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1. What makes a paediatric neurodisability paediatrician?

A neurodisability paediatrician is a clinician who specialises in the assessment and management of children and young people with disabilities resulting from congenital or acquired long-term conditions, usually those that affect the nervous or musculoskeletal systems. These conditions can be static or progressive in nature.

Although they are involved in the diagnosing, the neurodisability paediatrician’s emphasis is in managing the complex comorbidities seen, targeting the patients’ rehabilitation and enablement. While working closely with local teams in the hospital and community (such as genetics, neurology, community paediatrics, surgical specialties and palliative care, as well as NGOs, education services and social care), they often provide specialist regional advice in a model of shared care.

At a tertiary level, neurodisability paediatricians have developed specialist skills within the neurosciences. This includes the assessment of motor and neurobehavioural disorders (e.g. attention deficit hyperactivity disorder (ADHD) and autism, and neurorehabilitation, and they often subspecialise in one or more of these areas.

2. A day in the life of a neurodisability paediatrician

By Dr Katherine Martin, Consultant in Paediatric Neurodisability in Nottingham

"The content of my working day varies enormously and no two days are ever the same! I have a range of clinics; general neurodisability in which I assess and follow up children with a wide range of conditions ranging from motor disorders (e.g. cerebral palsy) to ADHD and autism, taking in a variety of genetic and other syndromes along the way, my more specialist clinics such as medical tone management, botulinum toxin injecting lists, and a range of clinics held jointly with other subspecialties including neurosurgery, respiratory, neurology, orthopaedics and genetics – combined working is of benefit to everyone, especially the children and families, and provides excellent learning for professionals.

"The majority of non-clinic-based work is multi-disciplinary liaison which may be through team meetings, attending schools or in-reach to the acute hospital wards. Some of this work is planned, such as school review meetings, and some is more acute, for example if one of my patients is critically ill and important decisions about levels of support need to be made. I may have received results confirming a significant diagnosis for a child, such as a life-limiting condition, and want to bring the parents in to discuss this earlier than their planned next appointment with me. I am also one of the clinicians on our local out of hours palliative care rota, providing medical cover for the community nearing team supporting children with neurodisabilities who are at end of life at home.

"It can feel difficult to ever fully ‘switch off’ out of work when you are the lead professional for so many long-term patients with chronic and complex conditions. My colleagues and I take a keen interest in each other’s caseloads and encourage each other to hand over any ongoing issues coming up to periods of time away from work to support work-life balance.

"Another key skill is ensuring that actions and tasks are delegated to the appropriate team member, rather than trying to ‘own’ them all. This ensures that time and energies are channelled in the most efficient way for all professionals and helps to maintain an effective team around the child and family."

3. How and where to experience paediatric neurodisability in your early medical career

Just as paediatric neurodisability is a widely varying sub-specialty, exposure to relevant experiences can occur through a range of opportunities, not just by attending clinics and meetings that are designated specifically as ‘neurodisability’.

Our work with a particular child often begins in the neonatal period when concerns or risk factors are identified – you may find that a neurodisability paediatrician comes to meet with families of high-risk babies on the neonatal intensive care unit (NICU), or attends discharge planning meetings, and that by joining them you can get a flavour of our role in early life.

We are likely to be involved in supporting and planning the ongoing rehabilitation input around a child who has a new disability following acquired brain or spinal cord injury e.g. post central nervous system (CNS) infection/inflammation, tumour or trauma – either reviewing on the ward or attending planning meetings.

There is a lot of overlap between our work and some of the work of a community paediatrician – we may both see or share the care of children with a range of neurodisabilities – why not find out what happens in your local area? Similarly, we often manage the longer-term care aspects of children with complex neurological diagnoses and therefore much of our work runs alongside that of the paediatric neurologists. Involvement in the management of longer-term neurology inpatients will give you a flavour of some of the rehabilitation work we are involved in.

4. Applying to a paediatric neurodisability programme

Assessors will not expect applicants to have undertaken a formal paediatric neurodisability post as these are not widely available to core trainees. However all paediatricians in training will have relevant experiences from other posts, such as managing children with complex disabilities on the acute wards or being involved in discharge planning for a baby going home from NICU with ongoing additional medical needs, and you should be able to draw on these experiences in your application form and your answers at interview.

It is also anticipated that applicants will be able to demonstrate an interest in the advances in paediatric neurosciences (such as advances in diagnostics, emerging therapies and the challenges as well as the positives that these bring), possibly through reflections on clinical cases or through choice of courses or other continuing professional development (CPD) accessed.

Multidisciplinary working is at the heart of successful neurodisability management. Applicants are expected to show understanding of the roles of different team members, the qualities of a successful team and the importance of the child and family as key members of that team, and to demonstrate strong communication skills.

5. Information for paediatric neurodisability trainees

All members of the CSAC are more than happy to be contacted with queries about experience and training.

The British Academy of Childhood Disability (BACD) is the professional organisation for paediatricians and other professionals working with disabled children. They hold an Annual Scientific Meeting plus more frequent regional events. They also endorse the Paediatric Disability Distance Learning Course run by Sheffield Children’s Hospital. The BACD website has areas with information specifically for core trainees looking to train in paediatric neurodisability. The central contact email is bacd@rcpch.ac.uk, or you can look up your .

The British Paediatric Neurology Association (BPNA) also runs courses and events that will be of interest to trainees pursuing a career in paediatric neurodisability, including webinars about the application and interview processes for paediatric neurology and neurodisability training.

External links

To find out more about paediatric neurodisability, the CSAC recommend the following websites as useful resources: