The Multidisciplinary Team (MDT) Approach

Treating a child requires a collaborative, child-friendly team:

• Paediatric Surgeon: The lead for surgical management.
• Paediatrician/Paediatric Intensivist: Manages the child’s overall medical health before and after surgery, especially in the Paediatric ICU (PICU).
• Paediatric Anaesthesiologist: Specializes in safely administering anaesthesia to children, whose responses to drugs and equipment needs are unique.
• Paediatric Nurse Specialist: Provides specialized nursing care and supports the family.
• Other Specialists: Depending on the condition, the team may include paediatric cardiologists, oncologists, neurologists, radiologists, and pathologists.
• Child Life Specialists: Professionals who help children and families cope with the stress of hospitalization through play, preparation, and education.

Key Differences Between Paediatric and Adult Surgery

• Physiology: Children have different fluid and electrolyte balances, metabolic rates, and thermoregulation needs.
• Anatomy: Their organs and tissues are smaller and still developing, requiring microsurgical techniques and specialized instruments.
• Pharmacology: Drug dosing is based on weight (mg/kg), and children metabolize medications differently.
• Psychology: Care involves explaining procedures in an age-appropriate way and providing immense emotional support to both the child and the family.
• Congenital Conditions: A large part of paediatric surgery deals with correcting birth defects.

Major Subspecialties of Paediatric Surgery

1. Neonatal Surgery: Focuses on surgery in newborns, particularly for congenital malformations that are life-threatening. Examples:
   • Congenital Diaphragmatic Hernia (CDH)
   • Esophageal Atresia / Tracheo-Esophageal Fistula (EA/TEF)
   • Abdominal Wall Defects (Gastroschisis, Omphalocele)
   • Intestinal Atresias
   • Necrotizing Enterocolitis (NEC) (a serious condition in premature infants)
2. Paediatric Surgical Oncology: Diagnosis and surgical treatment of childhood cancers. Examples:
   • Neuroblastoma (adrenal gland/tumor)
   • Wilms Tumor (kidney tumor)
   • Liver Tumors (e.g., Hepatoblastoma)
   • Rhabdomyosarcoma (soft tissue sarcoma)
   • Teratomas
3. Paediatric Urology: Manains conditions of the urinary tract and male reproductive system. Examples:
   • Hypospadias
   • Undescended Testicles (Cryptorchidism)
   • Vesicoureteral Reflux (VUR)
   • Posterior Urethral Valves
   • Bladder Exstrophy (a complex birth defect)
4. Paediatric Cardiothoracic Surgery: Corrects congenital heart defects and chest conditions. Examples:
   • Atrial/Ventricular Septal Defects (ASD/VSD)
   • Tetralogy of Fallot
   • Congenital Lung Malformations (e.g., CPAM – Congenital Pulmonary Airway Malformation)
   • Pectus Excavatum (sunken chest wall)
5. Paediatric Gastrointestinal (GI) Surgery: Treats disorders of the digestive system. Examples:
   • Appendicitis
   • Intussusception (telescoping of the intestines)
   • Hirschsprung’s Disease (absent nerves in the colon)
   • Inflammatory Bowel Disease (IBD) complications
   • Biliary Atresia (blocked bile ducts in infants)
6. Paediatric Hepatobiliary and Transplant Surgery: Focuses on liver, kidney, and intestinal transplantation in children.
7. Paediatric Trauma Surgery: Manages surgical care for injured children. Trauma is a leading cause of death in children, and their response to injury is unique.
8. Fetal Surgery: An emerging field where interventions are performed on a fetus in utero to correct severe congenital anomalies (e.g., spina bifida, twin-twin transfusion syndrome).

Common Paediatric Surgical Procedures

• Minimally Invasive Surgery (MIS): Laparoscopic and thoracoscopic (keyhole) surgery is now the standard for many procedures (appendectomy, fundoplication, orchidopexy) due to less pain, smaller scars, and faster recovery.
• Bowel Resection: Removal of a diseased portion of the intestine.
• Pyloromyotomy: Correction of pyloric stenosis (a condition causing projectile vomiting in infants).
• Fundoplication: Procedure to treat severe gastroesophageal reflux disease (GERD).
• Colostomy/Ileostomy: Creating an opening (stoma) for the bowel to empty into a bag, often temporarily to allow healing.
• Pull-Through Procedure: For Hirschsprung’s disease, to remove the diseased colon and connect the healthy part to the anus.

The Treatment Journey & Family-Centered Care

1. Diagnosis: Involves imaging (ultrasound, MRI, CT), blood tests, and sometimes genetic testing.
2. Preparation: The child and family are prepared psychologically and physically for surgery. Child life specialists are crucial here.
3. Surgery: Performed with specialized equipment in an operating room designed for children.
4. Postoperative Care: This happens in a recovery room, then a ward or PICU. Pain management is a top priority and is tailored for children.
5. Recovery and Follow-up: Children often recover faster than adults. Long-term follow-up is essential to ensure normal growth and development after the procedure.

Here’s a more detailed look at estimated costs for common paediatric surgical procedures:

1. Common General Paediatric Surgeries

2. Neonatal & Congenital Defect Surgeries (Medium to High Complexity)

These often require a Neonatal ICU (NICU) stay, which is a major cost factor.

3. Paediatric Surgical Oncology (Cancer Surgery)

This is only the surgical cost. Total treatment cost including chemotherapy, radiation, etc., will be much higher.

4. Paediatric Cardiothoracic Surgery (Often the most expensive)

5. Critical Care Costs (A Major Factor)

• Neonatal ICU (NICU) per day: $120 – $360+
• Paediatric ICU (PICU) per day: $120 – $300+

Conclusion:
Paediatric surgery is a vast and rewarding field that combines technical surgical skill with a deep understanding of child development and family dynamics. The core principle is to provide the best possible surgical outcome while minimizing physical and emotional trauma, ensuring the child can go on to lead a healthy, normal life. The approach is always multidisciplinary and family-centered.