Community child health - sub-specialty

1. What makes a community child health paediatrician?

A community child health paediatrician is a doctor who has expertise in working with vulnerable groups of children and their carers. They also have a particular role with children who are 'looked after' or are in the process of being adopted. They hold clinics in a variety of settings, including schools, with an emphasis on continuity of care, and have strong skills working with multiple agencies, particularly with education and social care.

Community paediatricians have a vital role in planning and implementing local strategies to improve the health of all children in their area, including safeguarding policies and overseeing universal and targeted lifestyle programmes.

2. A day in the life of a community child health paediatrician

By Dr Emma Bradley Community child health paediatrician in Bristol

"No two days are ever the same. I carefully check my diary! We see children who are vulnerable either through disability or safeguarding concerns in a mix of clinics - Autism spectrum disorder (ASD) and Attention deficit hyperactivity disorder (ADHD) assessments or reviews, reviews for children with disabilities such as cerebral palsy, neurodisability, Down syndrome, and challenging behaviours, children in care, adoption, specialist paediatric gynaecology clinic for children with alleged historic abuse or medical genital conditions, child protection medical and special school clinics.

"We support acute safeguarding work alongside our multiagency colleagues, particularly social care and police. We closely work with multidisciplinary and multiagency teams – joint assessment clinics (ASD, neurodisability) attending team around the family meetings, safeguarding meetings and special educational needs (SEN) work.

"Community paediatrics is a great place to develop strategic leadership skills – there are lots of roles to shape local services such as designated doctors for special educational needs and disabilities (SEND) or safeguarding, and most consultants will lead on one or more areas to develop services that meet the population's needs. There are opportunities to manage teams and/ or develop your teaching interest. Children are often not top of the list of priorities in either local or national targets so our role in advocating for them is a crucial one."

3. How and where to experience community child health in your early medical career

Every region in the UK has a named CCH lead - they are listed on the CCH CSAC web page. If you would like to come and do a taster session then do get in touch with them and they will be able to facilitate this either in your base hospital or in a different department.

Most paediatric centres will have community paediatricians working alongside them so there are opportunities to get involved in most areas. You could use a study leave day to do this, which is a good way not to be spending a limited study leave budget.

When working in acute settings you can ask to attend discharge planning meetings, or other conferences about named patients to get some sense of the sort of work we do – thinking about the patient in their home environment – what are the challenges and how can we make this safe for them. Joining members of the multidisciplinary team (physiotherapy, speech and language, occupational therapy) would also be useful, and a way to see if you enjoy the multidisciplinary work which is at the core of our practice. Again you can do this with any age group.

You will be exposed to aspects of community paediatrics throughout your career wherever you end up, even in adult specialties a lot of the patients will be parents with responsibilities, so thinking about the impact of their condition on their ability to parent will be paramount to ensure child safety and for them to thrive.

4. Applying to a community child health programme

We recognise that not every trainee will have the opportunity to do a community post prior to applying for sub-specialty training. Therefore we are looking for transferable skills.

We suggest you look closely at the RCPCH application form for sub-specialty training and ensure that you are able to maximise your marks on this to enhance your chances of getting an interview. In doing this you will be able to demonstrate that you have the sorts of skills we need to shape you into a good CCH paediatrician – knowledge, experience, flexibility and adaptability, leadership qualities and tenacity.

When preparing for the interview – think about what makes a good paediatrician, and consider your experience to date – think about cases you have seen, key interventions, recent research in the field, and also the transferable skills you have e.g. leading a group outside work. Also, think about how you can tell us why you want to be a community paediatrician (and why community rather than similar specialities – be specific). Your interest for community paediatrics should come through to your interviewers! Talk to current community child health trainees if you are able to, and consider asking your educational supervisor for interview practice.

5. Information for community child health trainees

Each region has a CCH lead who will be your go-to person for local queries e.g. how training is organised in your deanery - this is on the CSAC info page. In addition, the CSAC members will always be happy to either help or signpost you with queries. Your training adviser should be your first port of call for queries regarding progression or anything that cannot be resolved locally, and the chair and deputy chair will be happy to help too.

CCH is a need specialty – there are not enough of us being trained to replace those retiring/reducing hours - therefore many departments will be carrying vacancies. The best way to find out is to make contact with the teams you are interested in working with and tell them you are approaching the end of your training and looking for a consultant post. Most departments will be delighted to hear from you and let you know what they may be able to offer and timelines. It can take time for a department to set up a consultant role so we suggest approaching them about a year before your CCT date to give them time to sort things out if they are able and allow you time to work on your CV to meet their needs.

External links

To find out more about community child health, the CSAC recommend the following websites as useful resources:

• British Association for Community Child Health (BACCH)
• Coram British Association for Adoption and Fostering (CoramBAAF)

BACCH's affiliate groups:

• Association for Paediatric Palliative Medicine 
• British Academy of Childhood Disability
• British Association for Child & Adolescent Public Health
• British Association of Paediatricians in Audiology
• Child Protection Special Interest Group
• Paediatric Mental Health Association
• George Still Forum