Paediatric sub-specialty glossary
Positions and variety in paediatrics
The majority of paediatricians work as general paediatricians in district hospitals looking after babies and children with both short term (acute) and longer term (chronic) illnesses.
Paediatricians also work outside of hospitals in the sub-specialty, community child health, with children who have disabilities or other special needs, or with general health issues such as immunisation and allergies.
A number of paediatricians will sub-specialise in one of the 16 sub-specialty areas of paediatrics and will become an expert in that area within hospitals.
This is the largest group of paediatricians. General paediatrics is the care of children in hospital. Sick children can have simple or complex diseases and the paediatrician needs to know how to manage these independently or by working with other colleagues.
Routine work includes seeing children in outpatients departments, emergency work on the wards or tending to sick babies in special care baby units. Other tasks are teaching and training, administration (such as writing letters and reports), talking to families and working closely with other health professionals.
General paediatricians also often have a special interest in a certain area of paediatrics and/or lead on certain areas of training and education.
Paediatric sub-specialties (with the exception of Community Child Health) require competitive entry as not all posts are available in all deaneries, for all trainees who want to complete their training in a sub-specialty. Entry to sub-specialty posts is through what is known as the NTN grid.
Neonatal Medicine (Neonate means a baby under four-weeks old):
While most hospital paediatricians look after sick newborn babies in special care baby units, neonatologists specialise in the care of the sickest and most premature babies in neonatal intensive care units. There tends to be one such intensive care unit covering for five or six local hospitals, often in teaching hospitals.
Community Child Health:
Community Child Health is the care of children outside hospital. It is rewarding and challenging - every day is different. Community paediatricians see children as outpatients for a variety of reasons and their patients can include children with long-term disability (eg cerebral palsy, learning disability), children with mental health issues (eg autism and ADHD), children who it is feared are being abused, or children who are being fostered and adopted. They also take responsibility for advising on the health of communities. Some community paediatricians work in the highly specialised area of audiology, looking after children with severe hearing loss.
Child mental health:
A developing specialty that allows clinicans to work in a variety of settings and deal with a range of issues relating to the mental health and wellbeing of children. Work may include chronic medical conditions, neuropsychiatric disorders, substance misuse or eating disorders.
Clinical pharmacology and therapeutics:
A small speciality dealing with how medicines effect children, and how doctors should use them. This includes working out the right dosage for a child and looking at the side effects and overall effectiveness of children's medicines.
Diabetes and endocrinology:
This specialty involves treating children and young people with illnesses linked to their hormones (endocrine system). This system regulates metabolism, growth and development. This area of paediatrics treats children with conditions such as diabetes and the much rarer hormonal problems of childhood, such as growth failure. All local hospitals will have one or two general paediatricians who look after children with diabetes.
Another growing area of paediatrics, dealing with the care of children needing immediate treatment in Accident and Emergency departments.
Gastroenterology, hepatology and nutrition:
Gastroenterology is the management of children with problems in the digestive system, such as the stomach and the intestines. Hepatology is the study and treatment of liver disorders. Nutrition is important as some children need special diets in order to manage their condition. A good example of this is Crohn's disease (see www.crohns.org.uk for further information).
Immunology, infectious diseases and allergy:
This deals with infectious diseases and their effects on the child, which can be complicated by the child's immune system (how the body defends itself) and whether it can work against the disease or infection. HIV and Aids are major parts of the workload. It also covers children who experience severe allergic reactions.
Inherited metabolic medicine:
This area of paediatric medicine is a developing, but highly specialised, area, which deals with children with Inborn Errors of Metabolism (IEMs). IEMs can present at any age, but most commonly shortly after birth or in childhood.
Dealing with problems in the kidneys and urinary system, including kidney transplantation and dialysis (helping the kidneys remove waste products from the blood.)
A growing area of community paediatrics, dealing with children with life-long neurological problems such as cerebral palsy or after brain injury
The care of children with problems in their nervous systems, such as epilepsy or difficulty with movement.
The treatment of children with cancer such as leukaemia and tumours. A doctor who specialises in cancer is called an oncologist and they are concerned with the diagnosis, development, treatment and prevention of the disease.
Paediatric Intensive Care Medicine (PICM):
This area of work is based in Paediatric Intensive Care Units (PICU). It is the care of the very sickest children in regional units. Many have to stay in hospital for long lengths of time and may not recover.
Palliative medicine is the active total care of terminally ill children and young people and their families. Care is usually provided within a clinical setting and involves general medicine, oncology and management of symptoms along with therapeutics and psychological management. Work in this area may lead to consultant positions in paediatric palliative medicine in independent hospices, cancer centres or units and community services, or a combination of all three.
This deals with problems with breathing and the lungs, which includes conditions such as severe asthma and cystic fibrosis.
The care of children with rheumatic diseases involving a broad spectrum of conditions, including inflammatory arthritis, vasculitis, and hypermobility syndromes. Rheumatologists work within multidisciplinary teams delivering holistic care for children with chronic illnesses and provide transitional care for adolescents. This is an exciting specialty with rapid advances in research and development of new treatments translating into improving outcomes for children with rheumatic diseases. For further information on 'a day in the life of a paediatric rheumatology trainee' and training in paediatric rheumatology please consult the website for the British Society of Paediatric and Adolescent Rheumatology.
These associated medical specialties still involve working with paediatric patients and are an important part of the paediatric multi disciplinary team but training is not supervised by the Royal College of Paediatrics and Child Health.
Child and Adolescent Mental Health (CAMHS):
For more information about training as a child psychiatrist see the Royal College of Psychiatrists. Since chronic illness inevitably has an effect upon mental health there is an element of this in all paediatricians' work, and many undergo additional training provided by the RCPCH for this purpose.
This is the management of heart problems in children and young people. This still tends to be a sub-specialty of (adult) cardiology rather than paediatrics and the training is supervised by the Royal College of Physicians.
The surgical treatment of diseases, trauma and malformations of childhood years which encompasses the foetal period to teenage years. Specialist areas include: neonatal surgery, urological surgery, hepatobiliary surgery, GI surgery and oncological surgery. Completion of core surgical training is required before pursuing paediatric surgical training. For further information visit the Royal College of Surgeons.
Diagnosing and managing genetic disorders will inevitably involve working with children and their families in this fascinating and expanding medical specialty which is available via the Royal College of Physicians.
Skin disorders and diseases require skilled diagnosis and treatment / management, which is the role of a dermatologist. A dermatology physician will work with patients from all age ranges, including children and young people. Paediatric dermatology is not available as a paediatric sub-specialty, although a paediatrician may have a specialist interest in this area. Training in dermatology is offered through the Royal College of Physicians.
A radiologist uses imaging techniques to diagnose, treat and monitor a huge variety of diseases and injuries. It is possible within radiology training via The Royal College of Radiologists to pursue a special interest in paediatric radiology.
This medical specialty deals with hearing and balance disorders, working with children and adults. Some community paediatricians may have a particular interest in this area but the full training programme is available from the The Royal College of Physicians
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