Why Is Choosing a Pediatric Orthopedic Surgeon for Your Child Important?

As a parent, when your child needs orthopedic care, it’s tempting to turn to a general orthopedic surgeon who has treated you or someone you know before. However, it’s important to recognize that children with conditions like clubfoot, limb deficiency and scoliosis have special, changing needs that require the attention of a specialist, like a pediatric orthopedic surgeon.

To demonstrate how specialized these practitioners are, just look at the numbers. There were over 27,000 orthopedic surgeons in the United States as of 2023, according to a report. However, per a 2024 analysis, there were only about 1,200 pediatric orthopedic surgeons.

But their rarity isn’t the only thing that makes these doctors so special. We talked to a pediatric orthopedic surgeon (and chief of staff) as well as a physician assistant in pediatric orthopedics from two Shriners Children’s hospitals to discuss the differences between the two types of orthopedic surgeons – and why making the right choice to treat your child is crucial.

Different Education

In the U.S., those seeking to become orthopedic surgeons need to graduate from an approved medical school (typically four years) and graduate from an approved orthopedic surgery residency program (typically five years). However, pediatric orthopedic surgeons must complete additional subspecialty training, like a fellowship (typically one year).

Vishwas Talwalkar, M.D., a pediatric orthopedic surgeon and chief of staff of Shriners Children’s Lexington, knew when he was in high school that he wanted to treat children, he said. He also wanted to be an orthopedic surgeon at one point. So, it wasn’t until he was exposed to different kinds of patients and cases in medical school and during his residency that he realized pediatric orthopedics was the right choice for him.

“I realized that taking care of children was a lot more interesting and fun for me, and I thought that the variety that they presented was stimulating and the operations were interesting, and I thought I could do a broader variety of things in pediatric orthopedics than I could in almost any other field,” he said. “So, it was just, it was easy for me to decide.” He began working at Shriners Children’s in 1999 and hasn’t looked back since.

On the other hand, Christine Betancourt, PAC, MPAS, from Shriners Children’s Erie knew she wanted to pursue this field as a teenager, she said. “I was a very active kid and was a dancer throughout my childhood, college and into my early adult years. I then taught children as a dance teacher throughout PA school. I sustained many musculoskeletal injuries as a young athlete and underwent orthopedic surgical intervention when I was a teenager.”

As a physician assistant in pediatric orthopedics, she has been trained and mentored by pediatric orthopedic specialists, “continually learning and advancing my knowledge base to remain on the forefront of evidence-based practice,” she said.

Different Knowledge of the Body

When it comes to the difference between the two types of orthopedic surgeons, Betancourt puts it succinctly: “Kids are not just small adults,” she said. “Their bones are growing and, with that, come differences in the injuries that they sustain and the way that we appropriately treat those injuries.” Dr. Talwalkar adds that pediatric orthopedic surgeons also understand child cognitive development, enabling them to address global problems that regular orthopedic surgeons might miss.

Another key point: Amazingly, every bone in our bodies has its own growth timeline. “While the majority of bone growth is completed by skeletal maturity (roughly age 16 for males and two years after a first menstrual period for females), the clavicle is the last bone to stop growing around the age of 25,” Betancourt said. “Pediatric orthopedic specialists are experts on bone growth, knowing which growth centers are open at specific ages and the patterns in which the growth plates will close.”

Understanding the difference between adult and child physiology is especially important when it comes to fractures. Since children’s bones are still growing, some fractures can heal on their own without surgical intervention. But it takes a specialist to know when that will work. “The goal is to make an appropriate diagnosis so that we are not undertreating an injury, but we are also not overtreating something that will improve on its own,” Betancourt said.

In particular, when fractures involve a growth plate, special care must be taken. “It can be complicated because [intervention] may affect the growth of the limb or cause a deformity,” Dr. Talwalkar said. “So, there are a variety of ways of knowing how the body grows and develops and the anatomy that's involved in that growth and development, and that affects how we take care of kids.”

In addition, when a patient presents with a problem, it takes a trained eye to know if it’s a true injury or just a normal issue, perhaps causing growing pains, Betancourt noted.

Different Relationships

Dealing with children requires an entirely different skillset than dealing with adults, and pediatric orthopedic specialists hone their approach over the years. An appropriate pediatric bedside manner is important not just so the child will have a positive impression of the practitioner but so that the patient will communicate with them, listen thoroughly and follow directions.

Dr. Talwalkar said that his approach differs, depending on the child, but he does whatever it takes to connect with them. “The most important thing is you have to get down to their level. So, if that means you have to sit on the floor, you sit on the floor. If it means that they're more comfortable in their parent’s lap, you examine them that way. If they have siblings in the room who can get them to do the things they need to do for you to observe them, then use all the tools that are necessary.”

Treating children also calls for using kid gloves, so to say, when dealing with patients to make their entire experience – and each and every visit – as positive as possible. “The whole staff here is focused on how to make a child's visit a little less scary and a little more fun so that, when they leave, they feel like they want to come back instead of being scared about the interaction,” he said.

Since many pediatric orthopedic patients require ongoing care, both Betancourt and Dr. Talwalkar enjoy forming long-term relationships with children as well as their families. “Being a part of the journey of a child from onset of injury through treatment and ultimately through their progression back to play is what I love and appreciate the most about my role,” Betancourt said.

Dr. Talwalkar agrees: “Because you get to develop a relationship with them – a lot of my patients I've known essentially their whole life – I value that relationship. That's one of the things that I enjoy.”

Indeed, compared to treating an adult patient who may or may not bring someone with them to a hospital visit, pediatric patients are usually surrounded by family. The practitioners thus have to communicate with them, develop a rapport with them and take their unique home environment into account.

“We also treat the family as a unit,” Betancourt said. “The treatment plan developed for each patient considers their unique family situation as well as their unique lifestyle and goals. Educating patients and their families is a genuine passion of mine. I always take extra time to ensure that my patients and their families understand their injury, and they also understand the reasoning behind my decision-making and treatment approach.”

Shriners Children’s special brand of wrap-around care, which aims to treat every aspect of a patient, makes parents’ lives easier by providing many services under one roof. “A unique and wonderful aspect of the Shriners system is our multidisciplinary care,” Betancourt said. “Patients are able to see a pediatric orthopedic specialist who can enlist the support and guidance of our child life specialists, physical therapists, occupational therapists, orthotists and prosthetists, nutritionists and social workers.”

After working at Shriners Children’s for 26 years, Dr. Talwalkar still enjoys every day at the hospital as much as his first. He loves the kids, of course, calling them “resilient and so much fun,” but he appreciates his colleagues, too. “I've had great partners to work with, and pediatric orthopedics tends to attract people who are pretty happy and fun to be with,” he said. “I think it's a career that – if I had to do it all over again – I would choose it in a heartbeat. It's been wonderful.”