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by Ann W. Kummer
One of the best aspects of the field of speech-language pathology is that there is the opportunity to work in a great variety of job settings with very different clinical populations. A new graduate in the field can choose to work exclusively with adults or only with children. For those who prefer pediatrics, there are opportunities in school settings, outpatient clinics, private practices, or health care settings.
Although statistically, pediatric speech-language pathologists in health care settings make up only a small percentage of the ASHA membership, this subgroup of specialists tends to be passionate about the profession and its work setting. Turnover tends to be low, and job satisfaction tends to be high. This type of setting offers unique challenges, but also very unique rewards. As one of my staff members once said, “This is the worst job I have ever had, but it is definitely the best job I have ever had!” (I guess it all depends on the day!)
There are certainly advantages and disadvantages of working in each type of setting—pediatric health care, adult health care, and schools. The sidebar on the right provides a cursory comparison of the characteristics of working in pediatric health care settings with the other two settings.
Typical Populations
The typical population in a pediatric health care facility differs from that of an adult hospital and also from a school setting. Unlike the adult arena, strokes and laryngectomies are not commonly seen in children. In pediatrics, common inpatient diagnoses include head trauma (particularly in teenagers), feeding disorders/dysphagia due to a history of prematurity or neuromuscular disorders, birth defects, tracheal stenosis, or bronchopulmonary dysplasia. Trachs and vents are commonly seen by inpatient pediatric SLPs and those who provide pediatric home care. Patients who require long-term hospitalizations (i.e. hematology/oncology or transplant patients) are commonly seen by SLPs due to developmental issues. Finally, psychology units usually provide a population of patients with language disorders, particularly in the area of pragmatics.
In the outpatient arena, SLPs in a pediatric health care setting commonly treat patients with speech and/or language disorders of unknown etiology. In this setting, however, there are also a large number of patients with developmental disabilities secondary to a history of prematurity, traumatic birth, or neurological problems. Many of the patients are medically fragile. Other common medical diagnoses include hearing loss/cochlear implants, vocal fold nodules/dysfunction, and cleft palate/craniofacial anomalies. Without a doubt, the fastest-growing populations in pediatric health care include patients with apraxia, autism, or feeding disorders.
For more on what makes pediatric speech-language pathology different from adult health care and school settings, see my top 10 list at the right.
Conclusion
The practice of speech-language pathology in a pediatric health care setting is not for everyone. It requires a great deal of intellectual curiosity, a need for a challenge, a willingness to work long hours, and a desire for continuous learning. More than anything, however, it requires a love of children. The rewards are not always monetary. Instead, sometimes the best reward is a child’s smile and hug at the end of a session.
Ann W. Kummer is director of the speech pathology department at Cincinnati Children’s Hospital Medical Center, and professor of clinical pediatrics at University of Cincinnati Medical Center. Contact her at ann.kummer@cchmc.org.
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