Guidelines for Referral to Pediatric Surgical Specialists

Abstract

The Surgical Advisory Panel of the American Academy of Pediatrics (AAP), in response to a recommendation from the AAP Subspecialty Work Group and with the collaboration of the Surgical Sections of the AAP, has created referral guidelines intended to serve as voluntary practice parameters to assist general pediatricians in determining when and where to refer their patients to pediatric surgical specialists. It is recognized that the guidelines here may be difficult to achieve. Communities vary. Specialties overlap, and more than 1 type of pediatric or other surgical specialist may be qualified to manage a particular problem. Many complex pediatric problems are optimally managed by a medical-surgical team rather than an individual surgical specialist. This does not negate the value of the guidelines, however, because the child who needs specialized surgical care is best served by the skills of the appropriate pediatric surgical specialist. Major congenital anomalies, malignancies, major trauma, and chronic illnesses in infants and children should be managed by pediatric medical and surgical specialists at pediatric referral centers. Such centers dedicated to children can provide expertise in many areas, including the pediatric medical and surgical specialties, pediatric radiology, pediatric anesthesiology, pediatric pathology, and pediatric intensive care. The optimal management of the child with complex problems, chronic illness, or disabilities requires coordination, communication, and cooperation of the pediatric surgical specialist with the child’s primary care pediatrician or physician. When a surgical condition has been identified, ideally, a pediatric surgical specialist should be called to address the issues related to this condition with the family and the respective pediatrician. In rural areas where it would be a hardship to the family and the child to travel long distances, the family in conjunction with the primary care pediatrician/physician should weigh the advantages of traveling to a center with a pediatric surgical specialist …