Objective To characterize dyadic and general friendships of youth with spina bifida (SB). Methods Families of youth with SB recruited a peer to participate; 106 dyads participated. Youth with SB and peers completed questionnaires and interviews regarding characteristics of the dyadic friendship and each individual’s general friendships. Results Youth with SB and their peers were similar in many ways. However, youth with SB rated the friendship as closer and were more likely to see peers as best friends rather than the reverse. Regarding general friendships, youth with SB spent fewer days with friends, reported lower levels of companionship, security, and closeness in their friendships, and reported lower levels of emotional support from peers and family. Conclusions Youth with SB experience significant differences in the quality and reciprocation of friendships. Targeted interventions may assist youth in developing high quality friendships.