Based on the experience of 2 physicians from physiatry and developmental pediatrics, this article proposes a framework for improving care and outcomes for children with spina bifida. The combined skills of physiatrists and developmental pediatricians, along with other disciplines, can form the ideal team to manage the complex issues faced by this population. The developmental pediatrician is best suited for directing care for younger children through the elementary and middle school years, during which time behavioral and educational issues are prominent. As the child assumes more responsibility for self-management in adolescence, the physiatrist is ideally suited to provide major clinical input that improves functional outcomes. The addition of the discipline of physiatry to traditional, developmentally oriented pediatric interdisciplinary teams can add the much needed dimensions of activity and participation, and improve functional outcomes at the adult level by encouraging activities in adolescence that lead to full participation in adulthood.