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When Your Child Needs Surgery

A pediatric surgeon provides an overview of what to expect. 

Taking a child to a surgeon to be assessed or treated can be an unexpected—and unsettling—prospect. Here, Christopher Gitzelmann, MD, Associate Professor of Surgery, Rutgers Robert Wood Johnson Medical School and Section Chief, Pediatric Surgery, Saint Barnabas Medical Center (SBMC), demystifies the process for concerned parents. “At the Pediatric Specialty Center at Saint Barnabas Medical Center, each year we perform thousands of pediatric surgical procedures, including lifesaving emergency surgeries as well as routine procedures,” explains Dr. Gitzelmann. “Our pediatric surgeons are board-certified in general as well as pediatric surgery.” In addition, SBMC has pediatric anesthesiologists on staff to care for the youngest patients.

What are the common conditions pediatric specialists see?

At Saint Barnabas, we treat any child from newborn through age 16. Typically, we see cases from the outpatient clinics, the Neonatal Intensive Care Unit [NICU] and the Emergency Department [ED]. The conditions we see vary depending on where the case is coming from.

Cases from the outpatient clinics are typically hernia repairs, soft tissue problems, lumps, bumps and the like. Occasionally we’ll have requests for placement of a central line or feeding tube and things of that nature. The cases from the ED can be anything from the most typical conditions to the most complicated, but they tend to be appendicitis, bowel obstruction and general malformations that had gone undiagnosed, as well as trauma patients.

In the NICU, we typically treat new babies that have a malformation. This can include things like abdominal wall defects and other general congenital malformations.

What can parents do to prevent their children needing surgery?

Obviously, prenatal care and healthy diet are important. But many times, the malformations we see could not have been prevented. The same goes for things like appendicitis—there’s nothing you can really do to prevent the need for surgery.

What are warning signs that a child should be brought to the ED?

For appendicitis, you need to be aware of a pain of the right lower quadrant that persists for 24 to 48 hours. The pain will progress in intensity and will often be coupled with a fever and nausea.

For other intestinal problems, be wary of excessive vomiting. Pay particular attention to the color of the vomit. Green vomit is a definite warning sign that the child needs to be taken to the ED right away.

How can parents tell the difference between appendicitis and a virus? 

This is a common problem because they often present with identical symptoms, and with appendicitis, time is of the essence. With a virus, the symptoms will get better after 24-48 hours. On the other hand, with appendicitis, the pain and symptoms will be persistent and will get worse over time.

How can parents prepare a child for surgery? 

In emergency settings, parents might not have much time to prepare a child. Fortunately, we have trained child life experts available during the preoperative period to assist and distract children to help them not be afraid.

When preparing for a planned, non-emergency surgery, doctors can assist parents in talking with the child and explaining the procedure. If the child is an appropriate age, we recommend explaining the full process so that there are no surprises along the way. And if you can, let them know when they’ll be able to go home.

How can parents properly care for a child after surgery?

Typically, wound healing takes about two weeks. Proper healing has a lot to do with movement and depends on where the incision was. We generally recommend keeping the child out of gym class and out of contact sports and other rigorous activities. For cosmetic reasons, it’s always a good idea for parents to massage the incision once it is healed with a cream that will reduce scarring.