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Scoliosis: When Life Throws Your Child a Curveball

Child getting Scoliosis test.

With many schools closed during the pandemic, kids missed out on some of the routine health screenings that normally take place on campuses. Take scoliosis: The condition is so common that many California schools screen children for it—in the seventh grade for girls and one year later for boys.

The earlier it's caught, the better the odds of stopping scoliosis from causing real problems down the line. The good news is parents can easily check for signs of scoliosis at home.

We compiled five FAQs to help families better understand scoliosis, including when to see a doctor and what to expect. Elaine Butterworth, RN, director of Patient Experience and Education for the Pediatric Orthopaedic Program at Cedars-Sinai, helps guide you through it.

How and when is scoliosis diagnosed?

Elaine Butterworth: The Adams Forward Bending Test, which is what's used in schools, is simple and can be done at home. The child bends forward at the waist with their hands in front of them, palms together. If the back looks uneven, with one side higher than the other when you're standing behind them, it's a good idea to make an appointment with a pediatrician or spine doctor for evaluation.

"Scoliosis isn't usually serious—but it can be."

An X-ray is the definitive way to make a diagnosis. At the Cedars-Sinai Spine Center, we offer an EOS X-ray machine, which emits up to 98% less radiation—a prudent choice on still-growing children who may need frequent testing.  

What other symptoms could indicate scoliosis in my child?

EB: There are a few telltale signs. Lack of symmetry is an important one. One shoulder may be higher than the other, for example, or one side of the ribcage or hip may stick out more. An uneven chest can also indicate scoliosis.

Surprisingly, back pain isn't usually a symptom that appears among children and teens. Note that lack of symmetry doesn't have to mean scoliosis, and it's normal for our bodies not to be perfectly balanced. Ultimately, if you have concerns, it's always advisable to check with your child's doctor.

"At the Cedars-Sinai Spine Center, we offer an EOS X-ray machine, which emits up to 98% less radiation—a prudent choice on still-growing children who may need frequent testing."

If my child has scoliosis, how worried should I be?

EB: Scoliosis isn't usually serious—but it can be. Affecting about 3% of adolescents, it involves an abnormal curve that's shaped like a "C" or an "S" and that is 10 degrees or larger when viewed on an X-ray. While only 1 in 1,000 cases require treatment and many people live out their lives without even knowing they have it, some cases do progress as the child grows. 

A severe curve can lead to disability and in rare cases can reduce the amount of space within the chest, making it hard for the lungs to work properly. Even children with mild scoliosis should be monitored closely. The good news is that it can often be stopped before causing real problems.

How and when is scoliosis diagnosed?

EB: That depends on how much growing your child still has to do and how significant the curve is. When kids have almost reached adult height, or if the curve is smaller than 20 degrees, it may be best to leave things alone. If your child still has growth left, or the curve is larger, you have options—and surgery is rarely needed.

  • Observation. The most common and conservative approach is to monitor the situation with periodic visits to the doctor while your child is still growing. Regular X-rays will detect if the curve is changing.
  • Bracing. This option may be recommended for moderate curves. The goal here is to keep the curve from progressing to the point where surgery is needed. It's worn under clothes, so nobody can tell when the patient has it on.
  • Schroth therapy. This is a unique type of physical therapy that requires special certification. Few practitioners are certified in Schroth, and research is ongoing to determine its effectiveness. Patients do report that it makes them more mindful of their body position, which is good for posture and alignment in general. It can be used as an adjunct to bracing, as it promotes body awareness early in life, is non-invasive, and has no adverse effects.
  • Surgery. This is reserved for severe curves that either haven't responded to conservative treatment or are very unlikely to do so. An operation can straighten and "untwist" the spine. Patients are usually quite happy with their improved appearance, and are 1-2 inches taller.
Whatever your child's situation, one thing is always true: the curve doesn't define who they are. Our care team can help your child with both the physical and emotional effects of scoliosis.