Children require special care whenever they undergo a surgery.
That is where the pediatric anesthesiologist comes in. Pediatric anesthesiologists are trained to handle smaller, more vulnerable patients – not just during an actual procedure but often in those moments just beforehand, when parents and their kids need reassurance the most.
There are a host of considerations that must be weighed when caring for a child because of their smaller size. Oxygen levels must be carefully monitored in infants younger than six months.
Medication doses tend to be less uniform to administer to children. And amounts of blood loss that wouldn’t threaten an adult can be especially devastating in a child. Besides all of that, pediatric anesthesiologists are trained to comfort youngsters, so good bedside manner is a must.
Here to explain it all is Scott Siegel, M.D., a pediatric anesthesiologist at The Children’s Hospital at Saint Peter’s University Hospital in New Brunswick, NJ.
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Preparing Children (And Their Parents) For Surgery
Featured Speaker:
For more information about Saint Peter’s Healthcare System
Scott Siegel, MD
Scott Siegel, MD. is the Director, Pediatric Anesthesiology The Children’s Hospital at Saint Peter’s University HospitalFor more information about Saint Peter’s Healthcare System
Transcription:
Preparing Children (And Their Parents) For Surgery
Bill Klaproth (Host): Children require special care whenever they undergo a surgery and that is where the pediatric anesthesiologist comes in. Here to explain more is Dr. Scott Siegel, a pediatric anesthesiologist at the Children’s Hospital at Saint Peter’s University Hospital. Dr. Siegel, thank you so much for taking the time to talk with us today. How are pediatric anesthesiologists especially trained to care for children?
Dr. Scott Siegel (Guest): Okay. It’s a good place to start, Bill. People understand anesthesiologists are physicians. After medical school, anesthesiologists do a residency in anesthesia, usually two to three years. And then, the pediatric anesthesiologist is distinguished by doing an additional year of some specialty, what’s known as fellowship training, specifically in pediatric anesthesia.
Bill: What is the difference then between a pediatric anesthesiologist and somebody who just administers to adults?
Dr. Siegel: Right. It’s a really important question. For parents that are listening that have that concern, let me see if I can give a good answer. The fact that there are pediatric anesthesiologists does not mean that someone who is not a pediatric anesthesiologist cannot take care of children. What we really need to distinguish between our anesthesiologist that may have a diverse practice and that they take care of children as part of their practice versus, perhaps, an anesthesiologist that never takes care of children, and compare either of those two to an anesthesiologist who either exclusively takes care of children or has special expertise in taking care of, again, not necessarily a healthy child but a child with special concerns, special needs, special medical issues, or medical problems, including very small children such as a newborn infant or even an infant that’s maybe only a few months of age.
Bill: Okay. What are some of the special considerations when administering anesthesia to a child?
Dr. Siegel: There’s a number of differences. Obviously, children are not just small adults. They have certain special needs that are dictated by their anatomy and their physiology. Those are things that a pediatric anesthesiologist or someone that practices a lot of anesthesia on children would be familiar with. There’s differences in things such as the amount of oxygen that an infant may need or the doses of the medications or the kinds or amounts of fluids that are administered. There’s certainly differences in the vital signs and the way that we assess the well-being of the child as compared to an adult. So, there’s any number of parameters that are going to be different. And again, even within the pediatric population, we distinguish between, let’s say, newborn infants, infants under six months of age, and perhaps toddlers up to two years of age. Even within the pediatric population, it’s multifaceted in terms of the care and the kind of care that’s administered.
Bill: So, even within anesthesiologists, there could be somebody that specializes in a baby that’s under six months old compared to a child that’s five years old.
