Pediatric neuro critical care is currently a 'hot' topic, and places are starting to want people who do it, however there are very few dedicated pediatric neuro ICUs (meaning that they only take care of neuro cases). Instead, you become the sub subspecialist in neurocritical care, you're the liason with the neurosurgeons and neurologists, and together set the protocols for TBI, DI, status epilepticus. It's of course expected that you would be doing research of some sort within this scope as well. The best route is go peds-->critical care-->neurocritical care (1 more year after critical care). This will give you the ability and standing to work within the unit and do procedures, but you won't be doing outpatient stuff. If you want to work in a PICU and take care of a ventilator and multisystem organ failure (which happens even if the primary insult is neurological), then this is the way to go.
Doing peds neuro with further training/interest in neurocritical care is still valuable, but you will primarily be a neurologist. This puts you in the consultant role rather than primarily managing patients. Our neurologist who does critical care is extremely helpful. He interprets EEGs and MRIs and works with us closely for patients in resistant status epilepticus. But he doesn't touch the vents or get into the other organ systems all that much.
