HealthAugust 05, 2020

Navigating pediatric subspecialties: What's right for you?

By: Julia Michie Bruckner, MD, MPH

If you pursue pediatric subspecialties, you’ll develop long-term relationships with families while enjoying opportunities for research and teaching.

So kids have hooked you, and you've decided to become a pediatrician. Practicing primary care pediatrics is rewarding, but if you have more particular interests, numerous pediatric subspecialties offer an enriching career as well. All generally involve completing a three-year fellowship after pediatric residency. Many pediatric subspecialists then stay in academia, caring for patients, teaching trainees and conducting research. Here's a closer look at the wide range of pediatric subspecialties available—and how to choose the one that might be right for you.

Choosing a pediatric subspecialty

All the pediatric subspecialties give you the chance to make a lasting difference in a child's life. What should you consider when choosing a pediatric subspecialty?

Home in on a body system

If one organ system and its diseases have piqued your passion, one of the following pediatric subspecialties may be a great choice for you.

Pediatric cardiology

Pediatric cardiology is perfect for those fascinated by the development of tiny hearts and the problems they may experience such as congenital heart disease, arrhythmias and cardiomyopathies. You get to diagnose and counsel families expecting children with hypoplastic left heart syndrome, monitor aortic stenosis in patients with Williams syndrome or see parents' joy and relief after their child receives a heart transplant.

Pediatric endocrinology

Hormones are essential to a child's growth and development. Pediatric endocrinology addresses disorders of hormones such as diabetes, growth hormone deficiency and hypothyroidism. You get to guide patients through a challenging new diagnosis of Type 1 diabetes, help teen girls with polycystic ovarian syndrome manage struggles with irregular menses or initiate hormone therapy for gender-diverse youth.

Pediatric hematology/oncology

Cancer or a blood disorder is life-altering for a child and family. Pediatric hematology/oncology is the specialty for those who want to guide families through illnesses such as leukemia, lymphoma, solid tumors, sickle cell anemia, thalassemia and aplastic anemia. You can help families navigate their children's devastating diagnosis of Ewing's sarcoma, see a child cured of sickle cell anemia after a bone marrow transplant and follow your pediatric cancer patients into adulthood through survivorship clinics.

Pediatric gastroenterology and nutrition

A healthy diet and functioning gut are key for a growing child. Pediatric gastroenterology and nutrition is for those interested in inflammatory bowel disease, celiac disease, obesity and failure to thrive. You can scope to diagnose eosinophilic esophagitis, help a teen get her Crohn's flares under control and manage gastrostomy tubes and TPN in children who are unable to eat in typical ways.

Pediatric neurology

Pediatric neurology offers a wide variety of options for managing illnesses of the brain and nervous system, including migraine headache, epilepsy, neonatal stroke, Duchenne muscular dystrophy, spinal muscular atrophy and Rett syndrome.

Organ-system-based subspecialties

Pediatric pulmonology focuses on patients with severe asthma, cystic fibrosis, congenital lung malformations and interstitial lung disease. Pediatric allergy/immunology works on diagnosis and treatment of immunodeficiencies as well as food and environmental allergies. Pediatric rheumatology treats kids with autoimmune and inflammatory disorders like juvenile idiopathic arthritis, dermatomyositis, periodic fever syndromes and Kawasaki disease. Pediatric nephrology handles all things kidney, including vesicoureteral reflux, nephrotic syndrome, polycystic kidney disease and kidney failure.

All of these organ-system-based subspecialties provide a balance of inpatient service, outpatient clinic and opportunities for research and medical education in your practice. They allow you to build lasting relationships with your patients as they grow and to support their primary care provider with your particular expertise.

No matter what pediatric subspecialty interests you, deepen your knowledge with Wolters Kluwer books and journals.

Focus on acuity

If you have an interest in caring for critically ill children, several pediatric subspecialty options exist. These subspecialties require great teamwork, working shifts — including nights and weekends—and an ability to cope with witnessing severe illness and death in children.

Pediatric emergency medicine

If you enjoy the variety and unpredictability of being on the front line, pediatric emergency medicine may be for you. You are able to sedate children for reduction of their fractures, suture their lacerations, intubate infants in respiratory failure from bronchiolitis, promptly start antibiotics on a toddler with sepsis and quell status epilepticus.

Pediatric critical care

Many children will go from the emergency department to the pediatric intensive care unit, where they are cared for by pediatric intensivists—experts on managing acute and chronic critical illness in children. You can focus even further within pediatric critical care, choosing to pursue cardiac critical care or neurologic critical care, for example.


If you like caring for our sickest and tiniest patients, perhaps your place is in neonatology. You will attend high-risk deliveries, counsel families experiencing preterm labor and care for premature infants as well as critically ill full-term infants.

Specialize in a special population

Children change dramatically as they age, and some children don't develop typically. If you've become drawn to a particular age group or special needs population, there are pediatric subspecialties where you can pursue your interests. These offer a clinical practice in inpatient and outpatient settings as well as particular opportunities for research and community involvement.

Developmental and behavioral pediatrics

Pediatric genetics and metabolism trains you to care for children with complex inherited or metabolic disorders such as phenylketonuria, tuberous sclerosis and Gaucher disease. In developmental-behavioral pediatrics, you focus on children living with autism, Down syndrome, Tourette syndrome or attention-deficit/hyperactivity disorder.

Pediatric infectious diseases

Those interested in caring for children with significant infections will find a home in pediatric infectious diseases, where you'll treat HIV, tuberculosis or MRSA. This subspecialty also melds naturally with work in epidemiology, infection control and global health.

Adolescent medicine

If you enjoy the company of teenagers, adolescent medicine gives you an opportunity to address their unique relationship to issues like substance abuse, anxiety, eating disorders, sexual health and gender identity development.

Child abuse pediatrics

Child abuse pediatrics trains one to prevent child abuse and manage its effects, including diagnosing abusive injuries, differentiating medical mimickers of abuse, treating youth who have been sexually assaulted and serving as an expert in legal proceedings.

Pediatric palliative care

Pediatric palliative care trains one to shepherd children through chronic and/or terminal illness, focusing on their quality of life, relieving discomfort and supporting their families through these challenges.

Navigating Pediatric Subspecialties

For more information, explore the Council of Pediatric Subspecialties website, which offers in-depth descriptions of the niche fields discussed above.

If you find yourself having trouble choosing a pediatric subspecialty, you can always combine them and complete multiple fellowships. Popular combinations are pediatric cardiology with pediatric critical care and pediatric hematology/oncology with pediatric hospice and palliative medicine. Whatever your choice of pediatric subspecialty, you'll have a lasting impact on children's health.

Julia Michie Bruckner, MD, MPH
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