How to Find a Best Hospital for Pediatric Orthopedics

When your child breaks a bone or develops a spinal condition, your No. 1 priority is getting the best treatment at the right hospital. In an emergency, location often dictates the decision -- your child goes to the nearest facility that can provide care. However, for elective surgery or a comprehensive evaluation, your options widen.

Because kids are still growing, they have unique medical and surgical considerations. Below, specialists in pediatric orthopedics share their perspectives on finding the best care for your child.

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Dealing with an injured or sick child can be overwhelming even for the most educated and savvy parents, says Dr. Daniel Green, a pediatric orthopedic surgeon at the Hospital for Special Surgery in New York City. "The emotion and anxiety that accompanies the situation often drives parents to [seek] care at the closest, fastest location," he says.

Location is important but it isn't everything. "In an emergency situation with a fractured leg, like a femur fracture of the thighbone, it's so painful you really have to follow your EMS and go to your local hospital and get stabilized and assessed," Green says. "In many instances, emergency care at that community hospital or that local hospital is the best for you."

However, Green adds, with some knee, ankle or even hip injuries, it's OK for a child to get a splint at the time, giving parents a week or so to regroup and consider their surgical options if needed.

Specialty care is typically best provided in a specialty hospital, according to Green. That could mean an orthopedic hospital with a dedicated pediatric center or a children's hospital with a pediatric orthopedic staff.

Low infection rates represent a hallmark of good care. "Parents should inquire about a hospital's pediatric infection rates, as well as its approach to infection prevention in pediatric patients," Green says. Fortunately, he says, infection rates for ordinary elective orthopedic procedures in children are very low, typically less than 1 percent among hospitals in general, although they may be slightly higher for some spinal surgeries.

In some states, infection rates are publicly available to allow comparison. For example, you can click around an interactive map of Washington hospitals to compare in-state rates. If you live in Colorado, you can view Colorado's 2017 report on health care-associated infections to find data on joint-surgery outcomes. To be more transparent, some hospitals post their own results publicly. Another decision tool parents can use is the latest U.S. News Best Children's Hospitals rankings.

Second opinions can be valuable for parents weighing their child's options. "Parents shouldn't be afraid of requesting or seeking out a second opinion," Green says. "A second opinion can provide important insights into their child's condition so that they can feel confident about their treatment decision."

For a child facing surgery, choosing a surgeon is a major factor in choosing a hospital. Parents can start with two clear but simple questions, suggests Dr. Jennifer Weiss, a pediatric orthopedic surgeon who also specializes in sports medicine with Kaiser Permanente, based in Los Angeles:

-- Does your orthopedic surgeon have experience with the injury or condition that your child has?

-- Is your orthopedic surgeon's office comfortable taking care of children in your child's age group?

The answers should help narrow down your choices.

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Children aren't just small adults, Green emphasizes. Kids' injuries, treatments and recovery patterns are different. "Boys typically have open growth plates in their legs until 16 or 17 years of age, while girls' growth plates are open until 14 to 15," he says. Ask what percentage of an orthopedic surgeon's practice is dedicated to pediatric patients, he suggests.

"It's really the growth and development of the body and the kids' activities that combine to make their injuries different," Green notes. For example, he says, with injuries to the anterior cruciate ligaments of the knee, the ACL reconstruction is done differently in children. Similarly, if the kneecap is dislocated, patella surgery is performed differently in kids than in adults.

"Parents should want to know they have a surgeon with expertise in the specific orthopedic condition in question -- and compassion," advises Dr. Peter Newton, chief of the division of orthopedics and scoliosis at Rady Children's Hospital in San Diego, in an email. "We practice in a specialty with a wide array of conditions and super-specialization is required to manage the most complex conditions well," says Newton, who is also a clinical professor at the University of California--San Diego School of Medicine.

A forearm fracture requiring a cast is likely a simple issue that doesn't call for a hospital with an extensive support staff, Newton notes. However, for children with complex conditions, like a spinal deformity that requires complete reconstruction, their care may necessitate a wide variety of consultants and specialized services. The more complex the condition, he says, the more important an institution's quality and availability of a wide range of resources becomes.

Surgical expertise isn't easy to define, Newton says, but hallmarks of a dedicated, experienced surgeon include training and teaching others, commitment to lifelong learning, discovery of new knowledge through research and an emphasis on achieving and improving the quality of outcomes for patients.

Compassion is even harder for parents to pinpoint. "Sensing compassion is something parents need to do for themselves," Newton says. "Decisions on management, operative and nonoperative, require both expertise and compassion."

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When it comes to hospital staff, size and makeup matter, agrees Dr. Brian G. Smith, a professor with the department of orthopedics at the Yale University School of Medicine. Having a "critical mass" of at least five or six pediatric orthopedists allows subspecialization in the area affecting your child, such as scoliosis or a hip or foot condition, he explains in an email.

An academic affiliation with a medical school is another plus for a hospital, according to Smith. "This indicates an education mission and the staff keeping up with the latest treatments." Similarly, he adds, a research background shows that "the staff is trying to advance science and improve care for patients."

Parents can check the Pediatric Orthopaedic Society of North America website for in-depth information on children's orthopedic conditions and treatments.

Lisa Esposito is a Patient Advice reporter at U.S. News. She covers health conditions, drawing on experience as an RN in oncology and other areas and as a research coordinator at the National Institutes of Health. Esposito previously reported on health care with Gannett, and she received her journalism master's degree at Georgetown University. You can follow her on Twitter, connect with her on LinkedIn or email her at lesposito@usnews.com.