Developmental Pediatrics

Dr. Sharon Smile, Division Head

Dr. Sharon Smile, Division Head

The Division of Developmental Pediatrics is located at Sunny Hill Health Centre for Children and at BC Children’s Hospital. Sunny Hill is a tertiary care provincial centre providing services to children from around the province. The Division promotes excellence in clinical practice, education, and research in child development and rehabilitation. Its mission is to develop, share and utilize new knowledge that will enhance the health of children with developmental conditions and their families. Developmental Pediatrics is an active, evolving Division within the UBC Department of Pediatrics. See video

Updated May 13 2024

 

 

 

 

Research Collaborations in Childhood Neurodisability: Enhancing Services and Supports for Children, Youth and Families

Dr. Anton Miller is collaborating with and supporting colleagues nationally (Alberta, Ontario, Quebec) and internationally (Australia) in a range of projects that focus on improving health and wellbeing for children with neurodisability and their families, through changing the way services and supports are provided and policies are shaped. Projects include ENVISAGE - Caregiver, a Canada-Australia collaboration (PIs C. Imms and P. Rosenbaum) that seeks to establish new and positive perspectives towards childhood neurodisability among service providers: Project ACCESS, an Alberta-based project that will use administrative health, educational and social services data to inform and address issues of unmet need (PI J Zwicker); and a further Alberta-based project led by David Nicholas (funding applied for) and which has the potential to be scaled up nationally, to understand and support the role that patient (or family) navigation can have in the lives of affected children, youth and families.

Mother's mood matters: the developmental consequences in children with prenatal antidepressant exposure

Dr. Tim Oberlander's research focuses on developmental outcomes in children of depressed mothers who were treated with an SSRI (selective serotonin reuptake inhibitor) antidepressant during their pregnancies (Oberlander et al., 2004; 2006; 2008). His work spans studies that range from molecular/genetic and MR imaging to population epidemiological levels that characterize neurodevelopmental pathways that reflect risk, resiliency, and developmental plasticity (Weikum et al., 2012; Campbell et al., 2021; 2021). Dr. Oberlander's work shows that both maternal mood and in utero SSRI exposure influences childhood behavior and stress regulation, possibly via changes in central serotonin levels during developmentally sensitive periods. To this end, he has reported pioneering findings on neurobehavioral outcomes in infants, children, and youth of depressed mothers who were treated with an SSRI during pregnancy (e.g., Hutchison et al., 2019; 2023). His work shows that the developing brain has a remarkable capacity for plasticity and even in the face of adversity, some children do very well. The goal of his work is to understand how and why this happens.

Living Lab at Home

With the advent of COVID-19 related restrictions to in-person research, Dr. Tim Oberlander realized an urgent need to shift his biobehavioral research to shift to the community and since 2020 he has led development of the Living Lab at Home (LLAH) project at BC Children’s Hospital. This research program, co-led with Dr. Katelynn Boerner, aims to co-design, with patients and families from across the developmental spectrum, a platform for in-home data collection that enables multi-modal, micro-longitudinal real-world data from a custom designed smartphone app, daily activity (accelerometers) and saliva stress-related biomarkers (Boerner et al., 2023). The LLAH provides patient-informed, validated methods to collect daily data on pain and other related symptoms and experiences (e.g., physical activity, stress, mental health, social interactions). This platform offers an invaluable approach that ensures equity and accessibility to populations of children who have been excluded from participating in research (e.g., families in rural areas) and accelerates our understanding a complex self-report symptoms like pain and anxiety, and their inherent ever-changing nature and susceptibility to every day contextual factors.

