Serving Alaska's Smallest Patients: Pediatricians care for the whole health of the state's children.

• Author: Simonelli, Isaac Stone

The bimodal nature of our state's healthcare system, pressure on pediatric specialists, and the rugged nature of the state are all challenges facing pediatricians who practice in Alaska.

"The way I heard it when I was a student was most healthcare providers walk into the pediatric floor and think it's the saddest part of the hospital, right? Because there are sick kids," says Dr. Monique Child of Polar Pediatrics. "Some of us walk in there and go: this is the best part--there are popsicles and stickers and kids get better."

Child points out that unlike many instances in adult medicine, children's bodies seem determined to heal themselves.

"The beautiful thing about kids and pediatrics is that if you're lucky, even when something is bad, like let's say a congenital heart defect or something's wrong with the heart, the whole rest of the body is working to get better," Child says. "When I was doing adult medicine, it sometimes felt like you tried to fix something with a heart by adding a medicine or doing something and the kidneys don't like it or the liver goes off line. And so you end up chasing your tail."

Complicated Communication

No matter where they work, one problem pediatricians are forced to troubleshoot is communication barriers. Children are often unable or have difficulty describing events or incidents that led to a medical issue or the severity of their pain or symptoms.

"We have to take into consideration the developmental stages of kids, which changes quarterly in the early years of life," says Dr. Wes Gifford, a pediatric hospitalist at Alaska Regional Hospital. "Understanding what they're able to do is extremely important for interpreting their clinical presentation. For example, a six-month-old infant with a noticeable head lag and inability to roll from their chest to back is abnormal and suggests developmental delay which itself can be a harbinger of many different neurologic issues from brain tumors to subclinical seizures to child abuse. This kind of assessment is not in the wheelhouse for an adult doctor."

Another issue pediatricians face when it comes to communication is that it's not just their patient they need information from; they also need to work with parents to get a full picture of the medical situation.

"It takes a lot of social skills to help parents feel comfortable with your recommendations and motivate them to comply with what you think is really necessary for their child. A big part of our job is to...