Children are not anatomically smaller versions of adults, especially when it comes to surgery. Nor is their physiology the same. Consider that 100 cc’s of blood is about 5 percent of an adult’s total volume. A grown-up could easily handle such a small loss during a surgery. An infant could not; that 100 cc of blood is his entire supply.
Thus, says pediatric surgeon Stephen G. Murphy of the Nemours/Alfred I. duPont Hospital for Children, “Our operations are meticulous operations.”
That’s only one reason why children often need pediatric surgeons. Some children suffer congenital abnormalities not found in adults. Some diseases occur and progress differently in children. The biology of their tumors can be different. Anesthesia needs to be adjusted. Some surgeries, especially those to correct malformations, need to be repeated as kids grow. And children respond differently to operations and stress.
General pediatric surgeons are trained to handle it all, and they’re trained to treat everyone from adolescents to 1-pound preemies. Says Murphy, “We’re the last general surgeons who truly do everything.”
Though they perform myriad procedures—even bariatric surgery on morbidly obese adolescents—doctors also deal with the children’s mental and emotional development, and their parents. “Parents are an important part of the care team,” says Kirk W. Reichard of Alfred I. “We spend a lot of time educating them and making them feel at ease. They are consenting for someone else. They need to be comfortable with the information we give them.”
And doctors need to be able to deal with kids who, after serious procedures, must act more like adults, sometimes by making significant changes to their lifestyles.
“Bariatric surgery for kids is behaviorally and psychiatrically very different,” Reichard says. “These kids are all adult-sized, but they think like children. They need to be independent, but they can’t. We add the extra understanding of the way adolescents and pre-adolescents think, and we need to engage kids in the process. If we take the risk to do the procedure, we have an obligation to inform them about it.”
One nice thing about working with kids: Despite the issue that troubles each, most are otherwise healthy. With young bodies, they’re often able to heal quickly. Unlike helping a 70-year-old who may have another seven years of life, helping a 7-year-old may give them another 70. “It’s hard when a kid has a problem, but you can save a life,” Murphy says. “That’s pretty gratifying.”