Pediatric subspecialties: finding your focus

August 8, 2014

Article by Global Pre-Meds
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Newborns receive oxygen therapy at a hospital in Tanzania Working as a general pediatrician can be a perfect career choice for people who are interested in becoming a physician and enjoy caring for children. Pediatricians care for children from infancy through adolescence. They may treat children with common childhood illnesses, such as croup, asthma, allergies, viruses and injuries. They also provide information to parents and children on how to stay healthy and prevent disease. 

Within the field of pediatrics, there are several subspecialties on which you can focus. Although most pediatric subspecialties require additional training in the form of a post-residency fellowship, the length of training may vary.  

Regardless of which subspecialty you are interested in, the first step is becoming board certified as a pediatrician. A four-year college degree, which must include the required science classes, is the first step towards becoming a pediatrician. Admission requirements vary by medical school, but the MCATS are always required. Four years of medical school come next, along with a three-year residency in general pediatrics.

The training and residency requirements for each subspecialty may be different. Additionally, some residencies may alter training in order to allow physicians to start training in their subspecialty earlier. For example, according to the American Board of Pediatrics, an accelerated research pathway exists that may allow physicians to begin training in their subspecialty after completing two years of a general pediatrics residency (as opposed to three). Below are some pediatric subspecialties to consider:

Pediatric hematology/oncology: Pediatric hematologists/oncologists care for children who have cancers, such as leukemia, brain tumors and osteosarcoma. They may also diagnosis and treat children with various blood disorders, such as hemophilia, anemia and neutropenia. In order to become a pediatric hematologist/ oncologist, physicians must complete a fellowship, which is usually three years in length. After completing a fellowship, doctors are eligible to become board certified through the Pediatric Hematology/Oncology division of the American Board of Pediatrics.

Child abuse: Child abuse physicians specialize in diagnosing and treating children who are victims of abuse and maltreatment including physical, emotional and sexual abuse. They also treat victims of neglect. For example, child abuse doctors may treat children with chronic conditions that have occurred due to neglect or abuse, such as malnutrition or psychological problems. A three-year fellowship in child abuse pediatrics is required in order to become eligible for board certification. Child abuse physician specialists work in community hospitals, health clinics and in research.  

Adolescent medicine: Adolescent medicine specialists diagnosis and treat adolescents with various types of medical conditions. They may care for young people with conditions like alcohol and drug abuse, eating disorders, growth problems and mental health issues. After becoming board certified in general pediatrics, a three-year fellowship in adolescent medicine needs to be completed.

Pediatric critical care: Pediatric critical care specialists, also referred to as pediatric intensivists, diagnosis and treat children who are critically ill. They may treat a wide variety of conditions that require specialized treatment and a high level of monitoring. For example, pediatric critical care specialists may treat children with respiratory failure, sepsis and traumatic injuries. Similar to other types of subspecialties, a three-year post-residency fellowship is needed in order to become board certified in pediatric critical care medicine. 

Neonatology: Neonatologists care for premature babies and critically ill newborns. Neonatologists may diagnosis certain conditions during pregnancy. In other cases, the condition is diagnosed after the baby is born. They often attend high-risk deliveries in order to be able to provide immediate care for an infant. Neonatologists treat conditions, such as congenital abnormalities, cardiac conditions and life-threatening prematurity. After completing a pediatric residency, neonatal specialists must also complete a three-year fellowship in neonatology. In some situations, alternative training pathways are available.

Pediatric pulmonology medicine: Breathing problems do not just affect adults. Children are also born with or develop conditions that interfere with their respiratory systems. Pediatric pulmonologists specialize in evaluating, diagnosing and managing children with lung disorders, such as cystic fibrosis, asthma and pneumonia. Although there are exceptions, most pediatric pulmonologists complete a two to three-year fellowship after their pediatric residency. Physicians can become board certified in pediatric pulmonary medicine through the American Board of Pediatrics.

Pediatric cardiology: Infants and children may have cardiac defects from birth or may develop heart conditions during their childhoods. Pediatric cardiologists treat both acquired and congenital heart conditions. For example, they may treat children with heart murmurs, valve disorders and heart rhythm disturbances. Similar to other subspecialties in pediatrics, pediatric cardiology requires additional training after completing a pediatric residency. A pediatric cardiology fellowship, which is three or more years in length, must be completed in order to be able to take the exam to become board certified.  

Endocrinology: Pediatric endocrinologists care for children who have various hormonal or metabolic disorders. For example, they may treat children with disorders like diabetes, obesity, pituitary gland disorders and growth problems. After completing a pediatric residency, physicians interested in endocrinology need to complete a fellowship, which is usually three years long. There are alternative pathways, including a four-year fellowship that combines adult endocrinology with pediatrics. A five-year residency options] may also be available, which includes a two-year pediatric residency and a three-year pediatric endocrinology residency.  

Rheumatology: Doctors who specialize in diagnosing and treating children with disorders of the joints and bones are pediatric rheumatologists. This type of doctor often treats children and teens with diseases like vasculitis, lupus and juvenile rheumatoid arthritis. A fellowship, which is often two or three years in length, must be completed in pediatric rheumatology after a three-year general pediatric residency. In some instances, doctors may be able to choose an alternative pathway program and complete their training in rheumatology in less time.

Gastroenterology: Pediatric gastroenterologists care for children with digestive problems. Similar to adults, children can develop a wide variety of digestive conditions including ulcers, irritable bowel syndrome and pancreatitis. Doctors in this specialty also care for children with various types of illnesses affecting the liver. Training after a pediatric residency includes a two to three-year gastroenterology fellowship.