Pain and children with developmental disabilities

Since 1994, Dr. Tim Oberlander has conducted novel research examining pain in children with significant neurological impairments. This has included reports of beliefs among professionals (Oberlander, 2001); communication and pain in youth with cerebral palsy (Oberlander, 1996); acute pain reactivity in youth with cerebral palsy (Oberlander, 1999), and behavioral pain responses among children with autism spectrum disorder (ASD) (Nader et al., 2004; Curie et al 2023). More recently Oberlander has turned to investigate how to assess pain-related function and disability in children with developmental disorders (Schiariti & Oberlander, 2018). He has co-authored multiple chapters in this field and co-edited the first book on this topic (Oberlander & Symons, 2006). This body of work formed the first studies, book chapters, papers, and a book devoted to pain in children with significant neurological impairment. Collectively, this work has had a significant impact on clinical practice and research, raising critical questions about what we know and how we manage pain in an often-ignored vulnerable population of children. Oberlander is working with H. Siden to study novel treatment approaches to pain and irritability in children with significant neurological impairments. Oberlander and colleagues are also studying the nature and character of everyday chronic pain in youth with ASD using the LLAH approach to everyday data collection.

Cerebral Palsy Registry

Dr. Ram Mishaal and colleagues from across Canada are leading the Canadian Cerebral Palsy Registry, a confidential, nation-wide collection of medical and social information about children with cerebral palsy (CP). Sunny Hill Health Centre is the BC participating site of the registry, which was created to identify potential risk factors related to pregnancy and interactions of the environment and genetics. The Registry helps researchers to characterize the profile of children living with CP across the country and explore reasons behind the causes of cerebral palsy, in addition to supporting studies which may lead to improvements in the overall care of children with CP.

Cerebral palsy Early Diagnosis Clinic

Drs. Mor Cohen-Eilig and Ram Mishaal are leading the first clinic for early identification of Cerebral Palsy in Canada. In addition to providing clinical care, the team conduct research in order to better identify risk factors and factors that will optimize future function of children with cerebral palsy and their families.

Complex Neurodevelopmental Disorders

The division collaborates closely with the BC Autism Assessment Network and the Complex Developmental Behavioural Conditions program through Sunny Hill, BC Children’s Hospital on research and quality improvement projects to improve clinical care and our understanding of complex developmental conditions, including ASD and FASD.

Dr. Angie Ip and Dr. Preety Salh lead and support quality improvement projects in consultation with our clinical teams, patients, and families. Current projects include increasing flexibility in diagnostic assessments to provide more family and trauma centred care, improving access to care for families in underserved regions, and increasing clinician capacity through continuing education and inter-team and inter-division collaborations.

Dr. Angie Ip, Amanda Nietzsche, Dr. Timothy Oberlander, and Dr. Sarah Hutchison lead and collaborate with other universities, nationally and internationally, in linked data research related to children with ASD and other complex neurodevelopmental disorders.

Screen-time Management Intervention for Children with Autism

Dr. Mor Cohen-Eilig is working on a project “Developing an Innovative Data based Screen-time Management Intervention for Children with Autism: A Feasibility Study”.

Fetal Alcohol Spectrum Disorder (FASD)

Drs. Timothy Oberlander, Christine Loock and Nancy Lanphear are involved with NeuroDevNet Research project on FASD. This is a collaborative effort with other Canadian sites.

Social Disparities

Dr. Christine Loock continues to co-lead RICHER (Responsive Inter-sectoral/interdisciplinary Child/community Health Education Research) Social Pediatrics Program at BCCH and BCCHR research initiatives with UBC Nursing and Human Early Learning Partnership (HELP) to foster access to healthcare, dismantle barriers to care, and eliminate disparities in developmental and health outcomes. The RICHER team originally grew from our original Division of Developmental Pediatrics outreach services to equity deserving Vancouver neighbourhoods and other geographically underserved communities across BC. It now includes 3 division members plus general and sub-speciality pediatrics (e.g. youth health, ophthalmology, dermatology, and child psychiatry) linked with primary health care (nurse practitioners and family medicine). Her team was the first at BCCH introduce NPs into community shared care roles. Dr Loock remains active in the development of social justice curriculum at UBC and promoting intersectoral partnerships across British Columbia.

