Scoliosis
If you’ve brought your older child into our office recently for a well child exam, you may have noticed your child’s health care provider performing a screening exam for scoliosis, or curvature of the spine. You may have wondered exactly what the physician or nurse practitioner was looking for in that portion of the exam.
Simply defined, scoliosis is an abnormal curvature of the spine. Every child at or past walking age normally has front-to-back curves in the spine that develop in the first year of life, but some children can develop abnormal or exaggerated curves as they grow. There are several different subtypes, but the most common kind of scoliosis involves a lateral or side-to-side curving. We also classify scoliosis by the age of onset, whether in infancy, childhood or adolescence. Scoliosis is most common in adolescents and extremely rare in infants or young children.
Most of the time, we find no specific cause for scoliosis. We often find that there is a history of scoliosis in the family, and girls with scoliosis far outnumber boys. Our “typical” patient with scoliosis, then, is an otherwise healthy teenage girl. Very rarely, we will find a definable cause for the problem, such as a tumor or a disease such as neurofibromatosis. Children with conditions that cause their muscles to be weakened or unbalanced, such as muscular dystrophy or cerebral palsy, may also develop scoliosis. Scoliosis is not caused by poor posture, poor sleep habits, or lack of exercise.
To screen for scoliosis, we first observe the child in a standing position.
Notice the difference between the height of the shoulder blades
We check to see that the shoulders and hip bones are level. Then we instruct the child to bend forward at the waist, with his or her arms falling forward. We visually inspect the spine from behind and from in front of the child. The forward bending maneuver tends to bring out curves that would not be noticeable while your child is standing.
Notice how the right side is higher than the left side
If we see any indication of a curve, we will most likely send your child for a special scoliosis x-ray. This way the exact angle of the curve, if present, can be defined. Most curves are very mild and require only vigilance and periodic rechecks. A more severe curve may require bracing or even surgery, and an orthopedic specialist becomes involved in these cases. Usually, children with scoliosis need to be followed carefully until they have completed their growth. For girls, this is usually about two or three years after the onset of the first menstrual period; boys may still be growing at nineteen or twenty!
The public schools also have initiated screening programs in the physical education classes, and many children with scoliosis are first noticed in this manner. If your child brings home a note from school saying that he or she failed a scoliosis screening, please contact our office for an appointment with your child’s health care provider. Please also contact us for an appointment if you yourself notice any unusual shape or curving of your child’s back, or if you simply have concerns about this area. Early diagnosis of scoliosis remains our most important tool.
Note: The child in these two pictures has scoliosis