Dr. Siegel: Okay. That’s a fair question. I think you’re hitting on, really, the best answer for parents that are concerned about providing anesthesia care for their child. I would say, for the most part, if you have as a particular example, an otherwise healthy five-year-old for a tonsillectomy, you can be comfortable if you know that the hospital that you are going to has anesthesiologists that frequently care for five-year-old children and are comfortable caring for five-year-old children. You do not have to seek out specifically a pediatric anesthesiologist. If you so choose to, obviously that’s within anyone’s right to do so. But it’s not necessarily a necessity. However, I would say, I think most people would agree that children under two years of age—certainly, children under six months of age, and without question, newborn babies and, certainly, premature babies or infants in the neonatal intensive care unit—probably, under most circumstances, a parent would want specifically a pediatric anesthesiologist caring for those children.
Bill: All right. Excellent. I think that’s really important. Your advice or your suggestion is then for children under two years of age, certainly under six months of age or certainly, premature babies, that’s where a pediatric anesthesiologist, you would say, that’s when you need to look for one of those, correct?
Dr. Siegel: I would say that’s where a parent might gain an additional level of comfort. In terms of the qualifications of the anesthesiologist, again, understanding that board certification or where someone trained are important factors, that’s not the entire picture. There are certainly anesthesiologists that did not go to a pediatric fellowship that have been taking care of children for years, especially perhaps in underserved areas, where they don’t have the luxury of having a pediatric anesthesiologist who may be very competent in taking care of these children. But as a broad rubric, yes, the qualifications that we’re talking about are the starting point where parents can start to look. To add to the picture, understand that things completely change when you go from an otherwise healthy child to a child with perhaps a severe illness or a severe injury or some kind of complex congenital or acquired disease or special syndrome or involved in complex surgery, or a situation where the child needs a high level of intensity care pre-operatively and post-operatively. Those are all going to be mitigating factors in terms of a parent’s decision to decide whether or not their local hospital or their regional hospital provides them with the level of comfort that they’re looking for if they have to look outside of that scenario.
Bill: Absolutely. Okay. Very, very good. As a parent, how shall I ask for a pediatric anesthesiologist? Is there something I should say or somebody I should look for? What should I look for in a hospital? Is there a way to find that out? As a parent, where do I go to find a pediatric anesthesiologist?
Dr. Siegel: There are two issues. One is asking the question. Two is what you do with the information when you get the answer. It’s probably not difficult to get the information as long you ask, whether it’s the website of the hospital or whether it means calling the department of anesthesia and asking to speak to someone. Or a great resource would be to ask the surgeon, especially the pediatric surgeon that we’re talking about. Especially, in today’s day and age of the Internet, I don’t think it would be difficult for most parents to find out about the facility of the hospital that they’re either thinking of using or that they’re looking for, and there’s certainly all kinds of resources regarding anesthesia on the Internet. To name a few, specifically for our discussion, there’s the American Society of Anesthesiologists; there’s the American Academy of Pediatrics that has a subdivision on anesthesia; there’s an organization known as SPA, which is the Society for Pediatric Anesthesia. All these websites will give information on what a parent is looking for and what criteria they should look for, under what circumstances. But in relatively straightforward or simplistic scenarios, again, ask the surgeon, ask the facility, go on the website. That’s certainly a starting point. Now, it gets a little more complicated if the parent doesn’t really know what to do with that information and whether or not they should be satisfied that their child is being well-cared for. And a parent can ask for each facility for each scenario what the criteria are that the institution has in terms of who takes care of the children in the operating room, because every institution has criteria that will determine which anesthesiologists are taking care of the children.
Bill: I got you. Okay.
Dr. Siegel: Again, to reiterate, certainly ask the surgeon who’s involved, and be ready with that question probably at the first visit, because the day of, when you show up at the hospital for tonsils or for your hernia repair, whatever it might be, is not the time to start saying, “Well, I want a board-certified pediatric anesthesiologist.”
Bill: Right. Okay. I got you. So, in our last minute here then, what would you say to the parents of a child who is about to undergo surgery and require anesthesia? What’s your best advice for them?