Dr Loock has also been the Developmental Pediatrician and Medical Director for the BCCH Provincial Cleft Palate Craniofacial Program for over 25 years.

Cryoneurolysis in children with spasticity/ dystonia

Dr. Grace Li is working to evaluate the efficacy of cryoneurolysis to treat children with movement disorders.

Acute Rehabilitation Unit (ARU) Research

Dr. Stephanie Rohn – Pediatric resident supervised by Dr. Mor Cohen-Eilig, Amber Pelletier and Danielle Hill – Aquatic and Recreational therapists in the ARU have been working since January 2023 on the project “Barriers and Facilitators to Aquatic Therapy in the community post-discharge from an Acute Rehabilitation Unit”.

Our members are actively involved in all aspects of teaching undergraduate (medical students) and post graduate (residents) students as well as subspecialty trainees (Subspecialty Residents and Clinical Fellows).

Undergraduate Medical Education:

Overview
Undergraduate medical education has continued to be a significant area of focus for Division members. Members of the Division have been active in the design, development and delivery of the medical school curriculum for undergraduate medical and dental students at UBC. In addition, the Division continues to offer bedside-clinical teaching in all aspects of developmental pediatrics at Sunny Hill and the Community.

Contact Us

Ms. Monika Mezey, Program Assistant, Tel: (604) 453-8386
Dr. Trevor Kwok, MD PhD FRCPC
UBC Undergraduate Rotation Lead, Developmental Pediatrics
Tel: (604) 453-8000

Resident Education:

Overview
Improvement of the Developmental Pediatrics block in the Residency program has been one of the top priorities for the Division over the past several years. The training period for residents in developmental pediatrics/child rehabilitation is currently 4 weeks in the PGY-3 year. The majority of this clinical experience occurs on site at Sunny Hill Health Centre for Children and involves exposure to the neuromotor (both in and out patient), autism (PARC) and general development (CDBC) programs.

Additional structured learning activities in developmental pediatrics occur throughout the R1-R3 years in the form of monthly ward rounds focusing on child development in selected patients and, a two year long lecture series as part of the academic half day program. The first year of this program focuses on normal development and the second year on atypical development (language delay/disorder, intellectual disability, autism, learning disability, developmental coordination disorder). Elective rotations in child development are available to R4s and several residents have recently taken advantage of this opportunity. There are ongoing efforts to further integrate child development into general pediatrics and to refine the rotation goals and objectives.

Contact Us
Ms. Monika Mezey, Program Assistant, Tel: (604) 453-8386
Dr. Cohen-Eilig, MD FRCPC
UBC Residency Rotation Lead, Developmental Pediatrics
Tel: (604) 453-8300

Subspecialty Residency/ Clinical Fellowship Program:

Overview
The objective of the UBC Subspecialty Residency Program in Developmental Pediatrics is the training of academic Pediatricians with unique, in-depth expertise in child development and behavior (both normal and abnormal) from the prenatal period to late adolescence.

Training in our Subspecialty Residency Program enables Pediatric residents to gain proficiency in the assessment and management of a full spectrum of neurodevelopmental disorders including cerebral palsy, autism, intellectual disability, and learning disorders, and the neurobehavioural effects of prenatal substance exposure and environmental poverty. These conditions comprise more than 40% of General Pediatric practice, and are a cause of significant concern in the majority of children referred for Pediatric specialty consultation.

The UBC Subspecialty Residency Program in Developmental Pediatrics prepares the subspecialty Pediatric resident to:
• work as a member of an interdisciplinary professional team
• integrate findings from across disciplines in order to support families and their children with neurodevelopmental disorders
• act as a consultant in Developmental Pediatrics to Pediatricians, other physicians, professionals, and agencies caring for children with complex neurodevelopmental, behavioral, and psychosocial problems
• play a leadership role as a health advocate for children
• teach principles of Developmental Pediatrics in academic, continuing education, and community settings
• design and evaluate research in Developmental Paediatrics
• manage and administer Developmental Pediatric clinical services

Training and education in our subspecialty program occurs within the UBC academic community including Sunny Hill Health Centre for Children, BC Children’s Hospital, the Child and Family Research Institute Developmental Neurosciences and Child Health Cluster, and the UBC Human Early Learning Partnership. Sunny Hill Health Centre for Children supports children and youth with neurodevelopmental disorders, from birth to their 19th birthday, through both outpatient and inpatient services, and serves more than 5000 children a year from nearly 300 BC communities. As a UBC teaching hospital, Sunny Hill also trains more 150 students a year in medicine, social work, nursing, psychology, and therapy.

