Some kids are also afflicted by scoliosis, a condition where the spine curves sideways. Even though it typically doesn't hurt, you should watch out for signs like uneven shoulders and leg length. Mild cases might only require routine doctor monitoring. However, a young person with a severe case of scoliosis may require braces and occasionally surgery.
There are three different types of scoliosis in children:
. Idiopathic scoliosis is the most common type. "Idiopathic" means that the cause is unknown, but because it runs in families, it has a genetic (hereditary) basis.
. Congenital scoliosis is a fairly rare spine abnormality detected at birth.
. Neuromuscular scoliosis is a curvature of the spine caused by abnormalities in the muscles and nerves that support the spine. Examples include patients with cerebral palsy, spina bifida and muscular dystrophy.
Scoliosis usually causes no pain, so symptoms can often go unnoticed. Parents or caregivers should watch for the following signs in their child:
. Uneven shoulders.
. Constant leaning to one side.
. Uneven leg length.
. Prominent shoulder blade(s).
. An uneven waist.
. Elevated hips.
If you notice any of these signs in your child, contact your doctor to have your child screened.
If you or a caregiver or teacher thinks your child may have scoliosis, contact your doctor as soon as possible. The doctor should also be screening for scoliosis on a regular basis and may be the first to suspect the condition.
An evaluation for scoliosis has several steps:
. Your doctor will usually begin with a thorough history to determine if there is a family history of scoliosis. The history will also be used to screen for birth defects or trauma that may explain the curvature of the spine.
. The doctor will then conduct a physical examination of your child's back, chest, pelvis, legs, feet and skin. The doctor will be looking to see if the child’s shoulders are level, whether the head is centered and whether opposite sides of the body look level.
. The doctor will then ask the child to bend forward so that the back muscles can be examined, and to see if one side of the rib cage is higher than the other.
. While checking the limbs, the doctor will be evaluating whether the limbs are the same length. He or she will also check for abdominal muscle strain, which could cause spinal curvature.
. After a physical examination, the doctor may order an X-ray of the spine to confirm a diagnosis of scoliosis. The X-ray will be taken with your child standing so that the entire spine can be seen. The doctor will then measure the curves of the spine as shown on the X-ray. Curves that are greater than 25 degrees may require treatment.
If your doctor determines that your child has scoliosis, he or she will refer you to an orthopaedic spine specialist for treatment.
If your child has scoliosis, the recommended treatment will depend on their age, how severe the curve is, and whether it's getting worse. Many children will not need treatment, and only a small number end up having surgery.
Treatment is not always necessary for very young children because their spine may straighten as they grow. But if the curve does not correct itself, there's a small risk it could reduce the space for the organs to grow, so careful monitoring by a specialist is important. Your specialist may recommend regular examinations and X-rays to monitor the curve and decide if treatment is needed. Regular monitoring may also be recommended for older children with mild scoliosis, as treatment might not be needed if it's not getting worse over time.
In babies and toddlers, treatment to try to help straighten the spine as it grows may be recommended. This may involve wearing a plaster cast fitted around their back. The cast is worn constantly and cannot be removed, but it's changed every few months as your child grows. Parents often find it easier for their child to wear a cast while they're still very young, rather than getting them to wear a removable back brace every day. You may decide to switch to a back brace when your child is a bit older.
If the curve of your child's spine is getting worse, your specialist may recommend they wear a back brace while they're growing. This will not correct the curve, but might help stop it getting worse. There are still some uncertainties about how well braces work so they're not recommended by all scoliosis specialists.
. will be custom-made to fit your child's body
. will normally be made of rigid plastic, although flexible braces are sometimes available
. is designed to be difficult to see under loose-fitting clothing
. usually needs to be worn for 23 hours a day
. should not interfere with most everyday activities – it normally only needs to be removed for baths, showers, swimming and contact sports
Your child will usually have to wear the brace for as long as they're growing. For most children, this means they can stop wearing it when they're around 16 or 17.
Surgery may be recommended if your child's scoliosis continues to get worse despite trying other treatments, or if they have severe scoliosis and they've stopped growing. The type of surgery offered will depend on your child's age.
Younger children – generally those under 10 – can have an operation to insert special rods alongside the spine. This can help stop the curve getting worse as the spine grows. After the operation, your child will need to return to their specialist every few months to have the rods lengthened to keep up with their growth. Depending on the type of rods used, this will be done either:
. during a minor procedure where the rods are extended through a small cut (incision) in the back
. using a remote control that activates magnets inside the rods – no incisions are needed to lengthen these rods
Even if they have surgery, your child may need to wear a brace to protect their back. When they stop growing, the rods can be removed and a final operation to straighten their spine may be carried out.
Like any operation, spinal surgery carries a risk of complications. It will only be recommended if your surgeon feels the benefits outweigh the risks. Some of the main risks include:
. bleeding – if this is severe, your child may need a blood transfusion
. wound infection – this can usually be treated with antibiotics
. the rods or metalwork moving or the grafts failing to attach properly – additional surgery may be required to correct this
. in rare cases, damage to the nerves in the spine – this can lead to permanent numbness in the legs, and can sometimes cause paralysis of the legs and loss of bowel and bladder control
Make sure you discuss the potential complications with your surgeon.
Regular exercise is important for children with scoliosis. It can help improve muscle strength and may help reduce any back pain. Children with scoliosis can usually do most types of exercise. They only need to avoid certain activities if advised to do so by a specialist. It's not yet clear whether specific back exercises or physiotherapy can help improve scoliosis – they're not recommended by all specialists. There's currently little reliable evidence to suggest that other therapies, such as osteopathy and chiropractic, can help correct a curved spine or stop it getting worse.
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