Dr. Siegel: Stay calm, because the children pick up on the parents’ anxiety. If the parents are anxious, if the parents are worried, if the parents are upset, the children are going to be even more so, and the children are going to know that there’s something up, that there’s something that they need to fear, that they need to be worried about. And the parents need to communicate with the children. Each to its own, but the parent really needs to—if the child can handle it—to explain to the child what’s happening. And certainly, don’t hide things from the child. Children don’t like to be surprised, and honesty usually works as long as it’s done gently.
Bill: Absolutely. Great advice, Dr. Siegel. Thank you so much for your time today. We really appreciate it. For more information on Saint Peter’s, please visit saintpetershcs.com. This is Saint Peter’s Better Health Update. I’m Bill Klaproth. Thanks for listening.
Preparing Children (And Their Parents) For Surgery
Bill Klaproth (Host): Children require special care whenever they undergo a surgery and that is where the pediatric anesthesiologist comes in. Here to explain more is Dr. Scott Siegel, a pediatric anesthesiologist at the Children’s Hospital at Saint Peter’s University Hospital. Dr. Siegel, thank you so much for taking the time to talk with us today. How are pediatric anesthesiologists especially trained to care for children?
Dr. Scott Siegel (Guest): Okay. It’s a good place to start, Bill. People understand anesthesiologists are physicians. After medical school, anesthesiologists do a residency in anesthesia, usually two to three years. And then, the pediatric anesthesiologist is distinguished by doing an additional year of some specialty, what’s known as fellowship training, specifically in pediatric anesthesia.
Bill: What is the difference then between a pediatric anesthesiologist and somebody who just administers to adults?
Dr. Siegel: Right. It’s a really important question. For parents that are listening that have that concern, let me see if I can give a good answer. The fact that there are pediatric anesthesiologists does not mean that someone who is not a pediatric anesthesiologist cannot take care of children. What we really need to distinguish between our anesthesiologist that may have a diverse practice and that they take care of children as part of their practice versus, perhaps, an anesthesiologist that never takes care of children, and compare either of those two to an anesthesiologist who either exclusively takes care of children or has special expertise in taking care of, again, not necessarily a healthy child but a child with special concerns, special needs, special medical issues, or medical problems, including very small children such as a newborn infant or even an infant that’s maybe only a few months of age.
Bill: Okay. What are some of the special considerations when administering anesthesia to a child?
Dr. Siegel: There’s a number of differences. Obviously, children are not just small adults. They have certain special needs that are dictated by their anatomy and their physiology. Those are things that a pediatric anesthesiologist or someone that practices a lot of anesthesia on children would be familiar with. There’s differences in things such as the amount of oxygen that an infant may need or the doses of the medications or the kinds or amounts of fluids that are administered. There’s certainly differences in the vital signs and the way that we assess the well-being of the child as compared to an adult. So, there’s any number of parameters that are going to be different. And again, even within the pediatric population, we distinguish between, let’s say, newborn infants, infants under six months of age, and perhaps toddlers up to two years of age. Even within the pediatric population, it’s multifaceted in terms of the care and the kind of care that’s administered.
Bill: So, even within anesthesiologists, there could be somebody that specializes in a baby that’s under six months old compared to a child that’s five years old.
Dr. Siegel: Okay. That’s a fair question. I think you’re hitting on, really, the best answer for parents that are concerned about providing anesthesia care for their child. I would say, for the most part, if you have as a particular example, an otherwise healthy five-year-old for a tonsillectomy, you can be comfortable if you know that the hospital that you are going to has anesthesiologists that frequently care for five-year-old children and are comfortable caring for five-year-old children. You do not have to seek out specifically a pediatric anesthesiologist. If you so choose to, obviously that’s within anyone’s right to do so. But it’s not necessarily a necessity. However, I would say, I think most people would agree that children under two years of age—certainly, children under six months of age, and without question, newborn babies and, certainly, premature babies or infants in the neonatal intensive care unit—probably, under most circumstances, a parent would want specifically a pediatric anesthesiologist caring for those children.
