The doctor will initially take a detailed medical history and may ask questions about recent growth. During the physical exam, your doctor may have your child stand and then bend forward from the waist, with arms hanging loosely, to see if one side of the rib cage is more prominent than the other.
Your doctor may also perform a neurological exam to check for:
- Muscle weakness
- Abnormal reflexes
Plain X-rays can confirm the diagnosis of scoliosis and reveal the severity of the spinal curvature. If a doctor suspects that an underlying condition — such as a tumor — is causing the scoliosis, he or she may recommend additional imaging tests, such as an MRI.
Most children with scoliosis have mild curves and probably won't need treatment with a brace or surgery. Children who have mild scoliosis may need regular checkups to see if there have been changes in the curvature of their spines as they grow.
While there are guidelines for mild, moderate and severe curves, the decision to begin treatment is always made on an individual basis. Factors to be considered include:
- Sex. Girls have a much higher risk of progression than do boys.
- Severity of curve. Larger curves are more likely to worsen with time.
- Curve pattern. Double curves, also known as S-shaped curves, tend to worsen more often than do C-shaped curves.
- Location of curve. Curves located in the center (thoracic) section of the spine worsen more often than do curves in the upper or lower sections of the spine.
- Maturity. If a child's bones have stopped growing, the risk of curve progression is low. That also means that braces have the most effect in children whose bones are still growing.
If your child's bones are still growing and he or she has moderate scoliosis, your doctor may recommend a brace. Wearing a brace won't cure scoliosis or reverse the curve, but it usually prevents further progression of the curve.
The most common type of brace is made of plastic and is contoured to conform to the body. This brace is almost invisible under the clothes, as it fits under the arms and around the rib cage, lower back and hips.
Most braces are worn day and night. A brace's effectiveness increases with the number of hours a day it's worn. Children who wear braces can usually participate in most activities and have few restrictions. If necessary, kids can take off the brace to participate in sports or other physical activities.
Braces are discontinued after the bones stop growing. This typically occurs:
- About two years after girls begin to menstruate
- When boys need to shave daily
- When there are no further changes in height
Severe scoliosis typically progresses with time, so your doctor might suggest scoliosis surgery to reduce the severity of the spinal curve and to prevent it from getting worse. The most common type of scoliosis surgery is called spinal fusion.
In spinal fusion, surgeons connect two or more of the bones in the spine (vertebrae) together, so they can't move independently. Pieces of bone or a bone-like material are placed between the vertebrae. Metal rods, hooks, screws or wires typically hold that part of the spine straight and still while the old and new bone material fuses together.
If the scoliosis is progressing rapidly at a young age, surgeons can install a rod that can adjust in length as the child grows. This growing rod is attached to the top and bottom sections of the spinal curvature, and is usually lengthened every six months.
Complications of spinal surgery may include bleeding, infection, pain or nerve damage. Rarely, the bone fails to heal and another surgery may be needed.
Lifestyle and home remedies
Although physical therapy exercises can't stop scoliosis, general exercise or participating in sports may have the benefit of improving overall health and well-being.
Studies indicate that the following treatments for scoliosis are ineffective:
- Chiropractic manipulation
- Electrical stimulation of muscles
- Dietary supplements
Coping and support
Coping with scoliosis is difficult for a young person in an already complicated stage of life. Teens are bombarded with physical changes and emotional and social challenges. With the added diagnosis of scoliosis, anger, insecurity and fear may occur.
A strong, supportive peer group can have a significant impact on a child's or teen's acceptance of scoliosis, bracing or surgical treatment. Encourage your child to talk to his or her friends and ask for their support.
Consider joining a support group for parents and kids with scoliosis. Support group members can provide advice, relay real-life experiences and help you connect with others facing similar challenges.
Preparing for your appointment
Your child's doctor may check for scoliosis at a routine well-child visit. Many schools also have screening programs for scoliosis. Physical examinations prior to sports participation often detect scoliosis. If you are informed that your child might have scoliosis, see your doctor to confirm the condition.
What you can do
Before the appointment, write a list that includes:
- Detailed descriptions of your child's signs and symptoms, if any are present
- Information about medical problems your child has had in the past
- Information about the medical problems that tend to run in your family
- Questions you want to ask the doctor
What to expect from your doctor
Your doctor may ask some of the following questions:
- When did you first notice the problem in your child?
- Is it causing your child any pain?
- Is your child experiencing any breathing difficulties?
- Has anyone in the family been treated for scoliosis?
- Has your child grown rapidly during the past six months?
- Has your child started menstruating? For how long?