Pediatric surgery in The Netherlands differs from pediatric surgery in other European countries. This article deals with the general structure of Dutch pediatric surgery and some of its particularities. Although pediatric surgery is not officially recognized in The Netherlands, the Dutch have found a way of selecting and centralizing children who need surgical therapy in 6 centers of excellence. This has been mainly achieved by agreements between scientific professional organizations. The limited number of academic pediatric surgical centers guarantees a high quality of skill and care, and a lot of clinical exposure for trainees. On the other hand, allowing general surgeons to do most of the surgery in children, albeit the less complicated procedures, may not be ideal. The limited number of trainees does not allow for a nation-wide training program. The small number of pediatric surgeons and trainees make pediatric surgery in The Netherlands vulnerable, both in field of care as well as in the field of research. As pediatric surgery in The Netherlands is not recognized as such, pediatric surgeons who have been trained in most of the other European countries but have not completed their general surgery training, cannot be employed as pediatric surgeons in The Netherlands. However, pediatric surgery in The Netherlands has found a comparatively clear way of defining its distinctive areas of clinical work. It cannot be overlooked and is well established in the academic centers of the country.