Pediatric Neurology

This is an incredibly rewarding sub-specialty that has some differences from all the other pediatric subspecialties due to the scope of practice, timeline of training, and residency applications

Child Neurology (interchangeable with Pediatric Neurology) is a pediatric subspecialty that focuses on neurologic conditions in the ages 0-21 in the following divisions: general neurology, neuroimmunology, neuromuscular disorders, neuro-oncology, epilepsy, neurocritical care, headache, sleep, genetics, and potentially more in the future. Child neurologists are trained within 3 realms: pediatrics, adult neurology, and pediatric neurology. Some of the sub-sub-specialties require additional training. Following training, child neurologists are board certified in Adult Neurology with a special certification in Child Neurology. Because of this board certification based out of Adult Neurology, they can also see patients who are older than 21. They may also choose to become board certified in Pediatrics, but this is NOT necessary to practice child neurology. Child neurologists can practice in a variety of places: academic medical centers, community hospitals, and private practice. This is a truly unique field that allows you to practice among different ages, settings, and disciplines.

1) Categorical Programs: This is the most common way to become a child neurologist and has become a standard among almost all training programs. This means an applicant applies to a 5 year child neurology program as a 4th year medical student. Once matched, the trainee will complete all 5 years of training at ONE academic institution. Training begins with 2 years as a pediatrics resident, which will be designed to give the same degree of training as a 3-year ACGME accredited pediatrics residency. This will be followed by 1 year training in adult neurology, which will allow the resident to master the neurologic exam, localize lesions, and understand neurologic emergencies. Training will complete with 2 years in pediatric neurology, where the resident will transition into and be called a fellow role, similar to fellows in other pediatric subspecialties, such as pediatric cardiology, endocrinology, etc.

2) Advanced Programs: This pathway is for those who would like to train in pediatrics and neurology at TWO different institutions. It is also a 5 year timeline. The applicant applies as a 4th year medical student to pediatric programs and the advance child neurology programs separately. Once matched, the resident will complete 2 years in their pediatrics program and then move onto the neurology training at another institution. Neurology training is on the same timeline as a categorical position, where it is 1 year of adult neurology followed by 2 years of pediatric neurology.

 3) Reserve Programs: This is an option for a pediatrics resident who decides he or she wants to pursue neurology training. The pediatrics resident will apply to a reserve position with the intention of beginning neurology training after having completed 2 years of an ACGME accredited pediatric residency. Similar to categorical and advanced positions, the neurology training will consist of 1 year of adult neurology followed by 2 years of pediatric neurology.

Since all residencies are overseen by the ACGME, all child neurology programs will conform to set requirements for their trainees (ex. 12 months in adult neurology, 2 mandatory PICU rotations, etc.), so every child neurology graduate will be equipped to take boards and practice independently. However, there are more subtle differences between programs that may work better for a resident depending on personality, style, and preferences.

• Structure of the adult neurology training: some programs have residents complete the 1 year of adult neurology training in 12 months within PGY-3. Others have the 1 year interspersed with pediatric neurology rotations during PGY-3 and PGY-4. Depending on whether the resident wants to get all of the adult training out of the way or have it broken up along a longer period of time, this may make a difference.
• Consult vs. primary neurology service: at some institutions, neurology is a consult-only service that will take neurology consults on the general pediatrics wards, PICU, NICU, and ED. They are not the primary medical decision makers for those patients, as those matters will be handled by pediatrics residents. At others, neurology is a primary service that admits patients specifically with neurologic diagnoses. The team, usually consisting of the pediatric neurology fellow and pediatric residents will be the primary medical decision makers in the care of the neurologic condition as well as handle matters such as admitting/discharging the patient, coordinating other consults for that patient, writing scripts, etc.
• Freestanding children’s hospital vs. general hospital: at a freestanding children’s hospital, residents will have to go to a different hospital for the adult neurology training and nursery rotations (since the newborn nursery will be in the same building as the OB unit). At a general hospital, the training location may be more consolidated. However, many residencies will have multiple clinical sites regardless. Freestanding children’s hospitals generally have more volume and greater number of pediatric subspecialties represented, and faculty and staff are accustomed to working solely in a pediatric population. However, a pediatric neurology service at a general hospital will still have a large number and variety of patients since pediatric neurology is in high demand throughout the entire nation.

• Shadow in the pediatric neurology clinic or do an elective in pediatric neurology. Child neurology takes lots of practice given that children are often uncooperative with a detailed neurologic exam and there are a lot of patterns in development that one must become accustomed to observing (milestones are hard to memorize!). Additionally, child neurology patients often have complex medical histories, and exposure to the largest variety of patients can help one realistically see the care coordination required for these patients.
• Consider away rotations: this gives you an opportunity to spend a month at a different institution and gain exposure to how child neurology is practiced in a different setting. Away rotations are NOT required for matching successfully into a child neurology residency, and many residents at top programs did not do an away rotation. Additionally, an away rotation does not guarantee that you will receive an interview invitation later in the year. This is for your personal benefit to see if this program might be a good fit for you depending on the people, the structure, and the geographic location. 
  
  
  • Applications for away rotations usually open in March, and the deadline for each application is generally a month before the start of that rotation. However, institutions use a variety of systems to accept and process applications, so opening dates and deadlines vary. Be prepared for some programs to give you a decision about the away rotation as late as 2-3 weeks before the intended start date. Institutions are often trying to place their home students into their electives, so that is why away rotation decisions can seem extremely late.
  • You can prepare in the beginning of the year by going to student health and making sure your vaccines are up to date and your vaccine titers are adequate. Especially for the Hep B vaccine titer, that can delay your application by a few weeks since a low titer requires you to re-vaccinate and then check levels after a certain period of time.
  • Some programs require a letter of recommendation. Find a faculty who can speak to your clinical strengths and be prepared to provide him or her with an updated CV.

• Look into resources on what child neurology programs are available and some of their details: 
  • Child Neurology society
  • Freida.ama-assn.org

• Letters of recommendation: most programs require 3 LOR and the requirements vary. Most programs do not require a chair letter. It is acceptable to get a combination of letters from pediatric neurology, pediatrics, and neurology, in addition to non-pediatric neurology faculty if that person knows you well and can speak to your strengths as an applicant.
• Scheduling electives: child neurology is highly interdisciplinary, and these electives will give you additional knowledge to complement your skills and knowledge in child neurology – neuroradiology, ophthalmology, child psychiatry, neuropathology, any adult neurology electives, dermatology, PM&R, behavior and development, and medical genetics.

Child neurology is not a “sad/depressing field.” It is true that many neurology patients can have chronic and highly disabling conditions, but a child neurologist can provide the support and compassion to a family and help establish a sense of normalcy despite the medical challenges. This is an exploding field given massive amounts of new knowledge on genetics and therapeutics. Children with fatal neurologic diseases are now surviving longer due to amazing efforts in neurology research that that have quickly reached clinical practice just in the past two decades. Even without groundbreaking medical advances, child neurologists find their line of work to be highly rewarding because they can participate in longitudinal care and watch patients thrive despite deficits or intervene acutely in critical situations and observe patients improving in real time. Child neurology is a highly diverse, intellectually stimulating, and fulfilling practice that will only continue to grow. For those who love children, the brain, and hopefully both, give this specialty a chance!

Last Revision: January 23, 2020