Presenting Pediatric Cases on the ABOS Part II

Pediatric cases are the ones candidates tend to underprepare for. The operative decision-making feels familiar. The classifications feel learnable. So candidates study the bones and the hardware — and walk into the exam unprepared for the part examiners actually probe hardest: the conversation with the family.

If a case selector assigns you a pediatric case out of your twelve, you're defending more than your surgical technique. You're defending how you talked to the parents, how you weighed growth, how you set expectations, and how you documented all of it. Miss any of those, and the examiners have a clean path to push you.

Why Pediatric Cases Are Different

Adult cases are, in a sense, one-person decisions. You explain the options, the patient chooses, you document consent, you operate. Pediatric cases sit on top of a second layer: the parents are also the decision-makers, and the child's long-term trajectory — growth, function, sport, activity — sits squarely in the middle of every conversation.

That layer changes what “shared decision-making” has to look like in your case summary. It's not a single consent conversation. It's a series of discussions with adults who are afraid, who often disagree with each other, and who are making a choice for someone who can't fully consent themselves. The examiners know this. They'll probe it.

The Three Things Examiners Probe

1. The Family Conversation

This is the most underprepared part of pediatric case presentations. Candidates write “discussed risks and benefits with family” and assume it's enough. It's not.

Examiners want to hear that you actually had a conversation — who was in the room, what the parents' concerns were, what questions they asked, and how you answered. They want to know whether you presented non-operative options honestly or whether you steered the family toward surgery because that was your comfort zone.

The phrase “through shared decision-making” is mandatory in every case presentation, but in pediatric cases it has to come with substance. Name the alternatives that were considered. Name what the parents preferred and why. Name the moment the decision was made.

2. Growth and the Long View

A skeletally immature patient is not a small adult. Every decision you make has to account for remaining growth and the long-term trajectory of the limb, the joint, or the spine. You don't need to recite textbook growth data on the stand — but you do need to show the examiners that growth was explicitly part of your decision-making.

What did you discuss with the family about how growth might affect the outcome? What follow-up did you plan because of the patient's age? If a later procedure might be needed, did you raise that possibility at the time of consent, or did the family only hear about it afterward?

This is also where the overlap between conservative care and surgery gets tested. Pediatric bones tolerate non-operative management in situations where adult bones wouldn't. The examiners may push you on whether you operated too early, or whether you let something drift that should have been fixed. Your answer has to show you weighed both paths and had a defensible reason for the one you chose.

3. The Follow-Up Plan

Pediatric follow-up is longer than adult follow-up. A child you operated on at ten years old has years of growth ahead. Examiners will look at your documentation to see whether your follow-up plan reflects that, or whether the patient disappears from your notes after the six-week visit.

A strong pediatric case summary shows a clear, longitudinal plan: when you saw them, what you were monitoring at each visit, and what the endpoint looks like. If the family was lost to follow-up, say so. Don't hide it — examiners will find it in the records, and if you glossed over it, you handed them a problem that didn't need to exist.

Common Pitfalls

Across the pediatric cases candidates bring in for coaching, the same mistakes show up over and over:

• Vague family communication notes. A single sentence about “risks discussed” is not a defensible consent conversation in a pediatric case.
• Glossing over growth considerations. The case summary talks about the fracture or the deformity but never explicitly addresses how the patient's remaining growth shaped the plan.
• Thin follow-up plans. Short-term follow-up only, with no mention of how the patient will be monitored across the years that matter.
• Over-confident outcome language. Pediatric families want optimism, so candidates pick up the habit of promising outcomes they can't guarantee. Examiners notice. Stay humble — “overall satisfied” beats “excellent result” every time.
• Treating the parents as a footnote. In the summary, the parents should be part of the story, not an aside at the end.

How to Prepare Your Pediatric Cases

Start with the case summary. Before you practice presenting, read it as if you were an examiner looking for weaknesses. Every time you find a vague line about the family conversation, rewrite it with specifics. Every time the plan skips the growth question, add a sentence that addresses it. Every time the follow-up feels thin, extend it.

Then practice out loud. Pediatric cases are particularly vulnerable to rambling because there's so much context to cover — the child, the parents, the growth, the alternatives, the follow-up. The only way to stay tight under pressure is repetition. Present the same pediatric case ten times until the structure flows without thinking.

And practice the pushback. Have someone challenge your decision to operate. Have them ask why you didn't wait. Have them ask what the parents thought. Have them ask what happens if the outcome drifts over the next five years. The examiners will ask some version of all of these — the only question is whether you've heard them before.

One more thing worth practicing: the tone. Pediatric cases carry emotional weight that adult cases usually don't, and candidates sometimes slip into either over-explaining (because they feel the need to justify operating on a child) or under-explaining (because they assume the examiners will fill in the blanks). Neither works. Present the case the same way you'd present an adult case — calm, structured, specific — and let the pediatric-specific reasoning surface naturally inside that structure.

A Note on the Cases You Didn't Choose

Remember that candidates only defend their own cases. The case selectors pick twelve out of the collection you submitted, and you can't predict which ones they'll assign. If you included pediatric cases, assume the selectors will pull at least one. Prepare every pediatric case you submitted to the same standard — there's no such thing as a throwaway case in your twelve, and pediatric cases are the ones candidates most often wish they'd prepared harder after the fact.

The Bottom Line

Pediatric cases don't fail because candidates don't know the surgery. They fail because candidates underprepare the surrounding story — the family conversation, the growth reasoning, the long-term plan. All three of those live in the case summary before they ever live in your voice. Fix the documentation first, then practice presenting it until the story is automatic.

When the examiners probe the parts most candidates underprepare, you'll already have the answer ready.