Pediatric Rheumatologist: What They Treat and When Your Child Needs One
Quick answer: A pediatric rheumatologist is a children’s doctor who diagnoses and treats conditions that cause inflammation in the joints, muscles, bones, skin, blood vessels and other connective tissues, many of them autoimmune. They treat juvenile idiopathic arthritis (JIA), lupus, juvenile dermatomyositis, vasculitis such as Kawasaki disease, periodic fever syndromes and uveitis. After medical school, they complete 3 years of pediatrics residency and 3 years of pediatric rheumatology fellowship, and are board certified by the American Board of Pediatrics. Ask your pediatrician about a referral if your child has joint swelling, morning stiffness or a limp that lasts more than a few weeks, unexplained fevers, a rash with joint pain, or muscle weakness.
What is a pediatric rheumatologist?
A pediatric rheumatologist is a medical doctor who specializes in rheumatic diseases in children, from infants to teens. Rheumatic diseases happen when the immune system causes inflammation in parts of the body such as the joints, muscles, skin, eyes, blood vessels or organs. Many are autoimmune, meaning the immune system mistakenly attacks the body’s own tissues; others are autoinflammatory, causing repeated bouts of fever and inflammation.
These conditions are more common in children than many parents realize. The CDC estimates that about 220,000 U.S. children and teens have diagnosed arthritis, roughly 1 in 330. The Arthritis Foundation puts the number with arthritis or another rheumatic disease at about 300,000.
What does a pediatric rheumatologist treat?
According to the American Academy of Pediatrics (AAP), pediatric rheumatologists care for children with:
| Condition | What it affects |
|---|---|
| Juvenile idiopathic arthritis (JIA) and other arthritis | Joints: swelling, pain, stiffness |
| Systemic lupus erythematosus (lupus) | Skin, joints, kidneys, blood and other organs |
| Sjögren syndrome, scleroderma and mixed connective tissue disease | Skin, glands and connective tissue |
| Juvenile dermatomyositis and other muscle inflammation | Muscles and skin |
| Vasculitis, including Kawasaki disease, IgA vasculitis (Henoch-Schönlein purpura), ANCA-associated vasculitis and Behçet’s disease | Blood vessels |
| Periodic fever syndromes, such as PFAPA | Repeated fevers and inflammation |
| Chronic uveitis | Inflammation inside the eye |
| Chronic recurrent multifocal osteomyelitis (CRMO) | Bones (non-infectious inflammation) |
When should my child see a pediatric rheumatologist?
Most children see a pediatric rheumatologist after a referral from their pediatrician. Signs that may lead to a referral include:
- Swollen, warm or painful joints, especially with stiffness in the morning or after rest, lasting more than about 6 weeks
- Limping, refusing to walk or trouble with stairs, without an injury
- Missing school or activities because of joint pain or stiffness
- Fevers that last more than 2 weeks with no clear cause, especially with rash, mouth sores or swollen joints
- Rashes such as a butterfly-shaped rash across the cheeks and nose, a purple rash on the eyelids, or red patches over the knuckles
- Muscle weakness, such as trouble climbing stairs, getting up from the floor or lifting the arms
- Fingers or toes that turn white, blue and then red in the cold (Raynaud’s), when episodes are severe or frequent
- Abnormal blood tests, such as signs of inflammation or a strongly positive ANA
Get urgent care for severe muscle weakness, trouble swallowing or breathing, a joint that is very swollen and hot with fever, or a child who seems very sick. See our red-flag guide for parents.
Pediatric rheumatologist vs. pediatric orthopedist: who should my child see?
| Pediatric rheumatologist | Pediatric orthopedist | |
|---|---|---|
| Focus | Inflammation and immune-related disease of joints, muscles and tissues | Bone and joint structure, injuries and growth problems |
| Common reasons to see | Ongoing joint swelling and stiffness, lupus, unexplained fevers with joint pain | Fractures, sports injuries, scoliosis, hip or foot problems |
| Main treatments | Medicines, joint injections, physical therapy | Casting, bracing and surgery |
| Surgery? | No | Yes, when needed |
If you’re not sure, start with your pediatrician. Joint pain after an injury usually points to orthopedics; swelling and stiffness without an injury, or joint pain with fever or rash, often points to rheumatology. Sports-related problems may also be seen in pediatric sports medicine.
Why see a pediatric rheumatologist instead of an adult one?
Children aren’t small adults. Their bodies are still growing, and rheumatic diseases can affect growth, bones and development differently than in adults. Children also describe symptoms differently and may not be able to sit still for an exam. Pediatric rheumatologists are trained to examine children at every age and to earn their trust, and they know how to choose and dose medicines for growing bodies.
What training does a pediatric rheumatologist have?
According to the AAP, pediatric rheumatologists complete:
- At least 4 years of medical school
- 3 years of pediatric residency, training in general children’s health
- 3 years of fellowship focused on conditions affecting children’s joints, muscles, bones and connective tissues
They are board certified by the American Board of Pediatrics in both pediatrics and pediatric rheumatology. Many also do research to improve care for children with rheumatic diseases.
What happens at the first visit?
