Develop. Med. Child Neurol. 1967, 9, 529-530

EDITORIAL IS THIS SEPARATION HELPFUL?

THE patterns of paediatric organisation must-and ought to-differ according to the skills and inclinations of the people available and to local traditions and needs. This is written, not because there is a universally applicable answer but to pose a question about two related present trends in paediatric organisation.

On one hand departments of child neurology are being set up. Chairmen of U.S.A. pediatric departments search for well trained physicians to make use of generous facilities. The Czechoslovakian association of paediatric neurologists has scores of members in contrast to the U.K. where only 3 doctors restricting their practice to children have received the accolade of membership of the Association of British Neurologists.

The other trend is illustrated by the U.K. Ministry of Health recommending in 1964 that all the 14 regional hospital boards should consider setting up centres for handicapped children. In the context such centres are for helping neurologically handicapped children. They are not intended to deal with all children with epilepsy, defects of vision, hearing or language, cerebral palsy, spinal paraplegia, global and specific learning difficulties or developmental disorders of emotional or social origin but to act as reference centres and to disseminate knowledge in this field. Many handicapped children are well cared for by their family, paediatric and public health doctors working together and helped by a social worker or agencies, but when assessment is difficult because the child is very young or the handicap probably multiple, the special experience of a reference centre specialising in the care of handicapped children* will be valuable.

If our knowledge and the quality of care of children is to advance, specialisation is essential in paediatrics. What is to be the relation between the care of handicapped children and child neurology? Shall we plan to have both departments and, outside the largest centres, which is the more urgently required? Because neurology has been accepted as a specialty, university boards (and perhaps univer-

* A word is needed for this specialty of the assessment and management of handi- capped children. The work done in Institutes of Defectology may be admirable but not the name. ‘Developmental paediatrics’ is used by some but while one may make an antithesis of the developmental and the disease aspects of paediatrics, would everyone understand that developmental paediatrics implies only the assesssment and management of children with chronic handicap? And is not developmental paediatrics (as opposed to developmental medicine) a tautologous phrase?

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DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY. 1967, 9

sity professors of paediatrics) more easily accepted the idea of a department of child neurology. The U.K. Ministry of Health seems more persuaded of the need to improve the services for handicapped children.

It would be a pity if we accepted once and for all that there must be an either-or choice, for children need the benefits that will follow from having both specialties. A department of child neurology may give a good comprehensive service or it may concentrate on the presenting handicap. It would be a pity if child neurology became too much separated from the assessment and care of handicapped children; both would lose. Their interrelationship needs to be discussed. Certainly anyone who works in either field needs to have had training in the skills and attitudes which enrich the other.

There seem to be two good reasons for emphasising at the present stage that hospitals ought to provide as soon as possible services directed primarily at helping handicapped children (and their families). One is that there are a great many such children who need and will benefit from improved diagnosis and management and a comprehensive approach is of value in neurolipidosis as it is in cerebral palsy. The second is that centres for the developmental assessment and comprehensive screening of handicapped children can also meet an urgent need for better education in this part of paedi- atrics in undergraduate medical education, vocation training of future paediatricians and continuing education of all practising doctors to whom children are brought.

RONALD MAC KEITH

SPECIAL EDUCATION Official journal of the Association for Specid Education

Educotionol journal of The Spostics Society

Leading professional journal concerned with the education of all types of handicapped children

Published quarterly - at € 1 annually

From : The Circulation Department, Special Education, 12 Park Crescent, London, W.l

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