Pediatric specialists must know how to get the most information possible out of a tiny body who can't answer questions, can't follow commands, or is simply incapable of doing most of the things required in an adult physical exam.

Why a Pediatric PM&R Subspecialist?

The fundamental distinction between adult medicine and pediatric medicine, regardless of specialty, is the fact that the bodily processes of children are changing from the time of conception into the twenties. This includes major organ function, skeletal development, hormonal processes of all sorts, metabolism, and immune processes as well as the many functions of the nervous system.

This complicates all aspects of care from medication management, to lab interpretation, radiology testing to nutrition and fluid management. Prior to all of this, even the ability to perform a thorough physical exam and gather information about the patient's history may be drastically limited.

Medication management in children requires years of dedicated training to be done safely. The size range of patients' bodies is far greater in pediatric medicine than in adult based specialties. A pediatric specialist must be equally prepared to calculate the medication dose for a 5-pound infant versus a 300-pound teenager. Moreover, many medications that are standard for adults are actually contraindicated in children, such as a very common antibiotic for adult bladder infections that causes permanent damage to the growth plates of children’s bones. Lastly, children commonly show medication side effects in a completely different manner than adults. Physicians in adult residency programs receive limited training in this area.

One of the greatest challenges in caring for children is the fact that so many of them are not yet able to talk well enough to explain how they feel or to follow directions during a physical exam. Pediatric specialists must know how to get the most information possible out of a tiny body who can't answer questions, can't follow commands, or is simply incapable of doing most of the things required in an adult physical exam. This is where fine details can really fall through the cracks in the hands of an adult-based specialist. How does one know if a four-year-old has cognitive impairment due to a brain injury? How does one know if the fine motor skills in a seven-year-old child with a past hand injury are appropriate for her age? These issues are critically important to the child's future and require years of dedicated training in the area of childhood development, an area that is not a focus of adult residency programs or many pediatric subspecialty training programs.

It is true that physicians who are board certified in an adult-based specialty are typically required to take a few weeks of pediatric rotations during residency but this requirement is a small fraction of their training. Furthermore, a breakdown of the board exam questions dedicated to children reflects a small percentage of the exam. Therefore, these questions tend to be very general and lacking in depth compared to the board exam questions that are given after dedicated pediatric fellowships (additional training programs) in any given specialty.

Board certification in a pediatric specialty or subspecialty is the standard way to assure a physician has had long-term training dedicated to the care of children.

Read Why Dr. Wendy Goodwin.