Pediatric Surgery: Why It’s Different

ScrivenRichard Scriven, MD
Pediatric Surgeon and
Pediatric Trauma Medical Director
Stony Brook Children’s Hospital

Children are small. They need smaller instruments, different medications, a very different way of communicating, and they are likely to live much longer than adult patients. Dr. Richard Scriven, Pediatric Surgeon and Pediatric Trauma Medical Director, explains how pediatric surgery and care is unique.

Children’s bodies are built differently
A 5mm laparoscopic instrument is not going to give the same results with a 1-2 lb. neonatal baby as a it would with a 200 lb. adult. A specialized pediatric team will routinely choose to use a 3mm instrument and that may not be available at a regular hospital. A child’s physiology is also very different from an adult’s—blood pressure, pulse, and respiration rates are all different. Children’s tissues may be biologically quite distinct from adult tissues too, as their bodies are still growing, so cancer treatments must also be adjusted for a child’s body. Because children are much more sensitive to the effects of radiation than adults, a pediatric specialist will try to minimize the number of tests they order. When a child falls off his or her bicycle, a battery of CT scans may seem impressive and reassuring, but those scans can cause major health issues years down the road. Specialized pediatric teams order the minimum number of scans necessary for an accurate diagnosis.

Children communicate differently
Babies, toddlers and children also communicate differently and need different levels of emotional support, along with their families. Although Dr. Scriven performs dozens of appendectomies a year, he acknowledges that, “this is often the most stressful thing that a family has gone through.” If a parent needs to have the diagnosis repeated five times, then that’s what Stony Brook doctors will do. Communicating with the family is a critical part of getting the child well. Pediatric doctors need to communicate at a different level.

Child Life Specialists
The reality is that hospitals with their unfamiliar environment and procedures, can be challenging for children and families. Stony Brook’s Certified Child Life Specialists work to make the child’s hospital visit more comfortable, anxiety-free, child friendly and, in many cases, fun. Child Life Services are most commonly used to familiarize children with the hospital environment and help patients cope with the stress that often accompanies hospitalization. In conjunction with an “ouch-less” approach to care, Child Life Specialists work with the multidisciplinary healthcare team to reduce anxiety and fear of pain. These trained professionals prepare children for treatment using age-appropriate education, and introduce a variety of coping techniques including guided imagery, relaxation and diversion. Sometimes a Child Life Specialist accompanies a patient to their procedure for support.

Life expectancy
As surgeons we also need to consider longevity. Most pediatric patients will live another 80 or 90 years, and children can heal really well, so repairs to young bodies must be built to last. The goal of pediatric surgery is a durable operation with minimal scarring, because most children are going to live for a very long time afterwards. Minimally invasive surgery, using tools designed specifically for young bodies, reduces the lasting impacts of surgery when that child becomes an adult. For Dr. Scriven it is the depth of auxiliary services, and the sheer number of pediatric doctors and surgeons that differentiates Stony Brook from smaller community hospitals. According to Dr. Scriven, “at a smaller hospital you are just not going to be able to access a specialist at 3 am. At Stony Brook you can.”

To make an appointment, call (631) 444-9400. To learn more about our pediatric surgery and all the services provided, please visit our website at:

More about Dr. Scriven

Dr. Scriven first joined Stony Brook Medicine in the 10th grade, wearing the volunteer brown jacket. He always wanted to be a pediatrician, but was fascinated by the surgical training, so he combined the two and now has what he considers to be the best job in the hospital. Dr. Scriven is celebrating his twentieth year with Stony Brook and he volunteers with the local fire department.