Training Pathways, Workforce Distribution, and Professional Practice of Child Neurologists in Brazil: A Cross-Sectional Study With Implications for Access to Care.

BACKGROUND: To analyze training pathways, geographic distribution, and professional practice of child neurologists in Brazil. METHODS: This national cross-sectional descriptive service evaluation integrated three data sources: (1) official registries of accredited child neurology residency programs and certified specialists, (2) a structured survey of residency program coordinators, and (3) a nationwide survey of practicing child neurologists. Descriptive statistics and exploratory analyses were performed. RESULTS: In 2025, Brazil had 30 accredited child neurology programs offering 90 annual positions. There were 1,339 certified child neurologists (0.66 per 100,000 inhabitants), with marked regional disparities. Of 27 programs, 24 responded (88.8%); 91.7% were university-affiliated. Basic diagnostic procedures were universally available (computed tomography and electroencephalography), whereas access on-site for other modalities was limited (magnetic resonance imaging: 66.7%; functional neuroimaging: 41.7%; video-electroencephalography: 58.3%; polysomnography: 62.5%; genetic and metabolic testing: less than 20%). Among 215 child neurologists (mean age 40.4 years; 84.2% female), 47.9% worked exclusively outpatient, primarily managing neurodevelopmental disorders (96.7%), epilepsy (94.9%), and cerebral palsy (74.9%). Telemedicine was used by 60.9%. Income correlated with age (P < 0.001) and mixed practice (P = 0.011) but not region (P = 0.167). Career choice was influenced by training quality, positive models, and employment prospects, and 90.2% would choose the specialty again. CONCLUSIONS: Despite expansion, child neurology training and workforce distribution in Brazil remain uneven, with regional disparities and heterogeneous training that may limit equitable access. Nevertheless, most would choose the specialty again, with career choice driven by training quality, mentorship, and professional opportunities.