Our subspecialty program curriculum includes both in- and out-patient rotations in neuromotor disorders, brain injury and rehabilitation, complex developmental and behavioral conditions, and research design and evaluation, as well as electives in allied subspecialties including Genetics and Neurology. We are fully accredited by the Royal College of Physicians and Surgeons of Canada.

Program Curriculum
In the first year of the program, residents receive training in core Developmental Pediatrics through inpatient and ambulatory rotations at Sunny Hill Health Centre for Children. Trainees are involved with assessment of children with complex medical, developmental and behavioral conditions as part of a multidisciplinary team. During the first year of subspecialty training, residents spend 3 blocks at BC Children’s hospital in Child and Adolescent Psychiatry, Child Neurology and Medical Genetics. Residents are given time to begin their research project during a one block elective.

During second year, residents further develop their skills in Developmental Pediatrics rotating through the core Child Development and Behaviour rotations. Residents are expected to take a graded responsibility in their second year with enhancing their skills in communicating with families, and chairing parent and team conferences. Ample opportunity exists for elective time and an additional 2-month block is available, which is dedicated to research during the second year of training.

A weekly formal academic half-day program covers the core areas of Developmental Pediatrics. Residents attend regular monthly Developmental Pediatric journal club. The Division has monthly CME sessions. Residents have opportunity to attend optional neuropsychiatry and City Wide rehabilitation rounds.

For the Subspecialty Resident Orientation Manual, please contact Monika Mezey

How to Apply

Canadian Applicants: Applications for any of the Developmental Pediatric Subspecialty Program must be made through the CaRMS website. Residents completing PGY3 or PGY4 training in Core Pediatrics are eligible for the match.

International Applicants: Interested applicants should contact Monika Mezey

The required information to review includes the following:
1. CV
2. Medical degree (notarized if not in English)
3. Three reference letters
4. Letter of intent indicating:

  • why you want to train in Developmental Paediatrics
  • what would make you the best candidate for this position
  • where you plan to work when you are finished your training.
  • IELTS with a minimum score of 7 in all sections.
  • Visa sponsored applicants (Bahrain, Kuwait, Libya, Oman, Saudi Arabian, and the UAE): Once you have obtained sponsored funding, all requests for residencies/fellowships should be sent to Monika Mezey, Program Assistant.

    Visiting Electives:

    Canadian Residents: Residents currently enrolled in Canadian training programs for Developmental Pediatrics are welcome to apply for clinical or research electives with our division. Please contact Monika Mezey with dates of interest for your elective for consideration by our Resident Program Committee. The instructions and forms for out of province residents to apply for an elective can be found here: CPSCBC

    International Electives: Electives are encouraged to international applicants, to help determine whether our program is suited to their educational needs. Electives are 4 weeks in length, and allow a potential trainee to review the clinical scope of developmental pediatrics and training experiences offered at the University of British Columbia. For further information please contact Monika Mezey

    The required information to review includes the following:
    1. CV
    2. Medical degree (notarized if not in English)
    3. Three reference letters
    4. Letter from home institution stating that they will fund him/her during his/her elective
    5. Letter of intent indicating:

  • why you want to train in Developmental Paediatrics
  • what would make you the best candidate for this position
  • where you plan to work when you are finished your training.
  • 6. Academic IELTS Examination.
     
