The Daily Schedule Of A Paediatric Surgeon

A paediatric surgeon is a specialist surgeon who trains in the diagnosis and surgical management of illnesses, diseases and disorders that affect children. Medical issues that affect children will be managed by a paediatrician.

Surgeries performed on babies and children are different to those performed on adults. The paediatric surgeon has to take certain factors into consideration that can affect the outcomes of these procedures. Children differ to adults in terms of them having a larger surface area to mass ratio, less subcutaneous fat, more body water and a higher metabolic rate.

It's important to make a note that a lot of paediatric surgeries have to deal with congenital abnormalities in children.

Training

Paediatric surgeons have to complete the following qualifications before becoming specialist surgeons.

• The medical student qualifies as a doctor when they complete a 5-6 year medical and surgical undergraduate degree.
• 1-2 year internship period where the doctor rotates through the various medical and surgical disciplines.
• General surgery residency programme that takes 5 years to complete.
• Fellowship training in paediatric surgery that takes 2 years to complete.

Paediatric surgeons will focus on the gastrointestinal system of the body and they will manage conditions such as oesophageal atresia, tracheo-oesophageal fistula, hypertrophic pyloric stenosis, intestinal atresia, intestinal volvulus, necrotizing enterocolitis, intussusseption, meconium plugs, mesenteric ischaemia, appendicitis, Hirschsprung's disease, gastroschisis, omphalocele, abdominal hernias and an imperforate anus.  

Sub-specialties in surgery regarding paediatrics and the conditions managed

Surgeons wanting to focus on the paediatric side of their discipline can train further by completing fellowship programmes in the following sub-specialties. Conditions managed by these sub-specialists will also be mentioned.

• Paediatric emergency surgery - usually involving surgery for traumatic injuries such as burns, obstructed airways (crycothyrotomy) and explorative laparotomy for internal bleeding.
• Fetal surgery - neural tube defects, congenital diaphragmatic hernia, congenital heart disease and sacrococcygeal teratoma.
• Paediatric cardiothoracic surgery - tetralogy of Fallot, congenital heart defects such as atrial and ventricular septal defects and pectus excavatum and carinatum.
• Paediatric neurosurgery - separation of twins conjoined at the head, intractable epilepsy, spina bifida, neuroblastomas, hydrocephalus, craniosynostosis and other cranial malformations.

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• Paediatric orthopaedic surgery - clubbed feet, leg-length discrepancies, rhabdomyosarcomas, spinal conditions such a kyphosis and scoliosis and congenital bone issues such as achondroplasia and osteogenesis imperfecta.
• Paediatric hepatological surgery - biliary atresia, cirrhosis or chronic liver failure needing a liver tranplant, cystic fibrosis liver disease, hepatoblastoma, primary sclerosing cholangitis and progressive familial intrahepatic cholestasis.
• Paediatric nephrological surgery - chronic renal failure needing dialysis access or renal transplantation, renal trauma, glomelunophritis, neuroblastomas and Wilms' tumour.
• Paediatric urological surgery - undescended testes, urinary obstruction and vesico-ureteric reflux, hypospadias, epispadias, bladder and kidney stones, minor malformations of the penis, phimosis, hydronephrosis, bladder exstrophy, and ambiguous genitalia.
• Paediatric plastic and reconstructive surgery - grafting for burn wounds, polydactyly, congenital defects like cleft lip and/or palate, craniosynostosis, plagiocephaly, head and neck tumours such as angiofibroma, desmoid tumors, fibrosarcomas, haemangiomas and breast abnormalities such as gynaecomastia and macromastia.
• Paediatric cancer surgery - lymphomas and the tumours already mentioned above.

The Daily Schedule Of A Paediatric Surgeon

Paediatric surgeons will see their post-operative patients in the wards and ICUs 1-2 times a day depending on the patients' needs. Since the physiology of paediatric patients differs to that of an adult, more aggressive monitoring needs to be incorporated. Therefore, these patients are placed in specialized paediatric units where the nursing staff are also specifically trained to manage them.

The office of a paediatric surgeon is located in the hospital so that they can quickly get to patients in the wards, ICUs and casualty department when a medical emergency arises. These specialists will also be consulted by paediatricians and other surgical specialists.

The paediatric surgeon will be on call during after hour and weekend periods to consult with patients. These specialists will have to manage emergency conditions needing surgical intervention such as traumatic injuries, acute abdomens due to issues such as appendicitis and severe dehydration due to excessive vomiting caused by problems such as intestinal atresias or pyloric stenosis.

A general paediatric surgeon may also make use of the services of paediatric surgeons of other surgical disciplines when managing certain patients.

Monday

Usually an administrative day, Mondays are used to manage clinical and non-clinical aspects such as attending of important hospital management, staff and surgical representative meetings. Once these issues have been finalised, the paediatric surgeon will begin consulting with their patients.

Patients seen by a paediatric surgeon can be for the first time, as they are referred by physicians such as general practitioners and paediatricians, or they are follow-up patients consulted after their surgeries. The first-time patients can be sent for further investigations, which are then followed up by the surgeon and discussed with the family of the patient, be admitted for in-hospital tests and management of surgical emergencies or they can be scheduled for an elective procedure at a later date.

Tuesday

The paediatric surgeon will spend the day performing surgeries in theatre. The procedures that are done can be laparotomies or laparoscopic procedures depending on the pathology. Emergency surgeries tend to be done via a laparotomy as this allows for better visualization of the intra-abdominal organs and tissues.

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Wednesday

Wednesday mornings will be spent operating in theatre and the afternoons will be used to consult with patients and perform other clinical administrative tasks. These can include sending motivation letters to medical aid companies for the authorization of certain surgical procedures or doing further research for the specialists own academic requirements.

Thursday

The mornings are usually spent performing surgical procedures again and the specialist will also be managing any emergency cases that come into the casualty department.

If the paediatric surgeon is involved with the academic curriculum of the local medical school, then they may offer training to the undergraduate medical students, the postgraduate surgical residents and paediatric surgery fellows.

Friday

The mornings are spent consulting with first time and follow-up patients. The surgical list for the following week will be confirmed and printed, and any other administrative tasks that need to be dealt with will be done so in the afternoon.

The work week can then conclude once all these aspects have been finalised.