

What I'm really worried about is the anesthesia. Is it safe to give small children general anesthesia?

At NewYork-Presbyterian Morgan Stanley Children's Hospital, all of our patients are cared for by pediatric anesthesiologists. Like the other pediatric specialists here, they have all had additional training to care for children. While we can't make parents stop worrying altogether, we can reassure you that general anesthesia given to even premature babies by a qualified anesthesiologist is very safe -- statistically safer, in fact, then driving on an average highway.

Who is actually going to perform my child's surgery?

Every procedure performed in the operating room at Morgan Stanley Children's Hospital is conducted from start to finish by one of our fully qualified staff surgeons. "Conducting" an operation is a bit like conducting an orchestra: You need a number of people to get the job done, but the conductor (the surgeon) determines exactly what gets done, and by whom, and when. So we are often assisted by residents, and, in fact, could not physically do many of the more complex procedures without their help.

Why did my baby get a hernia?

In boys, the testicles develop near the kidneys; they travel down to the scrotum during the end of gestation. The "pathway" they leave behind them is called the processus vaginalis; its equivalent exists in girls, with the end of the pathway being the labia. This pathway normally closes by the time of birth. If it remains open, then the contents of the abdomen may potentially also travel down through it. If abdominal fluid passes down to the scrotum, this is called a hydrocele or a communicating hydrocele; if an ovary (in a girl) or intestines are involved, this is termed a hernia.

My child is scheduled for an outpatient hernia repair. How long will she take to recover from her surgery? How do I take care of the incision?

Most children recover from outpatient procedures like a hernia repair in a remarkably short time, often just a day or two. We are experienced in making our surgical dressings "child-proof," and most don't require any special attention from parents -- either we will remove it at your follow-up visit or it will fall off by itself. We usually use absorbable stitches, so usually there are no stitches to remove either. In general, you don't need to restrict your child's activities after hernia surgery. Your surgeon will give you individualized instructions about bathing, swimming, etc.

What should I tell my child about the surgery?

This really depends on the age of the child. For infants, it's most important that the parents communicate with each other. Toddlers are most disturbed by separation. We try to address the fear of separation by having parents come into the operating room until the child is asleep, and by bringing them to the recovery room while the child is waking up. Toddlers also are afraid of needles, so we try not to use any until the child is anesthetized. Lastly, they may worry that the surgery is a punishment -- so it's important for parents to reassure them.

School-age children may have fears of anesthesia, experiencing pain, or death. They may benefit from discussion of the procedure or a pre-op visit to the surgical area, and from reassurance. Adolescents need the support of their parents just as much as younger children, but they also need to be empowered. They should participate in discussions with their doctors, and be given a voice when decisions are being made.

What if one parent misses the initial consultation?

The parent who couldn't be at that visit with the doctor should contact the pediatric surgeon, so that he or she has a full opportunity to ask questions, review the issues, and have concerns addressed. The day of surgery is usually not the best time to have a full discussion with the surgeon -- parents don't have the opportunity to "digest" the information they are given.

Can I go into the OR with my child?

For most day surgeries, you can. Parents stay with their child until he or she is asleep, then the parents are brought into the recovery room when the child is waking up.

For some surgeries, often emergencies, it's not as safe to have parents in the OR -- your surgeon and your anesthesiologist will explain those special circumstances if they apply to you.

Do you have evening hours? What about weekends and emergencies?

Yes, we have evening hours; please call us if you would like to arrange an appointment. At least two pediatric surgeons from our division are on call and available at all times for emergencies.