    Contact Us
    Monika Mezey, Program Assistant, or
    Dr. Anna McNally, MD FRCPC, Subspecialty Residency Program Director, Developmental Pediatrics
    Telephone: (604) 453-8386

    Clinical Care:

    We believe that children should grow to achieve their own, unique potential. The Division of Developmental Pediatrics works primarily at Sunny Hill Health Centre for Children with families and communities as partners to better understand every child’s needs, and to develop tailored recommendations and services.

    In British Columbia, the service delivery system for Children and Youth with Special Needs (CYSN) is organized into tiers representing the many layers of expertise available to children, youth and families. This is based on a model which has been used successfully in other countries to help reduce gaps and overlaps in service, and increase collaboration between service providers.

    Services:

    The following two streams of services are available at Sunny Hill:

    ACUTE REHABILITATION, NEUROMOTOR PROGRAM AND SENSORY SERVICES

    The Child Development and Rehabilitation Program, offers specialized diagnostic and therapeutic services to children and adolescents experiencing developmental conditions and disabilities. The Sunny Hill program is a provincial service offering complex care, diagnosis and treatment for children and adolescents, up to 19 years of age. See video

    The following teams provide specialized services and functional assessments:

    • Acute Rehabilitation Inpatient program
    • Tone/Spasticity Management clinic
    • Cerebral Palsy Early Diagnosis Clinic (CPEDC) and Early Motor Assessment Clinic (EMAC)
    • Feeding Team
    • Hearing loss Team
    • Vision Impairment Program
    • Positioning and Mobility Team
    • Assistive Technology Team
    • The Motion Lab

    DEVELOPMENTAL AND BEHAVIORAL HEALTH

    The Child Development and Rehabilitation Program, offers specialized diagnostic evaluations to children and adolescents experiencing delayed cognition, communication and behavioural health issues. The Sunny Hill program is a regionalized Provincial service offering complex care, diagnosis and treatment for children and adolescents, up to 19 years of age, experiencing:

    • Autism Spectrum Disorders
    • Fetal Alcohol Spectrum Disorder
    • Complex Development and Behavioral Conditions

    For more information on Sunny Hill Health Centre clinical services, please click this link.

    Faculty:
    Sharon Smile, MBBS, DM (Paeds), MSc
    Alexandra Lowry, MD
    Angie Ip, MD, MHSc, FRCPC
    Anna McNally, MD, FRCPC
    Anton Miller, MD, MBChB, FRCPC
    Armansa Glodjo, MD, MSc, FRCPC
    Carey Matsuba, MDCM, MHSc, FRCPC
    Christine Loock, MD, FRCPC, DABP
    Dominique Eustace, MD, FRCPC
    Elena Lopez, MD, MSc, FRCPC, FCCMG
    Elizabeth Mickelson, MD, BSc(PT), FRCPC
    Emily Fisher, MD, MSc, FRCPC
    Grace Li, MD, FRCPC (Consultant Physical Medic. & Rehab)
    Gurpreet (Preety) Salh, MD, FRCPC
    Jill Houbé, MD, MPhil, FAAP, FRCPC
    Katelynn E. Boerner, PhD, RPsych
    Mandeep Mahal, MD, FRCPC
    Maureen O’Donnell, MD, MSc, FRCPC
    Mia Francl, MD, FRCPC
    Mor Cohen-Eilig, MD, FRCPC
    Ram Mishaal, MD, FRCPC, Senior Medical Director of Sunny Hill Health Centre
    Timothy Oberlander, MD, BA (Hons), MC, FRCPC
    Trevor Kwok, MD, PhD, FRCPC

    Research Staff:
    Amanda Nitschke, Research Assistant
    Jane Shen, Program Manager
    Dawna Brown, Research Assistant
    Sarah Hutchison, Child Development and Rehabilitation Research Manager

    Fellows:
    Natalia Diaz Pinzon
    Alison Faber

    Administrative Staff:
    Natalie Garrett, Administrative Coordinator (Temporary)
    Monika Mezey, Education Program Assistant