A Little about Child Neurology

I’ve been getting a lot of questions from people regarding child neurology. It’s not a well-known specialty; it’s barely discussed in medical school, and there’s little to no opportunity to do rotations in it. I believe at AUC specifically, we only have one green book rotation option at the University of Florida in Gainesville, in which special permission is needed from a faculty member to even rotate there.  With so little exposure, it’s no wonder why so few students know about it.  

So what is child neurology? What do child neurologists do? What sort of cases do they see? 

Child neurologists take care of children with any sort of neurological condition.  It’s mostly an outpatient specialty where the bread and butter cases include AD/HD, Tourette’s (tics), epilepsy, autism, headache, and cerebral palsy. A great deal of the time, child neurologists examine and work up patients who are referred for questions in developmental delay of speech, fine/gross motor skills, social skills or learning disabilities. Other pathologies child neurologists see are children with genetic disorders such as Angelman’s, Down, Fragile X, Tuberos Sclerosis Complex, among others and on rarer occasion children with brain cancer, muscular dystrophies, and mitochondrial disorders. I personally have an interest in concussions, chronic traumatic encephalopathy, and traumatic brain injury within the pediatric population, so we’ll see how well my training deals with those issues.

Although much of child neurology is centered in outpatient clinics, there are a huge number of child neurologists who work in the inpatient setting. Getting consulted to the NICU for newborns with floppiness or brain injuries (i.e. intraventricular hemorrhage), performing lumbar punctures, overseeing the epilepsy monitoring unit, reading EEGs, getting called to the ER for patients with question of seizure, cases of status epilepticus, etc.

If any of this sounds interesting to you, then maybe a career in child neurology is something you should consider.

How to apply to child neurology?

Child neurology used to be part of the Philadelphia Match, and it only just recently joined the main NRMP match (it’s in its third year). Like adult neurology, you can match into pediatric neurology directly. There is no fellowship necessary after doing 3 years of pediatrics, although you can do child neurology after doing the 3 years of pediatrics.

Child neurology is a small world. There are only 72 programs in the United States with the majority being university-based at major teaching institutions. You can enter a program as either a categorical, advanced, or reserved resident. Historically, most doctors entering child neurology would do 2 years of pediatrics and leave before their third year to enter a 3-year child neurology program. The problem with this of course, is that most pediatric residency programs aren’t thrilled about losing a resident for the third and final year of residency. Of recent years, most programs now offer a combined pediatrics/child neurology 5 year categorical residency program where you spend all 5 years training at the same institution. You do 2 years of pediatrics like any other pediatric resident (a few elective blocks are swapped for inpatient blocks), and then you move on to neurology for the final 3 years. By the end of the 5 years you can be double boarded in both pediatrics, as well as for neurology with “special qualifications in child neurology”.  Although most residents opt to only take the child neurology boards since most never practice general pediatrics.

When I applied this past year, I only applied for categorical positions.  I did end up applying to pediatrics as a back up but had I matched into a pediatrics residency position, I’m not entirely sure I would have gone the neuro route.  I decided early on I would finish my full 3 years and re-assess where to go from there.