Introduction

Paediatric surgery encompasses a wide range of surgical pathologies based on the age of the patient (newborn to <16 years). Children <4 years old or with complicated pathologies and major medical co-morbidities are best managed in tertiary centres. Older paediatric patients with surgical conditions can be managed locally with medical paediatric advice. In children with a progressing surgical illness physiological derangement occurs rapidly and often without sufficient warning. Paediatric input is particularly important when managing the very ill and the very young. This applies particularly to newborns prior to referral/transfer to a tertiary surgical unit, who require cannulation etc. Inform the paediatric team early; their experience and practical skills will be invaluable. In the case of transfer to paediatric surgery tertiary referral units, clear communication is imperative to ensure they are adequately prepared for the child. Paediatric escort may be needed for safe transfer.

The parent

Can usually give important clues about a child's illness, especially the subtle changes of its early course. Children often give valuable clinical information which should not be ignored. History taking and examination in children requires patience, may not be in the usual order, and is best done with the parent and a paediatric nurse present. Consent for examination and procedures may be given by the mother or father (legally married) or a legal guardian. Further details on this are dealt with in the Consent and medico-legal considerations Chapter.

Fluid management

Careful fluid management is essential. Basic maintenance fluid requirements for infants and children can be calculated as below.