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Introduction

A successful MDT is dependent on clear paths of communication and ensuring that the contributions of all members of the team are equally valued. When done well, this enables an integrated and coordinated approach to support the child and their family. Paediatric MDTs work both within a hospital or community setting.

As a paediatric nephrologist, I know that myself and my colleagues would not be able to deliver the highly specialised service without our brilliant MDT. From our innovative home therapies team who train families to confidently deliver dialysis to children at home, to our dietitians who ensure our children thrive and our play specialists who prepare children for major operations and to swallow tablets, everyone plays a vital role. Being part of a team also makes me feel valued at work and was key to my decision to become a paediatrician

Dr Kay Tyerman, RCPCH Officer for Workforce Planning

Who is involved?

The members of an MDT will vary from patient to patient and between sub-specialty areas of care, depending on the child’s condition and individual needs.

We asked some paediatricians to tell us the professions that were members of their MDT, and below is that list. Click to see more about each role that is often in a paediatric MDT.

Paediatrician

Paediatricians are medical doctors who treat infants, children and young people. They range from trainees starting their paediatric journey to SAS doctors working at all levels, locally employed doctors, and consultants who are the senior leaders in teams.

Some are general paediatricians and work across the full breadth of child health. Others are experts in a particular sub-specialty, of which there are many, including community paediatrics, intensive care, respiratory medicine and oncology - see the full list of sub-specialties.

Some children will have a general paediatrician and other specialty paediatricians in their MDT.  

Clinical pharmacist

Paediatric pharmacists are experts in medications and prescribing. They are fundamental to ensure that prescribing for children is both safe and effective. They provide advice about optimum drug choices to be used in a given clinical situation, the potential side effects of medications and any required drug monitoring.

Pharmacists also carry out structured medication reviews for patients with ongoing health problems and collaborate with the patient and their parents to deliver education and improve compliance. This education may involve supporting children to swallow tablets and advice to families on how to store medications at home.  

Paediatric nurse

Paediatric nurses have completed a degree in children’s nursing. They work in varying care settings such as an emergency department, acute assessment unit, general paediatric ward, neonatal unit, sub-specialty ward or outpatient setting.

Clinical nurse specialist

Clinical nurse specialists are expert nurses with specialist skills and knowledge in a particular area, such as paediatric rheumatology or paediatric gastroenterology.

They provide education and training, alongside practical and emotional support. They may be a patient’s key worker (a point of contact) through treatment. 

Paediatric advanced clinical practitioner

Paediatric advanced clinical practitioners are health practitioners, such as a nurse, pharmacist or occupational therapist, who are educated to a Master’s level or equivalent. They can assess, diagnose and initiate treatment in children and young people within their scope of practice. They may also take on key roles in leadership, management, governance, research and education.  

Paediatric advanced nurse practitioner

Paediatric advanced nurse practitioners are nurses who are educated to Master’s level. They have expertise in a specialist area which enables them to assess, diagnose and initiate treatment for children and young people.

Physician associate

Physician associates (PAs) are often graduates in bioscience or other areas who have subsequently completed a two-year postgraduate programme to qualify as a PA. They can support doctors in the assessment of children, carrying out procedures and ordering investigations as well as completion of administrative tasks.

At present, they cannot prescribe medications and they cannot order investigations that deliver ionising radiation.

The PA is a relatively new role within a paediatric MDT. See more on our page about PAs.

Dietitian 

Paediatric dietitians are trained to provide specialised nutritional care to infants, children and young people taking into account their age, condition and growth requirements. They may have specific areas of expertise for certain conditions, such as kidney disease (renal dietitians). 

Play therapist

Play is an essential part of childhood. Play therapists are specially trained to use play to promote development, promote recovery and to reduce anxieties and worries. They can also help children understand medical procedures and use distraction and therapeutic play to manage painful procedures.  

Clinical psychologist

Clinical psychologists aim to reduce psychological distress and enhance the promotion of psychological well-being. They also help children and young people manage the challenges of their condition, or families adjust to a new diagnosis or circumstance.

Physiotherapist

Paediatric physiotherapists help children whose movement and development is affected by injury, illness or disability through movement, exercise, manual therapy and advice. They are experts in child development and work collaboratively with children and their families to maximise a child’s physical abilities and independence.

Occupational therapist

Occupational therapists support children and young people to carry out the activities that they need, want or are expected to do, but that are challenging due to impairment, injuries or developmental conditions. They are an integral part of rehabilitation programmes. They often provide equipment to maximise a child’s function. 

Speech and language therapist

Speech and language therapists help to assess and manage children and young people who have difficulties with communication, eating, drinking and swallowing. 

Surgeon 

Surgeons are doctors who are trained to undertake surgery, usually on a specific part of the body. This includes orthopaedic, general surgery or ENT (ear, nose and throat) surgery.

Radiologist

Radiologists are doctors who are trained to interpret and direct the use of medical imaging such as X-rays, Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and ultrasounds to help diagnose and treat diseases and injuries. 

Diagnostic radiographers

Diagnostic radiographers use advanced imaging equipment to look inside a person’s body to help diagnose and understand an illness or injury. 

Therapeutic radiographers

Therapeutic radiographers use complex and advanced equipment to plan and deliver radiation treatment to treat cancer patients. They support patients throughout their radiotherapy treatment pathway.

Professional Youth Workers

Professional Youth Workers are Level 6 qualified with either a Youth Work degree or Youth Worker apprenticeship.  The Youth Worker's role is to build positive relationships with young people and provide opportunities to help them develop their social, emotional & personal skills through informal education, peer support activities, advocacy, signposting and much more. In a health setting, the Youth Worker's aim is to increase young people's confidence in managing their own health condition more independently, to provide a more holistic approach to care by ensuring young people are seen as more than just their health condition and to champion Youth Voice in the design & delivery of services. To find out more about youth work go to the , or to join the Health Based Youth Workers Group, go to . 

The roles mentioned above are not the only ones within an MDT; additional expert health professionals, who have unique skills and knowledge pertinent to paediatric healthcare, are involved in certain cases. This is to ensure comprehensive care for the baby or child. These professionals include GPs, social workers, health visitors, and paediatric palliative care doctors to name a few, amongst many others.

Top tips for effective MDT working

Clear communication has a positive impact on patient care

Having clear and effective communication within an MDT is essential for high-quality patient care. This ensures all team members are on the same page, promotes efficient collaboration and helps address patient needs thoroughly. 

Below supports the clear objectives and outcomes needed to foster team ethos:

• Have a nominated chair and minute-taker
• Encourage participation. Enable all members of the team to contribute so that all voices are heard and their contributions are respected.
• Set clear outcomes and action plans. Define SMART goals (Specific, Measurable, Achievable, Relevant, Time-bound) goals or timelines within the meeting to ensure that clear responsibilities are identified.
• Feel comfortable. Be open and honest with each other and share your feedback even if constructive.
• Support parents/carers to be part of the MDT and value their contributions and perspectives.
• Develop shadowing opportunities. Enable medical students, foundation doctors and non-clinical staff such as Service Managers or Ward Clerks to shadow others and to contribute to meetings. These opportunities provide insights into the decision-making process and the essence of an MDT meeting.
• Hold conversations where necessary. It may be difficult or stressful to have certain conversations at times whether it be in the MDT meeting itself or elsewhere, but as part of our Thrive Paediatrics initiative, we encourage everyone to be transparent with one another and to have an open dialogue. One of our Thrive Paediatrics blogs explores how we can start conversations with colleagues.

There are many vital roles and responsibilities amongst each individual and as a collaborative, you make up one multidisciplinary team, one workforce.