Pediatric neurosurgery very likely became an entity because of the admission of children with CNS diseases to children's hospitals and the development of subspecialization. This latter, in pediatric neurosurgery, has been more a result of events, such as the individual's working propinquity to other pediatric specialists and his being comfortable with children and their parents, than of methodical adherence to a philosophical precept. A fellowship in pediatric neurosurgery, in my opinion, has negative value, in that it would create a working/learning situation in which the fellow would take essential educational and responsibility experiences from the resident and would be delegated patient-care and teaching accountabilities he is not ready to assume. Two, more appropriate, alternatives could be either an additional year as a resident, or a proper staff appointment, depending upon the candidate and the institution. The pediatric neurosurgeon, like other subspecialists in our discipline, may be identified on the basis of what he does, how well he does it, and which societies recognize him as member. Since subspecialization as we see it today is inevitable and represents progress, a certificate (in the subspecialty of pediatric neurosurgery) awarded by the American Board of Neurosurgery would have positive implications, as would, for example, a Continuing Education Award, given by the AANS, the CNS, or the American Society for Pediatric Neurosurgery. Such certificates or awards could serve differeing purposes or provide differing recognition as the life of our subspecialty unfolds.