Bill: All right. Excellent. I think that’s really important. Your advice or your suggestion is then for children under two years of age, certainly under six months of age or certainly, premature babies, that’s where a pediatric anesthesiologist, you would say, that’s when you need to look for one of those, correct?
Dr. Siegel: I would say that’s where a parent might gain an additional level of comfort. In terms of the qualifications of the anesthesiologist, again, understanding that board certification or where someone trained are important factors, that’s not the entire picture. There are certainly anesthesiologists that did not go to a pediatric fellowship that have been taking care of children for years, especially perhaps in underserved areas, where they don’t have the luxury of having a pediatric anesthesiologist who may be very competent in taking care of these children. But as a broad rubric, yes, the qualifications that we’re talking about are the starting point where parents can start to look. To add to the picture, understand that things completely change when you go from an otherwise healthy child to a child with perhaps a severe illness or a severe injury or some kind of complex congenital or acquired disease or special syndrome or involved in complex surgery, or a situation where the child needs a high level of intensity care pre-operatively and post-operatively. Those are all going to be mitigating factors in terms of a parent’s decision to decide whether or not their local hospital or their regional hospital provides them with the level of comfort that they’re looking for if they have to look outside of that scenario.
Bill: Absolutely. Okay. Very, very good. As a parent, how shall I ask for a pediatric anesthesiologist? Is there something I should say or somebody I should look for? What should I look for in a hospital? Is there a way to find that out? As a parent, where do I go to find a pediatric anesthesiologist?
Dr. Siegel: There are two issues. One is asking the question. Two is what you do with the information when you get the answer. It’s probably not difficult to get the information as long you ask, whether it’s the website of the hospital or whether it means calling the department of anesthesia and asking to speak to someone. Or a great resource would be to ask the surgeon, especially the pediatric surgeon that we’re talking about. Especially, in today’s day and age of the Internet, I don’t think it would be difficult for most parents to find out about the facility of the hospital that they’re either thinking of using or that they’re looking for, and there’s certainly all kinds of resources regarding anesthesia on the Internet. To name a few, specifically for our discussion, there’s the American Society of Anesthesiologists; there’s the American Academy of Pediatrics that has a subdivision on anesthesia; there’s an organization known as SPA, which is the Society for Pediatric Anesthesia. All these websites will give information on what a parent is looking for and what criteria they should look for, under what circumstances. But in relatively straightforward or simplistic scenarios, again, ask the surgeon, ask the facility, go on the website. That’s certainly a starting point. Now, it gets a little more complicated if the parent doesn’t really know what to do with that information and whether or not they should be satisfied that their child is being well-cared for. And a parent can ask for each facility for each scenario what the criteria are that the institution has in terms of who takes care of the children in the operating room, because every institution has criteria that will determine which anesthesiologists are taking care of the children.
Bill: I got you. Okay.
Dr. Siegel: Again, to reiterate, certainly ask the surgeon who’s involved, and be ready with that question probably at the first visit, because the day of, when you show up at the hospital for tonsils or for your hernia repair, whatever it might be, is not the time to start saying, “Well, I want a board-certified pediatric anesthesiologist.”
Bill: Right. Okay. I got you. So, in our last minute here then, what would you say to the parents of a child who is about to undergo surgery and require anesthesia? What’s your best advice for them?
Dr. Siegel: Stay calm, because the children pick up on the parents’ anxiety. If the parents are anxious, if the parents are worried, if the parents are upset, the children are going to be even more so, and the children are going to know that there’s something up, that there’s something that they need to fear, that they need to be worried about. And the parents need to communicate with the children. Each to its own, but the parent really needs to—if the child can handle it—to explain to the child what’s happening. And certainly, don’t hide things from the child. Children don’t like to be surprised, and honesty usually works as long as it’s done gently.
Bill: Absolutely. Great advice, Dr. Siegel. Thank you so much for your time today. We really appreciate it. For more information on Saint Peter’s, please visit saintpetershcs.com. This is Saint Peter’s Better Health Update. I’m Bill Klaproth. Thanks for listening.