Good posture is a concern among parents today, but many parents may be surprised to learn that small curves in the spine that can affect posture are a normal part of development.
Elsa is a healthy 12-year-old who visited her pediatrician for her annual checkup. Her mother noticed one of Elsa’s shoulders appeared higher than the other when her daughter tried on swimsuits. Elsa is very active in swimming and volleyball. She denies any back or leg pain. On exam, the left side of Elsa’s back is slightly higher than the right when she bends forward. Her hips and leg length appear to be symmetrical. Elsa was referred for a spinal X-ray that confirmed she has scoliosis.
While Elsa isn’t a real patient, her situation is one experienced by thousands of kids. Scoliosis is a common condition in children and adolescents that makes the spine or backbone curve sideways, resulting in an S- or C-shaped curve of the spine. It can also cause the spine to twist so that one side of the back sticks out more than the other.
Scoliosis generally occurs between age 10 and the early teens when children are growing rapidly. It is more common in girls, but boys can have it, too. A birth defect, disease or injury can also cause scoliosis. It can run in families, so if someone in a child’s family has scoliosis, he or she may be more likely to have it. But the most common type is called idiopathic scoliosis, which means that the cause is unknown. We do know that scoliosis is not caused by carrying heavy bags or playing sports.
The diagnosis of scoliosis begins with a complete history and physical. If your pediatrician is concerned about scoliosis, he or she may order an X-ray of the spine. This can show how much the spine curves from side to side and if the scoliosis is likely to get worse as the child grows. An X-ray can also help determine if another problem in the body is causing the scoliosis.
Scoliosis usually does not cause symptoms and may go unnoticed. Therefore, a child who has a parent, brother or sister with scoliosis should have yearly checkups to screen for early signs of this problem. You or your child’s doctor might notice that shoulder, hip or breast is higher than the other, one shoulder blade sticks out more than the other or an uneven waistline.
However, your child might complain of back pain. With moderate curves, muscles are overworked and can spasm or hurt with prolonged standing or walking. He or she might also have trouble breathing. If the spine curves a lot, it limits space in the chest and the lungs might not have room to work correctly. This can cause breathing problems. Scoliosis this severe usually starts when a child is younger than 10 and is typically obvious before breathing problems happen.
Treatment is different for each child because it depends on the degree of the curve, when it’s identified and how much growing the child has left. Mild scoliosis usually does not need to be treated, especially if the child has finished growing. But severe scoliosis that can cause breathing problems and heart problems needs managed care. Treatment options include:
▪ Watchful waiting: A mild curve may get worse as a child grows (until age 18 or 20), therefore periodic exams are recommended. The child might need to see a specialist if the scoliosis starts getting worse.
▪ Bracing: At some point the curve may become severe enough to require the use of a brace to stop it from getting worse and prevent the need for surgery. This is most common when the child still has a lot of growing to do.
▪ Surgery: If the spine curves a lot, the doctor might recommend surgery. The surgery joins the vertebrae together to make the spine straight.A metal rod or other device may be left in the body to support the spine after surgery. This can keep the curve from getting worse.
Exercise, chiropractic care, electrical stimulation and nutritional supplements have not been shown to prevent scoliosis from getting worse.
Most people with scoliosis do not have lasting problems. A few people have back pain, but it is usually not serious. Encourage your child to walk, run, swim and participate in gymnastics and other sports. These activities keep children healthy and give a sense of well-being. Strong abdomen and back muscles that result from these activities support the spine and will prevent or reduce pain.
Oneith O. Cadiz, M.D., is an assistant professor of clinical pediatrics at UHealth — University of Miami Health System. UHealth is nationally and internationally acclaimed for education, research, patient care and biomedical innovation. For more information, visit UHealthSystem.com/patients/pediatrics.