There is an old saying that every pediatric practitioner knows by heart. It is practically engraved on our foreheads the moment we choose a pediatric specialty.
“A child is not simply a small adult”
This maxim is based on a number of differences between the child and the adult. The most obvious is the potential for growth. A child is continuously growing up to the ages of thirteen to fifteen in girls and sixteen to eighteen in boys, and sometimes beyond. The growth is dependent on specialized centers in the skeleton and in other parts of the bodies which cause the cells to duplicate and then to reform in an enlarged or lengthened shape. The spine is no exception, having a very complex growth system for every bone in the vertebral column.
Other differences are less obvious. The bones (and other organs) are constantly reshaping and what we term remodeling. In other words, the shape of a young child’s leg bone may be quite different than the same bone in the same child when she is older and may be more different still when she is a grown woman. This allows the bones to take on different functions that the child needs at different ages, whether it is learning to walk at one year old or fine tuning a soccer free kick at fifteen.
The least obvious but probably most important is the psychological difference between a child and an adult. The child as she grows is becoming aware of the world about her for the first time. She is taking new challenges and partaking new experiences that she will assimilate into her ‘adult’ view of the world. But until adulthood (and often beyond) that development of character is a work in progress. One can never anticipate the child’s or the adolescent’s response to a given problem.
So why has the medical community developed specific pediatric specialists that work with and specialize in treating children exclusively? It is because our training allows us to accommodate for the surprises that the child will hand us during the course of her care. Pediatric specialists are particularly good at hitting curveballs.
We also have knowledge and experience in anticipating the changes that a child will undergo in the course of her life. Our treatments are often geared not only towards the ‘here and now’ but also towards the future.
But this experience and expertise is developed, as with anything, only by specialized training and long practice. One can’t dabble in pediatric treatment – treating fifteen year olds at one moment and eighty year olds at the next. The differences in the treatment, the approach and the care are far too great to allow any sort of smooth transition.
Now turn the question around. Why did I choose Pediatric Spine? I completed a pediatric orthopaedic fellowship and have a practice that is exclusively children. Although I treat all problems, well over half of my practice is devoted to the care of pediatric spinal conditions. I find the problems compelling, challenging and extraordinarily rewarding. The spine is the central support of the child and problems in it cause central problems in a child’s life – whether these are issues with school or work or issues with the more complex social world of the growing child.
In the pediatric spine, we never are doing salvage work. We never are settling for accepting pain or accepting a status quo that is unacceptable to the patient. And because of the unique nature of the pediatric spine our range of treatments are far greater and more effective than those for the adult population – I will write much more on these topics as this blog develops.
So why did I choose to specialize in the pediatric spine? It is expressly because children are not just small adults. With every overreaction and moment of drama, they bring moments of serenity and composure and boundless energy that make treating them an n endless source of challenge and joy.