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Paediatrics 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 Paediatric and Neonatal
Intensive Care to the holistic approach necessary
in the management of a disabled child, from the
organisation 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 Paediatrician focuses on the child and the
family, working to minimise the adverse effect
of disease and to allow the child to live a normal
life.
 Paediatricians
work closely with other related medical specialities
such as Obstetrics, Anaesthetics, 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.
Paediatric nursing has evolved dramatically over
the past two decades; in particular the Paediatric
Specialities have emerged, closely allied to Academic
Paediatrics. 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 Paediatricians. While General Paediatrics 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. Paediatrics
has finally come of age as a speciality on an
equal footing with the other main specialities:
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 Paediatricians
General paediatricians 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.
Specialist Paediatricians
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 Paediatricians
Community Paediatricians 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 paediatric team.
Royal College of Paediatrics
and Child Health, 50 Hallam Street, London,
W1W 6DE e-mail: enquiries@rcpch.ac.uk
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