Enhancing Orthopedic Care: The Role of Pediatric Psychologists

Pediatric psychologists are highly integrated in various health clinics (e.g. endocrinology, hematology, oncology, etc.) but rarely (to our knowledge) are pediatric psychologists available within orthopedic clinics. The purpose of this article is to highlight the contributions of pediatric psychologists to pediatric orthopedics across clinical, research, and educational domains. 

Pediatric orthopedists are devoted to the prevention, diagnosis, and treatment of disorders of bones, joints, ligaments, tendons, and muscles. They provide surgical and non-surgical treatments (bracing, physical therapy) to patients ranging in age from infancy to young adulthood. Pediatric orthopedic surgeons often work within a multidisciplinary care system, which can include pediatric psychologists, to provide the best possible medical treatments for their patients.

Clinically, pediatric psychologists are trained to provide mental health services in a variety of medical settings and are often part of multidisciplinary teams. Pediatric psychologists are uniquely trained to provide services such as identifying and treating mental health concerns, improving adherence to medical regimens, preparing patients and families for surgical treatment, and providing education on non-pharmacological pain management.

Pediatric psychologists contribute to orthopedic care, specifically, by addressing a variety of clinical topics. Their presence within multidisciplinary teams ensures that psychological well-being is integrated into holistic care, ultimately enhancing the overall experience for patients and families. Pediatric psychologists assist children and families adjust to receiving a medical diagnosis and/or injury by providing emotional support and guidance. Psychologists guide families in understanding and accepting the implications of an injury or disability, fostering resilience, and promoting family cohesion. This is particularly important, as extant research indicates that children with disabilities are at an increased risk for mental health issues, including depression and anxiety. Within pediatric orthopedics, pediatric psychologists address these concerns through evidence-based interventions, which help children develop positive coping strategies and a positive self-image.  

Pediatric psychologists also play an integral role in assessing and educating patients and families in anticipation of orthopedic surgery. Pediatric psychologists meet with children and families on an outpatient basis prior to their surgery date to assist in coping skill development and provide detailed psychoeducation on all aspects of treatment. It is well documented that preparing children for procedural pain, including coping skill instruction, improves psychological adjustment, reduces pain following surgery, and reduces the amount of pain medication needed following surgery; Powers, 1999). Further, if mental health symptoms are identified as part of the preoperative assessment, psychologists can intervene prior to surgery to improve surgical outcomes, reduce stress in families, and improve perceived pain after surgery.

Additionally, pediatric psychologists are uniquely trained to assess and intervene when treating patients with chronic pain. Children with chronic pain have high rates of health care utilization and are at risk for continued pain, psychiatric comorbidities, and pain-related disability in adulthood. This is especially true for those experiencing back pain, amplified pain, and/or complex regional pain syndrome.

In addition to contributing clinically, many pediatric psychologists are rigorously trained in research methods, data analysis, and academic writing. Through collaboration with orthopedic colleagues, we can conduct complex projects aimed at better understanding the role that various psychological factors (e.g., mood, anxiety, pain catastrophizing) play in impacting orthopedic treatment outcomes (e.g., pain ratings, use of prescribed pain medication, length of hospitalization). Psychologists’ expertise in information dissemination may also help translate research findings into accessible formats both for formal publication as well as public consumption (e.g., public service announcements, patient education materials).

Finally, pediatric psychologists play a crucial role in educating future psychologists, medical residents, and fellows, as well as medical colleagues. Pediatric psychologists provide information regarding the impact of musculoskeletal conditions on a child’s mental health, social development, and overall well-being. Psychologists also teach strategies for effectively communicating with pediatric patients and their families, including communicating about a new diagnosis, providing information regarding a proposed treatment plan, discussing adherence behaviors, and when providing information and recommendations surrounding chronic pain treatment. Additionally, pediatric psychologists may lead discussions on ethical issues, cultural and diversity considerations, and interdisciplinary collaboration in pediatric orthopedics, ensuring that future healthcare professionals are well-prepared to address the complex and evolving needs of pediatric patients. This education is generally a dynamic process and takes place across multiple levels, ranging from intra-hospital didactics / trainings to clinical consultation, to national and international research conferences.

Becoming board certified is an important step for our medical colleagues to observe our expertise in a manner that is highly regarded in the medical field. These authors strongly encourage psychologists who are interested in collaborating with orthopedists to seek board certification not only as a commitment to their education, professional development, and desire to hold themselves to a standard of excellence, but to be recognized within medical disciplines. Within the last four years, an APA Special Interest Group has been formed with the goal of impacting clinical, research, and training within orthopedics and sports medicine, indicating a growing interest in the field and awareness of the lack of representation of psychologists within orthopedics.