Which peds subspecialty has the least babies?

[DinosaurStampede]

Except adolescent medicine obviously, but are there organ systems in which the sx typically arise in kids/adolescents? I'd love to see mostly older kids and for the smallish ones <4yo to be the minority of my patient load.

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[GoSpursGo]

You consider 4yo to be itty bitty?? Cuz if you really mean babies I would say Heme/onc, but if your cutoff is 4yo then you’ll wind up with a decent amount of ALL and neuroblastoma.

I suppose the answer is something like rheum or psych. The majority for some specialties like Pulm or renal might arise in adolescents, but you would wind up with a decent number of consults in small kids.

 

[DinosaurStampede]

You consider 4yo to be itty bitty?? Cuz if you really mean babies I would say Heme/onc, but if your cutoff is 4yo then you’ll wind up with a decent amount of ALL and neuroblastoma.

I suppose the answer is something like rheum or psych. The majority for some specialties like Pulm or renal might arise in adolescents, but you would wind up with a decent number of consults in small kids.

Edited my post for clarity. Thanks for your comment!

 

[DinosaurStampede]

You consider 4yo to be itty bitty?? Cuz if you really mean babies I would say Heme/onc, but if your cutoff is 4yo then you’ll wind up with a decent amount of ALL and neuroblastoma.

Also, 4yo is not a "cutoff", I'm happy to see some younger ones too. I just prefer when I can have a conversation with the kid. Heme-onc sounds interesting!

 

[SurfingDoctor]

There is probably not a subspeciality where you could avoid infants or toddlers in pediatrics, outside of maybe pediatric psychiatry. But I would agree that pediatric rheumatology probably has the lowest population of infants and toddlers. I mean, you still would have to deal with potential consequences of maybe vertical autoantibody transmission and maybe the rare congenital HLH, but otherwise, autoimmune diseases are very rare under toddler age because you need an robust immune system and the potential trigger.

I mean, if its an organ that you are born with in a fully developed state (ie, every organ except the immune system), you can have it be abnormal from the get go and have to see patients in their infancy.

 

[PHOfellow]

Heme/onc fellow here, can confirm that I can have a conversation with most of my patients, but still take care of a handful of infants/toddlers. That being said, I would definitely say that choosing heme/onc shouldn't be a decision based on an aversion to little ones! I'd echo that rheumatology has fewer young patients as well, and I'd add sports medicine as another potential ped subspecialty with few very young patients.

 

[Dr. Wexler]

Sports medicine. Tox.

 

[Dr. Wexler]

Sports medicine. Tox.

Probably should not have said tox. But you won't need to talk to many kids under 4yo.

 

[Ladholyman]

You can always do Adolescent Medicine if talking to teenagers are your thing.

Edit: Whoops, didn't read the part that you didn't want to do Adolescent.

Sports medicine then, maybe?

 

[BigRedBeta]

Except adolescent medicine obviously, but are there organ systems in which the sx typically arise in kids/adolescents? I'd love to see mostly older kids and for the smallish ones <4yo to be the minority of my patient load.

What's the timeframe you are looking for said tailored population?
Are you a med student or a resident?
How do you feel about taking care of adults too?

Other than Ado and sports med, you definitely won't be able to escape babies as a fellow. You can probably craft a practice in some fields that bends towards older kids - the most obvious being an Adult Congenital Heart Disease super fellowship after a regular Peds Cards fellowship, but also thinking like GI with a focus on inflammatory bowel disease. Given the difficulty in finding jobs after Heme/Onc fellowships, I think there are people out there really trying to subdivide out the field and claim expertise in Adolescents and Young Adults, or trying to focus on topics like fertility preservation for pediatric cancer patients. I'm sure most hematology departments would love someone who only wanted to focus on teenaged sickle cell disease patients as they can be challenging in a variety of ways. Maybe Neurology with a focus on Headaches?

More realistically if taking care of adults is a possibility, might consider doing IM/Peds combined residency and then specifically hunting for places that would let you do a combined adult/peds fellowship in whatever field you are considering, with the idea being that your specific niche would be transitioning pediatric patients to adult care. Be forewarned though that while these sorts of combined programs exist, they are rare and require a lot of coordination that may be a lot harder than one anticipates. Additionally, while there's undoubtedly a need, the job market is a bit murky in terms of what would actually be out there, with a lot of hurdles to manage (ie, not like a lot of academic Internal Med departments are looking for such things as may not really fit their mission, seems like a lot of training just to go into an adult private practice model). The elephant in the room is of course that you would actually end up taking care of adults that happen to have pediatric diseases, not just older kids.