Information for Core Paediatric Trainees

What does a paediatric neurodisability doctor do?

We work with children and young people with developmental problems and disabilities, resulting from both congenital or acquired long-term conditions. This includes, but is not limited to, children with motor disorders (e.g. spinal cord problems, neuromuscular problems, cerebral palsy), learning disabilities, acquired brain injuries, neurodevelopmental disorders (e.g. autism, ADHD), hearing or visual problems, and genetic conditions.

In collaboration with a multi-professional team we assess and manage these complex medical problems and the many co-morbidities that go alongside them (e.g. disorders of tone and posture, epilepsy, feeding difficulties, mental health difficulties, etc.), with an overall focus on promoting the best possible participation and quality of life, as well as support and advocacy for the child and family. Close working with other paediatric sub-specialties is also really important, such as such as neurology, genetics, palliative care, respiratory, gastroenterology, orthopaedics and child psychiatry. We also work closely with the education sector (we often see children in school, and provide advice to the local authority about the needs of our children) and the social care sector (the complex medical needs of our children mean that they often need housing adaptions, respite care, help coordinating services and, sadly, safeguarding problems are even higher in our population than in typically developing children).

The set-up of neurodisability services varies a lot by region. Some regions have specialist neurodisability doctors, whilst others have community paediatricians who fulfil this role. Most neurodisability teams work in community children’s centres or hospital outpatient settings, although some are based in tertiary neuroscience centres and often working closely with paediatric neurology services. Your regional BACD representative will be able to explain how your local neurodisability service and regional network are set up.

There is a large overlap between the groups of patients we care for between paediatric neurodisability, community child health and paediatric neurology, as well as a number of differences between the sub-specialties - please see our Specialties Comparison Table for more information.

What do people who specialise in paediatric neurodisability say about their careers?

The things that we enjoy about neurodisability as a career are:

• The children and families we work with are amazing and it is great to feel that we can make a difference to their lives. We get to know them really well, often involved from when they are a baby to when they move to adult services. 
  
• Our workload is varied – in a day we can see a 3 month old with Down’s syndrome, a 4 year old with autism and a 16 year old with cerebral palsy, each can be in a different setting (clinic, special school, ward etc) and each will have individual needs to consider.
  
• There is the opportunity to work in a variety of settings and develop a range of specialist interests; some neurodisability paediatricians work in a tertiary setting and have specialist skills such as tone and postural management or neurorehabilitation, and others work in secondary care for example in local child development centre and see children with a wide variety of conditions.
  
• Our colleagues are almost universally really nice people (!!), which makes for a fantastic team environment. We work closely with colleagues within a multi-disciplinary team so we can provide holistic care for the child and family, and we can continually learn from each other. It is a challenging job but very fulfilling, with great support from colleagues
  
• As the specialty is largely outpatient based, working hours are generally better, which makes it more family friendly (although some consultant posts will require you to contribute to the child protection on call rota, acute paediatrics on call rota, or sub-specialty out of hours work such as palliative care).

Visit our member stories to hear more about why some of our colleagues chose neurodisability as a speciality.

How do I become a paediatric neurodisability doctor?

• Most trainees who want to specialise in neurodisability apply for a sub-specialty (formerly known as ‘GRID’) training post in Paediatric Neurodisability or Community Child Health during their ST4 year (applications open in the autumn each year). 
  
• It is possible to apply for sub-specialty posts at later points in training if you have relevant experience (see RCPCH website for further information), and this is particularly something to consider if you are less than full time.
  
• Neurodisability sub-specialty training is 36 months long (typically ST5-ST7), usually 24 months neurodisability (include 3 months CAMHS) and 12 months paediatric neurology, but how these placements are coordinated varies between deaneries. 
  
• During sub-specialty training, 70% of your time will be spent in your sub-speciality and 30% in general paediatrics (contributing to the on call rota). You have to complete both the ‘Generic Specialty Level’ syllabus and the sub-specialty syllabus, for example ‘Paediatric neurodisability sub-specialty syllabus’, evidenced through an e-Portfolio.
  
• If you are keen to have a greater academic and research focus during training or gain experience of clinical research in paediatric neurodisability, the BACD Strategic Research Group would be delighted to hear from you. 

What experiences should I seek out if I am interested in a career in neurodisability?

To explore whether neurodisability is right for you, some of the following activities and experiences may be helpful. And for those applying for paediatric neurodisability sub-specialty training, being interested and motivated are the most important qualities, but thinking about the following will help show you have taken the time to understand the specialty.

• During general paediatric rotations seek out children and families with disabilities on the ward and speak to them about their journey so far. 
  • Attend complex patient/MDT meetings or discharge planning meetings for patients with complex disabilities, think about what the child and family’s needs are. 
  • Attend physiotherapy, occupational therapy and speech and language sessions for disabled children. 
  • See patients admitted following a significant head injury and finding out about what the follow up pathway is like. 
  • Look at Emergency Health Care Plans of children presenting acutely and consider what some of the important issues are when writing these plans.
  • Spend time with the Epilepsy Specialist Nurse to gain experience of discussing a new diagnosis of epilepsy, or emergency seizure management with families.
  • Attend outpatient clinics including community, neurodisability, genetics and neurology. 

• During your neonatal placements look to:
  • Attend developmental follow up clinics 
  • Observe physiotherapy assessments, both inpatient and outpatients
  • Contribute to a discharge planning meeting for a baby with complex needs and reflect on the roles of professionals involved
  • Be part of discussions with parents antenatally and during admission about potential neurodevelopmental outcomes of prematurity, following hypoxic ischaemic encephalopathy or cranial ultrasound scans.

• During community placements consider:
  • Spend time with therapists (physio, OT & SLTs). 
  • Ask a speech and language therapist to show you different types of alternative and augmentative communication a child may use. 
  • Spend time in a special school and think about what information to include in a child’s Education, Health and Care plan. 
  • Consider when an Emergency Health Care Plan is appropriate and what information to include. 
  • Look to attend a range of clinics including tone and postural management, autism diagnostic assessment, feeding clinics and complex disability clinics.

Let colleagues know that you are interested in disability; supervisors will be link you up with local neurodisability teams and support you to do relevant audits or quality improvement projects, training programme directors may be able to give you relevant training posts.

Look to attend relevant courses and conferences: the BACD Annual Trainee Meeting is held in the winter each year and BACD Annual Scientific Meeting in the summer. The Neurodisability Community (TNC) runs monthly webinars on topics aimed at sub-specialty trainees but are open to everyone. Make contact with your BACD regional representative to hear about events locally that may be of interest.

You might want to consider undertaking the BACD endorsed Child Development & Disability Essentials online course, aimed at core paediatric trainees and mapped to the RCPCH Progress+ curriculum, with a wealth of information on childhood disability and produced by experts in the field.

You could also look at events organised by the British Paediatric Neurology Association (BPNA), Association for Paediatric Palliative Medicine (APPM), British Association for Community Child Health (BACCH) and CoLab Partnership. There are free e-learning modules available from Disability Matters and you can complete an introductory unit of the Paediatric Neurodisability Diploma. 

Consider submitting an abstract for the BACD Annual Scientific meeting or the BACD session at the annual RCPCH conference – it may be selected for a poster or oral presentation! If you are interested in research, get in touch with the BACD Strategic Research Group for more information.