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Pediatric General Surgery Referral Guidelines
A pediatric surgeon has completed a 5-year residency training n general surgery, plus a 2-year fellowship in pediatric surgery. He or she is certified by the American Board of Surgery in both General Surgery and in Pediatric Surgery. For purposes of developing these guidelines, the following age group definitions are used: infant (0-1years), child (2-12 years), and adolescent (13-18 years).
l Patients 5 years or younger who may need surgical care should be cared for by a pediatric surgeon.
l Infants and children with perforated appendicitis should be cared for by a pediatric surgeon. If a nonpediatric surgeon makes the diagnosis or suspects the diagnosis of perforated appendicitis in a child, the child should be transferred to the care of a pediatric surgeon.
l Seriously injured infants and children may be stabilized at a local hospital and then should be transferred to a pediatric trauma center.
l Infants, children, and adolescents with solid malignancies should be cared for from the outset by a pediatric surgeon or pediatric surgical specialist and a pediatric medical cancer specialist.
l Minimally invasive procedures (eg, laparoscopy, thoracoscopy) in infants and children should be performed by a pediatric surgeon trained in these techniques.
l Infants and children with medical conditions that increase operative risk (eg, congenital heart disease) who must undergo a common surgical procedure (eg, hernia repair) should be cared for by a pediatric surgeon.
In the interest of good patient care, it is suggested that a general surgeon who cares for pediatric surgical problems not listed in the above categories should have had a minimum 6-month rotation as a junior or senior resident during his or her general surgical residency on a pediatric surgical service run by a pediatric surgeon. Emphasis in the training rotation should be on surgery of children older than 5 years.
A general surgeon performing surgery on children not listed in the above categories should care for a sufficient number of children annually to maintain a high level of competence, and should annually attend pediatric surgery postgraduate courses and meetings.