Early onset scoliosis is when a curve appears after birth, but before the age of around 10. Much like other forms of scoliosis, it is usually idiopathic, meaning that there is no known cause.

In some cases, curves caused by early onset scoliosis can self-correct without treatment. Larger curves, or a curve that continues to grow, may require further treatment.

It is also possible that congenital scoliosis may be spotted at this age in young children. Children with early onset or congenital scoliosis should stay under the care of a scoliosis specialist as they grow. If you are looking for your nearest specialist, contact SSR.

Diagnosis of Early onset scoliosis

Parents or carers of a child are often the first to notice that their child may have early onset scoliosis. Many children with early onset scoliosis are otherwise healthy and able to live comfortably with a small curvature in the spine.

Early signs of early onset scoliosis to look out for include:

• The rib cage sticking out on one side, especially at the back
• Uneven shoulders, or one shoulder blade sticking out more than the other
• The hip/waist sticking out
• As the child becomes old enough to walk, they may lean to one side
• The head may also tilt over to a specific side
• Clothing garments not fitting as well as they used to
• Being unable to stand up straight
• Regular physical pain or discomfort

If you think your child may have scoliosis, make an appointment with their doctor as soon as possible. The earlier the child is treated for scoliosis, the better. 

Checking for signs of scoliosis in older children

One of the best ways to check for signs of scoliosis in older children is to take the “Adam’s Forward Bend” test. The test can be undertaken with a doctor or parent/guardian present. To undertake the test, the child’s back will need to be uncovered so that their shoulders and spine are visible and the child should bend forward from the waist whilst keeping their legs and arms straight. If scoliosis is present, you may be able to see a bulge in the ribs area. If it is noticed that the child has a curve, your GP will then give a referral to see a scoliosis specialist.

Consultation

Your doctor will organise a consultation with a scoliosis specialist. At the first consultation, the child will be examined by X-ray which will help measure the size of the curve. You will then be informed of the Cobb angle, which is the exact degree of the curve.

There are four main types of treatment for early onset scoliosis. A scoliosis specialist will advise what type of treatment will be best for the child. This advice will depend on the type and size of the curve and whether it is likely to keep growing. It is vital to treat curves early and minimise their progression. If a curve is left untreated, it can lead to issues later on in life such as breathing difficulties. In extremely rare cases, this can be fatal.

Monitoring

A specialist will monitor a child over a period of time and assess if the curve is becoming larger. Some children will have a curve that does not get bigger, whilst other children will have a curve that continues to grow. Normally, the specialist will take, update and compare the child’s X-rays on each consultation. Some children will not need treatment, particularly if the curve straightens itself naturally. When this occurs, the child will continue to be monitored by a specialist until the curve has straightened.

Treatment: Casting

Some children will need their spine to be guided into its normal position as they grow, which can be achieved by using a cast. The cast starts from the underarms and covers the top half of the body. It is made of light materials and must be worn at all times. The cast will it will be changed regularly as the child grows. A cast will have a distinctive hole in the chest area, allowing the lungs to expand so that the child is able to breathe comfortably. In children under 2 years old, the cast will be changed every 2-3 months. Many parents find it easier for their child to wear a cast instead of wearing a removable brace. 

Bracing

Bracing is similar to casting; the aim is to reduce the size of the curve. Braces are mainly used for children and adolescents with smaller curves between 20˚ and 40˚. If a curve is becoming larger while the child is still growing, the specialist may decide that bracing is the best option. Wearing a brace can mean that the child can keep growing for longer before a more permanent treatment, such as surgery. Braces are usually worn for 23 hours a day and are regularly replaced as the child continues to grow.

Surgery

Sometimes, casts or braces are unable to stop a curve getting bigger. As a result, a child may need an operation. A common operation at this age involves attaching growing rods, which help guide the spine into place. The rods are usually attached to the spine and can reduce the curve by up to half the size when first fitted. After the implementation of the rods, the child will return to their treatment centre every 4-6 months for minor adjustments that compliment the growth of the spine.

Alternatively, a child can have magnetic rods implemented. Here, an initial operation is required to fit magnetic rods, however, no further surgery is needed to lengthen them. On occasion, the process of adjusting the rods, done via magnets, can cause minor discomfort. Most children will need to wear a brace to protect the rods.

Once the spine is fully grown, the rods are removed. At this stage, the patient will usually undergo a final operation, known as a spinal fusion.