The Importance of a Pediatric Surgeon

Children are not just “little adults” and when possible, should be treated by a physician who is specially trained in pediatrics. Their physiology is different, and since they’re still developing, their organs are not always in exactly the same location. In this episode of CHOC Radio, Dr. David Gibbs, a pediatric surgeon and the director of trauma services at CHOC, discusses:

Hear more from Dr. Gibbs in this podcast:

CHOC Radio theme music by Pat Jacobs.

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Preparing Your Child for Surgery

Surgery is scary for kids and parents, alike, but not talking about an upcoming surgical procedure can create more fear and anxiety in children. In episode number 29, Child Life Specialist Brianne Ortiz offers tips for preparing children, from toddlers to teens, for surgery.

The amount of information, in addition to how and when it’s presented, depends on the emotional and cognitive age of the child. Brianne recommends parents speak to children, ages 3 to 5, approximately three to five days before the scheduled surgery. These younger-aged children often think they’ve done something wrong, so it’s important to reassure them that’s not the case and to present information in concrete terms they understand. She reminds parents that toddlers don’t have a concept of time. Instead of saying a procedure will last an hour, for example, explain that it will be over in about the same time as their favorite TV show.

Adolescents most often worry about waking up during surgery and about pain. Brianne educates teens on the role of the anesthesiologist and the hospital’s pain scale. She encourages teens to engage with their care team and not be afraid to speak up.

Listen to the episode for more helpful tips, including resources offered by CHOC.

CHOC Radio theme music by Pat Jacobs.

Related posts:

  • The Importance of a Pediatric Surgeon
    Children are not just “little adults” and when possible, should be treated by a physician who is specially trained in pediatrics. Their physiology is different, and since they’re still developing, ...
  • Will Your Newborn Need Surgery? Plan Now
    The news comes as a shock, usually during the first prenatal ultrasound between the 16th and 20th week of pregnancy. Treatment planning, however, cannot begin too soon when a developing ...
  • Matthew’s Story: Healing in the Surgical NICU
    Grace Wu beams as she watches her son Matthew smiling and happy after enjoying his bottle. “It’s good to see him so happy and active,” she says. “That he could do ...

Will Your Newborn Need Surgery? Plan Now

The news comes as a shock, usually during the first prenatal ultrasound between the 16th and 20th week of pregnancy. Treatment planning, however, cannot begin too soon when a developing baby is diagnosed with a complex birth defect.

 

Some babies are born with complex conditions requiring surgery during the first few hours following birth. From the moment prenatal testing reveals an abnormality, CHOC Children’s is ready to help with the prenatal care and birth planning necessary to ensure the best-possible outcome.

CHOC has a trained and experienced team that includes perinatologists, neonatologists, pediatric surgeons and NICU nurses to guide families through the months before delivery. And families are essential to the planning process.

“The well-being of the child is surprisingly dependent on the well-being of the family, both psychologically and emotionally,” said Dr. David Gibbs, division chief, pediatric surgery, CHOC Children’s Specialists. “Preparation helps the family cope better, and the family that is coping better is able to provide better care for their child.”

According to Dr. Gibbs, recent advances in the care and outlook for babies born with abnormalities have come from closer prenatal coordination with perinatologists and families, combined with highly specialized neonatal intensive care. The CHOC NICU is rated by the American Academy of Pediatrics as a Level 4 NICU, the highest designation available and given only to facilities that also provide onsite surgical repair of serious congenital or acquired malformations.

That immediate access to the full NICU medical team, resources and support is critical for babies born with gastroschisis, a condition that requires surgery within the first hour following birth, and omphalocele, which must be corrected within the first few days. For the smallest and sickest, CHOC’s Small Baby Unit offers additional support to help babies grow and recover more quickly with fewer infections and setbacks.

For babies born with congenital diaphragmatic hernia, the CHOC Surgical NICU provides the optimal environment in which to stabilize and gain strength before surgery. One special room inside the CHOC NICU converts into a state-of-the-art operating room, allowing pediatric surgeons to perform delicate procedures within the unit.

And babies born with congenital cystic adenomatoid malformation (CCAM) may actually get to go home for continued evaluation months before surgery.

Deciding Where You’ll Deliver

Dr. Gibbs added that an important element of prenatal planning is deciding in advance where your baby will be born. Moms who know their baby will need surgery may choose to deliver at a hospital that is near a pediatric facility like CHOC. When the baby is born, the CHOC Transport Team is ready 24 hours a day to transport the baby to CHOC from hospitals throughout the region. Specially trained and equipped, this team uses ground and air transportation to travel to and from hospitals throughout Orange, Los Angeles, Riverside, San Bernardino and San Diego counties — and even beyond.

“We expect most children will do well and have normal lives,” Dr. Gibbs said. “But the first step is meeting with the perinatologist, pediatric surgeon and NICU team. Starting that relationship as soon as possible will make the process of coping with what may seem to be an overwhelming process a lot easier.”

CHOC’s surgeons provide cardiothoracic surgery, gastrointestinal (GI) surgery, general surgery, neurosurgery, urological surgery, otolaryngological (ENT) surgery, plastic surgery, ophthalmologic surgery and orthopaedic surgery.

Learn more about surgical services at CHOC.

