Care4Kids

Scoliosis

The spine is the axis of a child’s growing bone structure, and it’s the chief protector of the young nervous system. But in some children, the spine begins to curve abnormally. Instead of developing straight up and down, the spine may curve to one side like the letter “S.” In some children, it curves and twists like the letter “C.” This is known as scoliosis.

The cause of scoliosis is unknown. What is known, however, is that it isn’t caused by upbringing, posture, exercise, heavy backpacks or other habits. (For general health, however, children should limit the weight of their backpacks to 15 percent of their body weight.)

For reasons still being studied, scoliosis is more common in girls than boys. It tends to strike children just as they enter adolescence, during that critical developmental stage when growth is rapid. It also tends to run in families and may be connected to other medical conditions or diseases.

Too often, a child’s rapid growth masks scoliosis. It’s hard to spot in the early stages, especially because onset coincides with the growing child’s need for privacy — such as dressing and bathing out of parents’ sight. It’s also easy for parents to mistake scoliosis for poor posture or slumping.

Scoliosis is nothing to ignore. Your child’s appearance may be permanently disfigured by the condition. If the condition is advanced, her hips and shoulders may become asymmetric as her body automatically adjusts to maintain balance.

In rare, severe cases, your child may suffer fatigue, breathing difficulties and backaches. Only rarely does a large, untreated curve lead to more serious complications involving the heart and/or lungs or arthritis of the spine.

The good news is that there are no restrictions on most activities for children with scoliosis, nor are there restrictions on job-related activities as they grow older. Only those who have had spinal fusion surgery may need to adhere to some restrictions.

TYPES

DIAGNOSIS
Scoliosis rarely causes pain or discomfort. There are few outward signs until the curvature advances. If there is pain, doctors usually look for an underlying abnormality that causes the pain and scoliosis.

The condition often is spotted during routine physical exams by your child’s doctor or at school. Parents also can spot scoliosis. Look for:

To examine your daughter at home, have her put on her bathing suit and look at her back from behind. Is there a discrepancy in the level of her shoulders, shoulder blades, elbows or hips? Then have her bend forward so her back is parallel to the floor. Does one side of her rib cage seem to stick up?

Your child’s doctor can use a standing X-ray to confirm scoliosis and determine the degree of severity and treatment options.

TREATMENT
Most patients who have scoliosis will not require treatment. Only those with large curves, or who have shown significant worsening in their curves, usually require treatment.

Some curvatures can be deterred by wearing an external brace. The brace acts as a primary holding device to hold the curve but not correct it. It is effective about 75 percent of the time. In most cases, this will take the form of an underarm plastic jacket with built-in corrective forces that are custom-tailored to the patient. Some braces are worn 23 hours a day and will interfere only slightly with daily activities. Some curves respond to treatment with a nighttime-only brace. Your child’s doctor will determine which type of brace is best for her curve.

Normal activities are encouraged, and children in braces can compete in almost all sports while not wearing the brace. Once the child’s bone maturity reaches a certain level, she can be weaned off the brace.

Be prepared for her to refuse to wear the brace. Studies have shown that patients wear their braces only 65 percent of the time. In one study, 85 percent of patients were noncompliant. Adolescent girls are extremely conscious of their appearance, even under the best circumstances. Wearing a brace may make a girl feel deformed and different from her friends. Unfortunately, a brace simply doesn’t work if it’s not worn. Your daughter may be more likely to comply with wearing her brace if she can wear it at night only. Talk to her doctor about this option.

If she must wear her brace during the day, help her prepare for other people’s reactions to the brace. Encourage her to talk about her feelings and frustrations. It’s normal for her to complain about the inconvenience and restrictions that come with the brace. Help her find ways to view the brace as positive — but make sure she wears it according to the doctor’s directions.

Sometimes, braces aren’t enough. Braces don’t work when a child’s spine is finished growing; this is usually around age 14 for females and age16 or 17 for males. If the spinal curve is greater than 45 degrees or if scoliosis is paralytic or congenital in nature, surgery may be the best solution. Your son’s age and the location of his curve on the spine also may be factors.

Several surgical techniques — using sophisticated metal rods, hooks, wires and screws — can help straighten and un-rotate the spine. Bone is added and the spine is fused to maintain alignment over time.

After a spinal fusion, “rough” activity is limited for about 4 to 6 months. Most children are then able to return to their previous activities, with the exception of gymnastics and possibly contact sports. Many patients who have previously worn a brace or had a spinal fusion can resume playing sports such as basketball and softball. Your child’s surgeon must decide which activities are appropriate for him.

Females with scoliosis should have no problems with childbirth or pregnancy, even if they have had spinal fusion for a large curve. Scoliosis does have hereditary tendencies, so parents with scoliosis need to watch their children carefully.

Whether your child’s condition is treated with a brace or surgery, having scoliosis can be a blow to her self-esteem and self-image. Let her know that she is loved and accepted. Counseling and group support may be available; consult your child’s doctor. 


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