Exploring Your Options: Neonatal-Pediatric Respiratory Care


Respiratory therapy school is largely focused on the care of adults with pulmonary conditions. But a fair number of RTs step into their first class with an eye toward working with children someday. Many others consider about the opportunities that exist in the neonatal-pediatrics specialty a few years into their careers as well.

Do you have what it takes to care for our youngest patients?

In this interview, AARC Neonatal-Pediatric Section Chair Bradley Kuch, MHA, RRT, RRT-NPS, FAARC, explains what it’s like working with kids and how to know whether you are right for the specialty.

How would you describe the neonatal-pediatrics specialty to RTs who have never worked in the area?

Opportunity is the first feature that comes to mind when I consider specializing in neonatal-pediatric respiratory care. The role of the RT in this area is vast, ranging from attending high-risk deliveries to functioning as an ECMO specialist. The knowledge base and skill set grown in the neo-peds space fosters continued learning and role expansion. Two unique areas of opportunity include the transport team and research. These areas present much autonomy and academic growth for RTs looking for a challenge.

In terms of practice, many neonatal-pediatric institutions champion the role of the RT in practice. These centers often use evidence-based clinical practice guidelines and protocols, allowing the RT to function using their expertise. Being that approximately 70% of children requiring tertiary care receive at least one respiratory intervention, the RT knowledge base is a perfect fit for the neonatal-pediatric clinician. 

What are the educational, credentialing, and experience requirements for making the move to the neonatal-pediatrics specialty?

In terms of education, many centers seek RRT-eligible or credentialed candidates. Once in a role gaining neonatal-pediatric experience, the NPS is an excellent credential to have. The design matrix of the NPS exam incorporates all areas of the neo-ped care continuum. Those achieving this credential are always an excellent pick.

Experience is not the major hiring consideration; however, it is a plus. As a hiring director, I look for individuals that demonstrate a patient-family centered care approach to their practice. This, coupled with teamwork and excellent communication skills, makes the candidate an excellent fit. The last characteristic we seek is clinical decision making. As an integral part of the care team, the RT should have great decision-making skills to ensure the highest level of care possible.

How does working with infants and children differ from practicing traditional respiratory care in an adult hospital setting?

Working with infants and children is no more difficult than working with adults. It is the nuances of care that presents the greatest challenges. Being that the population is smaller and often more responsive to subtle changes in support, greater attention to support delivery is often needed. For example, neonates often have small tidal volume, and slight changes in the ventilator settings may result in significant changes in the minute ventilation. For this reason, clinical teams pay attention to effective tidal volume — frequently targeting a volume of 5-7 cc/kg.

Neonatal-pediatric respiratory care is weight-based too. Ventilator settings are focused on volumes delivered per body weight. This holds true with pharmacologic adjuncts as well. This is much different than in the adult population. This is one of the major differences experienced in the pediatric environment.

Because of the patient population, the care time standards are greater than that of the adult space. This means RTs have more time with their patients. This time is necessary as the RT must stay with the patient until the therapy is complete due to their young age. During this time, relationships are created with the patient and their family members. This is one area that is valued greatly by the neo-ped RT.

What opportunities for career advancement does the neonatal-pediatrics specialty offer?

The pediatric care environment uses RTs in a wide variety of areas inside and outside the hospital. The role of the RT includes expanded roles in the transport environment, ECMO, pulmonary labs, home care education, and research. The opportunity provided within these roles makes neonatal-pediatrics a great area for professional growth. In these roles, the growth is unlimited.

For example, we are seeing expanded roles in the transport space, where within state licensure, RTs are providing advanced airway management, inserting IVs, and managing invasive mechanical ventilation via dedicated protocols. This allows RTs to use the skills they have in a challenging environment. We also see growth of the RT in the ECMO specialist role, and RTs are functioning as ECMO coordinators as well as ECMO specialists.

In addition to these roles, we are seeing expansion of leadership roles. RTs are assuming organizational leadership roles in areas previously not occupied by RTs. The successes they demonstrate, along with their solid relationships with nursing administration, make the neo-ped RT a perfect fit. This is the future for RTs.

What are the biggest challenges and the biggest rewards of working in this specialty and why?

A unique challenge of working in a pediatric environment is also the most rewarding, and that is convincing the child to adhere to the therapy or training them to use the device correctly. This is challenging, as sometimes the patients have little to no interest in doing the prescribed therapy. However, working with children allows you to be creative and interject some fun into the therapy. It begins with patience and connection. Once you have that, you will see the patient get better and go home. That is the rewarding aspect of working with children.

Another challenge is identifying the correct therapeutic interface for the specific patient. Pediatrics has a wide range of patient sizes and shapes. This results in the need to find the correct device to provide support. This requires teamwork between the bedside RN and RT. Working through these challenges, finding an acceptable device to provide support that is comfortable and allows the team to meet the therapeutic goals, is very rewarding.

The greatest challenge by far is caring for sick or injured children. It is difficult to see critically ill children day in and day out. Working in the neo-peds environment surely has these times. That being said, the positive experience outweighs the negative. Infants and children do very well when compared to other patient populations. Being part of that success is a very rewarding experience. Seeing children at medical camps or during follow-up visits after their acute illness and knowing that you participated in their recovery is one of the most professionally fulfilling experiences you can have as a clinician.

What are the top things you think an RT should consider before making the move into neonatal-pediatrics and why?

There are three things one should consider before considering a transition to a career in neonatal-pediatric respiratory care —

  • First, do you have a passion to positively affect the life of an infant or child? As a respiratory therapist in neo-ped care, every day you will have a lasting effect on your patients. Being that many of these children return to a pediatric center for their ongoing care, you will become an integral part of the care team, often knowing the patient and family through the duration of the hospital courses. If this is the connection you are looking for, then neonatal-pediatrics is your calling.
  • Secondly, neonatal-pediatric care is a dynamic area that requires ongoing learning and dedication. If you are considering becoming a neonatal-pediatric RT be prepared for an ongoing learning environment with much organizational viability. The visibility will provide much opportunity.
  • Finally, in the neonatal-pediatric environment there will be good days and some bad days. The good days will always outweigh the bad days. The environment is one that is filled with relationships and great outcomes. It is one where you can truly define yourself with your patients, their families, and the care team. With some dedication you can build a long, successful, rewarding career in neonatal-pediatrics.

Find out more about neonatal-pediatric respiratory care by joining the AARC’s Neonatal-Pediatric Specialty Section. The section is open to any AARC member interested in the care of children and neonates and includes members from some of the nation’s top children’s hospitals.

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