The first appointment is usually longer than a regular checkup. The pediatric rheumatologist will:
- Ask detailed questions about your child’s symptoms and your family’s health history
- Review recent lab results, X-rays and other imaging
- Do a full physical exam, including checking every joint
Depending on what they find, they may order:
- Blood and urine tests, such as markers of inflammation and antibody tests
- Imaging, such as X-rays, ultrasound or MRI
- Joint aspiration, removing fluid from a swollen joint to test it
- Breathing tests, nerve tests or a skin or muscle biopsy in some cases
Some diagnoses take more than one visit. That’s normal, because many rheumatic conditions develop over time.
How to prepare
- Keep a symptom diary: when pain or stiffness happens, how long it lasts and what helps
- Take photos of swollen joints or rashes, since they can come and go
- Bring a list of medicines your child takes and any past test results
- Note any family history of autoimmune disease, psoriasis or inflammatory bowel disease
- Write down your questions ahead of time
How do pediatric rheumatologists treat children?
Treatment depends on the condition, your child’s age and overall health. Pediatric rheumatologists usually lead a team that may include your pediatrician, nurses, physical and occupational therapists, eye doctors, skin or kidney specialists, social workers, psychologists and nutritionists. Care may include:
- Medicines to control inflammation, such as anti-inflammatory drugs, steroid injections into a joint, disease-modifying medicines such as methotrexate, and biologic medicines
- Physical and occupational therapy to keep joints moving and muscles strong
- Regular eye exams for children at risk of uveitis, which can cause no symptoms at first
- Support for school, sports and emotional health
The goal is to control the disease early, prevent lasting damage and help your child live a full, active life.
How hard is it to find a pediatric rheumatologist?
Pediatric rheumatologists are rare. According to the Arthritis Foundation (2025), there are only about 420 board-certified, practicing pediatric rheumatologists in the U.S. Eight states have none, families travel an average of 57 miles to see one, and only about 1 in 4 children with arthritis is able to see one.
Most work at children’s hospitals, university medical centers and large community hospitals. Ways to find care:
- Ask your pediatrician for a referral; many specialists require one, and your insurance may too
- Check the nearest children’s hospital’s rheumatology department
- Ask whether telehealth visits are offered for follow-ups
- Search our pediatrician directory to find specialists near you
Frequently Asked Questions
What does a pediatric rheumatologist do?
A pediatric rheumatologist diagnoses and treats conditions in children that cause inflammation in the joints, muscles, bones, skin, eyes and blood vessels, such as juvenile idiopathic arthritis, lupus, juvenile dermatomyositis, vasculitis and periodic fever syndromes. They use exams, lab tests and imaging to make a diagnosis, then manage treatment with a care team.
Can children really get arthritis?
Yes. The CDC estimates about 220,000 U.S. children and teens have diagnosed arthritis, about 1 in 330. The most common type is juvenile idiopathic arthritis (JIA), which causes joint swelling, pain and stiffness.
When should I take my child to a pediatric rheumatologist?
Talk to your pediatrician about a referral if your child has joint swelling, morning stiffness or a limp lasting more than a few weeks, unexplained fevers lasting more than 2 weeks, a rash with joint pain, muscle weakness, or blood tests showing inflammation or a strongly positive ANA.
What is the difference between a rheumatologist and an orthopedist for kids?
A pediatric rheumatologist treats inflammation and immune-related diseases of the joints and tissues with medicines and therapy. A pediatric orthopedist treats injuries and structural bone and joint problems, such as fractures and scoliosis, and can perform surgery.
Does a positive ANA test mean my child has lupus?
Not necessarily. A low positive ANA is common in healthy children and, without other symptoms or abnormal tests, is unlikely to mean lupus. A pediatric rheumatologist looks at the whole picture, including symptoms, an exam and other blood and urine tests.
Is it serious if my child is referred to a rheumatologist?
A referral doesn’t mean your child has a serious disease. It means your pediatrician wants a specialist to look more closely at symptoms such as joint pain or fevers. Many children are found to have a minor or temporary problem, and those with a rheumatic disease benefit from early treatment.
What training does a pediatric rheumatologist have?
Pediatric rheumatologists complete at least 4 years of medical school, 3 years of pediatric residency and 3 years of pediatric rheumatology fellowship. They are board certified by the American Board of Pediatrics in pediatrics and pediatric rheumatology.
Do I need a referral to see a pediatric rheumatologist?
Often, yes. Many pediatric rheumatology clinics and insurance plans require a referral from your child’s pediatrician, who can also send lab results and notes to help the specialist. Check with the clinic and your insurance.
Related guides
- Common Disorders Treated by Pediatric Rheumatologists
- Juvenile Idiopathic Arthritis (JIA) in Children
- Lupus (SLE) in Children
- Best Practices for Children With Joint Disorders
- Types of Pediatricians
- Find a Pediatrician Near You
Sources
- AAP (HealthyChildren.org): What is a Pediatric Rheumatologist?
- CDC MMWR: Arthritis Among Children and Adolescents Aged <18 Years, United States, 2017–2021
- Arthritis Foundation: Increase Access to Pediatric Rheumatologists
- Valley Children’s Healthcare: Pediatric Rheumatology Referral Guidelines
Last reviewed October 2026 against the sources above. This article is for general information and is not a substitute for advice from your child’s doctor.
