When a child is diagnosed with a medical condition, the impact on a family is profound. Parents face emotional, financial, and physical stress, often compounded by guilt and uncertainty. Many families hesitate or delay treatment when surgery is recommended. Yet medical guidelines and decades of data show that timely surgery can directly influence a child’s long-term prognosis.
As a paediatric surgeon, I often remind parents: the earlier we identify and address a problem, the better the outcomes for the child.
Adapted from Sin Chew Daily (Original Chinese article, 10 September 2025) – VIEW HERE
Insurance and Financial Realities in Child Healthcare
The rising cost of healthcare in Malaysia has led many expectant parents to purchase maternal and child insurance. While such policies can ease financial pressure, they are not a guarantee. Insurance coverage often comes with conditions and restrictions, and many parents only discover limitations when making a claim.
A recent case in Perak highlighted this issue — a mother expecting insurance coverage for congenital disease treatment discovered her claim fell short due to the policy’s fine print. This reminds all parents to carefully review insurance terms before purchasing and ensure they undergo recommended prenatal screenings.
The Value of Prenatal Screening
Prenatal screening plays a crucial role in safeguarding both mother and child. Modern diagnostic tools — ultrasound, foetal echocardiogram, and non-invasive prenatal testing (NIPT) — allow structural defects to be identified early.
With this knowledge, doctors can plan whether the condition requires postnatal intervention or simple monitoring.
Conditions Detectable Before Birth
Fetal Hydronephrosis (Renal Swelling)
This condition is often due to obstruction in the urinary tract or reflux of urine from the bladder. In most cases (over 90%), the swelling resolves on its own, but severe cases require early surgery to prevent infections, kidney damage, or even life-threatening complications.
Choledochal Cyst (Bile Duct Dilation)
This rare condition can be detected on prenatal ultrasound. Surgery is usually required soon after birth to prevent jaundice, infection, stones, or bile duct cancer later in life.
Conditions Often Found After Birth
Some abnormalities are only detected after delivery.
- Esophageal Atresia – where the food pipe does not connect properly to the stomach, causing choking or pneumonia risk.
- Hirschsprung Disease (Megacolon) – caused by missing nerve cells in the intestine, leading to constipation, vomiting, and abdominal swelling. Treatment often involves staged surgery.
Why Minimally Invasive Surgery is Transforming Paediatric Care
Advances in laparoscopic and thoracoscopic (keyhole) surgery have revolutionised paediatric treatment.
- Smaller incisions and faster recovery mean children spend less time in hospital.
- Minimal scarring – often invisible by adulthood.
- Reduced risk of scoliosis – especially after chest surgery, where open techniques can cause internal scarring and muscle imbalance.
When Should Surgery Be Performed?
Not every abnormality detected before birth requires immediate surgery after delivery. In fact, most procedures are best performed around six months of age, when the child’s body is stronger and anaesthesia is safer.
However, there are exceptions:
- Emergency situations such as kidney obstruction or an acute hernia require urgent surgery.
- Undescended testes – the international standard is surgery at six months to preserve fertility and reduce cancer risk. Delaying surgery beyond puberty significantly increases risks.
The Challenge: Few Minimally Invasive Paediatric Surgeons in Malaysia
Paediatric surgeons are already few in number, and those specialising in minimally invasive surgery are rarer still. Complex operations like duodenal atresia, esophageal atresia, choledochal cyst repair, and lung malformation correction require advanced skill — often performed within a space the size of a matchbox.
Despite the challenges, these procedures offer enormous benefits: faster recovery, improved organ development, and reduced hospitalisation.
The Surgeon’s Role: Observation, Perseverance, and Lifelong Care
A paediatric surgeon’s responsibility does not end in the operating theatre. Detecting subtle signs, ensuring accurate diagnosis, and providing long-term support are just as important.
For example, a simple urinary tract infection in a baby may be a warning sign of a deeper structural problem. Further investigations such as a voiding cystourethrogram (VCUG) may reveal issues like reflux or anorectal malformation, which require timely intervention.
Equally important is long-term follow-up. I often spend extended time with families after surgery, helping children adapt to daily life, coaching parents on care, and offering psychological support well into adolescence.
Parents’ Concerns and Real Stories
It is natural for parents to fear surgery at a young age. However, unnecessary delay can be dangerous.
One child with an inguinal hernia was denied surgery despite medical advice. Months later, he was rushed to the emergency room with life-threatening complications. Fortunately, he survived, but such risks can often be avoided with timely intervention.
On the other hand, many parents who followed through with treatment are now grateful their children can live normal, healthy lives.
Financial Burden and Insurance Considerations
Paediatric surgery can be expensive, especially in private hospitals — with intensive care costs reaching up to RM10,000 per day. However, treatment options are available:
- Government hospitals offer subsidised care.
- NGOs and charities may provide financial support.
- Maternal and child insurance can offset some costs, but only if policies are properly understood and prenatal tests are done.
It’s also worth noting that insurance companies in Malaysia now offer maternal and child health insurance policies, providing parents with an alternative and eliminating the need for medical assistance. Insurance can also cover some medical expenses if necessary, but I would caution parents to carefully read the fine print when purchasing such insurance and to ensure they have all the necessary prenatal testing, including non-invasive chromosomal testing (NICC) or NIPT, and fetal detailed scans.
Conclusion: Early Detection and Minimally Invasive Surgery Change Lives
If there is one key message for parents, it is this: do not delay when abnormalities are detected. Early diagnosis and treatment, especially with minimally invasive surgery, can dramatically improve a child’s quality of life.
As one of the few paediatric surgeons in Malaysia specialising in minimally invasive surgery, my mission is to provide children with the best possible outcomes and to mentor the next generation of surgeons so that more families can benefit from this life-changing approach.