More articles about surgery:

  • The Importance of a Pediatric Surgeon
    Children are not just “little adults” and when possible, should be treated by a physician who is specially trained in pediatrics. Their physiology is different, and since they’re still developing, ...
  • Preparing Your Child for Surgery
    Surgery is scary for kids and parents, alike, but not talking about an upcoming surgical procedure can create more fear and anxiety in children. In episode number 29, Child Life ...
  • Matthew’s Story: Healing in the Surgical NICU
    Grace Wu beams as she watches her son Matthew smiling and happy after enjoying his bottle. “It’s good to see him so happy and active,” she says. “That he could do ...

Matthew’s Story: Healing in the Surgical NICU

Grace Wu beams as she watches her son Matthew smiling and happy after enjoying his bottle.

“It’s good to sbabies surgeryee him so happy and active,” she says. “That he could do that makes me very, very happy.”

It’s a marked change from the days following Matthew’s birth almost four months ago.

As a newborn, he was diagnosed with volvulus, a condition wherein the intestine is twisted and can ultimately cut off blood circulation. Symptoms of volvulus include a distended stomach and intolerance to feeding, which Matthew exhibited.

The baby was quickly transferred to CHOC Children’s for emergency surgery at just three days old. CHOC surgeon Dr. Saeed-Ur-Rehman Awan repaired the malformation by performing an ileostomy, wherein the intestine is brought outside the body.

Next, Matthew needed time to heal his organs. He spent the next three months recovering in CHOC’s Surgical Neonatal Intensive Care Unit, a special part of the hospital’s main NICU dedicated to the care of babies who need surgery.

There, Matthew was under the care of a multidisciplinary team that included Dr. Irfan Ahmad, a CHOC neonatologist and co-director of the surgical NICU, and many other clinicians.

In the unit, the team cares for patients jointly, discussing the cases of children like Matthew as a group and forming a treatment plan that often calls for the expertise of other specialties at CHOC.

Another key component of the surgical NICU care team is parents and families. In Matthew’s case, his parents and grandfather, Jerry, partnered with clinicians on every stage of the baby’s care.

“Jerry was there every single day holding Matthew – even when he was crying,” Dr. Ahmad says. “He was a great member of the team, and he provided a lot of support.”

As Matthew began eating orally in small volumes as well as through intravenous methods, he geared up for a second surgery that would reattach his intestines. That procedure was performed just three months after the first.

After several more weeks of recovery, Matthew was able to eat fully from a bottle and was on his way home, much to the relief of his family.

“I was very worried because for the first time, I thought I might lose him,” Grace says. “I am very thankful for the care he’s received.”

More articles about CHOC’s Surgical NICU:

Former CHOC Patient is Cancer Free Thanks to Da Vinci Robotic Surgical System

Julia Shenkman is a healthy and accomplished 17-year-old. She has a second-degree black belt in Taekwondo, is a member of her high school’s science team, and is fourth in her senior class in academics. Julia has another distinction: She’s a former CHOC Children’s patient who underwent a surgical procedure that involved the use of the then-landmark Da Vinci robotic surgical system.

In late 2003, CHOC became the first pediatric hospital in California to begin offering robotic surgery for children. The Da Vinci robot was an improvement over minimally invasive laparoscopic surgery because it gave surgeons a better view inside the surgery site and allowed them to more precisely manipulate instruments, which translated to less pain, fewer complications and shorter recovery time for patients.

In January 2006, Julia, then 8, was whisked to the emergency department at St. Joseph Hospital for severe abdominal pain and frequent vomiting. Blood work and X-rays for appendicitis turned up negative. It wasn’t until Julia’s doctor at CHOC, Mustafa Kabeer, pediatric surgeon, ordered an ultrasound that the cause of her distress was found: a large mass in her right ovary. Using the Da Vinci system, Dr. Kabeer operated on Julia and successfully removed the tumor, which was malignant. After three months of chemotherapy, Julia recovered and remains cancer free.

Julia with Dr. Mustafa Kabeer, CHOC Children's pediatric surgeon.
Julia with Dr. Mustafa Kabeer, CHOC Children’s pediatric surgeon.

Pediatric surgeons at CHOC have performed about 100 robot-assisted surgeries, says Dr. Kabeer, who before coming to CHOC helped implement the world’s first pediatric surgery robotics program at Children’s Hospital of Michigan in 2001. Recently, Dr. Kabeer started using the Da Vinci system to perform complex operations through one incision in the belly button, such as for removal of the gallbladder. The Da Vinci system at CHOC was made possible by a $1.5 million sponsorship from Costco Wholesale Corp.

“This type of technology helps us perform a wide variety of surgeries — some of them very complex,” Dr. Kabeer says. “It takes time, commitment and vision to start and maintain such a program, but this is one of the unique things about CHOC: We want to do this, and we are committed to doing it.

Related posts: 

  • The Importance of a Pediatric Surgeon
    Children are not just “little adults” and when possible, should be treated by a physician who is specially trained in pediatrics. Their physiology is different, and since they’re still developing, ...
  • Preparing Your Child for Surgery
    Surgery is scary for kids and parents, alike, but not talking about an upcoming surgical procedure can create more fear and anxiety in children. In episode number 29, Child Life ...
  • Will Your Newborn Need Surgery? Plan Now
    The news comes as a shock, usually during the first prenatal ultrasound between the 16th and 20th week of pregnancy. Treatment planning, however, cannot begin too soon when a developing ...