In recent decades, a subspecialty paediatrics has developed alongside general paediatrics with special skills acquired after additional training or fellowship in university paediatrics departments.

For several of these subspecialties there are both European and Belgian recognition standards.
Although recognition was approved twice by the Supreme Court, previous Ministers of Health have always disregarded this approval

The consequences of not recognising these special competences are far-reaching and are a risk to the child’s health:

• When parents consult a paediatrician with a special competence, they have no guarantee that the paediatrician does in fact have that special competence.
• Some conventions (cystic fibrosis, renal dialysis, diabetes) require the multidisciplinary team to include a paediatric pulmonologist, a paediatric nephrologist, or a paediatric endocrinologist, but these do not legally exist in Belgium.
• Due to the fact that a consultation for a referred patient with a sub-specialty problem is as much honoured as a consultation of general paediatrics, but takes at least twice as long as our 2019 survey shows, the pressure on paediatricians with special competence is high in university centres and large regional hospitals to work faster and thus sub-optimally with possible risks for the children. Stress and frustration is also high in these subspecialty paediatric services.
• Since the subspecialty paediatric services in Belgium have no official recognition, it is also difficult to get international fellowships recognised and offered.
• Due to the lack of recognition of paediatric subspecialties, children are still referred to adult internists who have no paediatric training and who perform technical services without having had the necessary training.
• The lack of recognition means that there is no control over the activities of some paediatricians who claim to have special skills, which is reflected in large differences in the number of specialist examinations in Belgium (cardiac ultrasound, bronchoscopy, gastroscopy) as demonstrated by the RIZIV/INAMI
• Within a paediatrics department, there is no possibility of honouring a requested opinion of a sub-specialist for an admitted child, which is possible for adults.

Article 8 of the Law of 28 March 2019 on the quality practice in health care stipulates that the health care professional may only provide healthcare for which he has the necessary demonstrable competence and experience. This must be recorded in his portfolio. It is highly questionable whether this new Law, in the absence of recognition of these special paediatrics subspecialty skills, offers any guarantee of quality to the child.