Pediatrics offers a career in a stimulating, challenging and rewarding area of Medicine. It is one of the richest in scope and variety, since it contains within it a microcosm of almost the whole of medicine, ranging from the ‘high-tech’ areas of Pediatric and Neonatal Intensive Care to the holistic approach necessary in the management of a disabled child, from the organization of preventative services in the community to the intensive treatment of a child with cancer. From the pre-term infant to the difficult adolescent the Pediatrician focuses on the child and the family, working to minimize the adverse effect of disease and to allow the child to live a normal life.
Pediatricians work closely with other related medical specialties such as Obstetrics, Anesthetics, and Surgery. They also work closely with other professionals such as Physiotherapists, nurses and Speech Therapists, as well as teachers and Social Workers; the concept of multidisciplinary teams is well advanced, providing an integrated package of care for the child and a stimulating and enjoyable environment in which to work.
Pediatric nursing has evolved dramatically over the past two decades; in particular the Pediatric Specialties have emerged, closely allied to Academic Pediatrics. Community Child Health, with its focus on prevention and the broader issues of health within the whole childhood community has become an important part of the responsibility of Pediatricians. While General Pediatrics remains the bedrock of the service there has been a recent trend towards more integration of the service, both between community and hospital and between secondary and specialist services. Pediatrics has finally come of age as a specialty on an equal footing with the other main specialties: in 1996 we finally achieved our own Royal College.
As you can see Paediatric nursing offers scope for a wide variety of careers to suit all tastes. Consultant paediatricians working in local hospitals generally develop a special interest in addition to their general paediatric and neonatal commitments. Those in teaching hospitals and regional referral units are more likely to be full time in a single speciality though many retain a general paediatric commitment; they may have a shared academic and clinical post. Consultants working in the community are increasingly involved in specialities such as disability or child protection.
General pediatricians treat most children requiring admission with acute illness. Acute management of ill children in hospital sometimes requires intensive therapy; the rapid recovery characteristic of children is a pleasant reward for involvement in a busy on-call responsibility. Outpatient referrals for medical opinions in children are seen in general paediatric outpatient clinics. The range of illnesses seen by the general paediatrician varies from the common problems of infancy such as feeding difficulties, failure to thrive or behavioural difficulties, to the diagnosis and long term management of more serious acute and chronic childhood illnesses such as severe asthma, cystic fibrosis, diabetes, epilepsy, juvenile arthritis, gastro-intestinal disorders and cancer. In larger districts a Paediatrician who has developed a special interest in that arena will manage these conditions. The Paediatrician often acts as a coordinator of care for a child with complex problems, and is in a good position to assess the importance of social and psychological issues in the causation of illness, as well as the impact of illness on the life of the child and family.
Care of the newborn is another responsibility for many general paediatricians. Larger DGHs may provide intensive care for the sick neonate, but smaller units will refer such babies to the nearest Neonatal Intensive Care Unit for a period. General paediatricians may also care for children with physical or learning difficulties and may undertake paediatric work outside hospital in the local clinics or schools. For more complex problems care of patients is often shared with specialists in the local Tertiary unit.
There are a large number of paediatric specialities covering similar subjects as in adult medicine, with additional areas such as neonatal and developmental medicine. Specialist paediatricians concentrate on a narrower field and often carry out more research than their general paediatric colleagues. They see referrals from the local hospitals and often the care of the child with complicated illnesses with the referring paediatrician. Because the number of such patients is small the paediatric specialists cover a wide area and are usually based in University teaching hospitals where specialised equipment, therapists and clinical and research laboratories are sited. Being a paediatric specialist does not mean that the important aspects of caring for the child and family are forgotten: this is an important responsibility and requires that these doctors must have wide experience in the care of children as well as in their speciality.
Community Pediatricians cover a wide range of roles; on one hand they often work as part of the general Paediatric team, often concentrating on clinical areas such as neuro-disability and child protection. Some work at the interface between Health and Education or Social Services while others organise district services such as Prevention and surveillance programmes for children working closely with general practitioners, health visitors and school nurses. Some consultant paediatricians with a special interest in this field may work full time as community paediatricians, while others work as members of a general pediatric team.