Children

Scoliosis in Children

What is Pediatric Scoliosis?

Scoliosis is a 3-dimensional curve of the spine, and when scoliosis is diagnosed in a child under the age of 10, it is considered Early Onset Scoliosis. Early Onset Scoliosis can be broken down into four main categories:

Type of Scoliosis	Description
Congenital Scoliosis	There is a malformation of one or multiple vertebrae during development in utero. It can include changes such as presence of a hemivertebra (one half of the vertebrae is missing), a unilateral bar (creates vertebral wedging), block vertebra (one or more of the vertebrae are fused together), rib fusions (thoracogenic) or missing a vertebra all together. Sometimes congenital scoliosis is associated with heart or kidney changes as well. This type of scoliosis is often progressive and may require more aggressive treatment.
Neuromuscular Scoliosis	Rather than changes in bone structure, neuromuscular scoliosis is caused by changes in the musculature around the spine. This type of scoliosis has the highest rate of complications with surgery compared to all other types of scoliosis.
Syndromic Scoliosis	Loose connective tissues such as ligaments and tendons can result in scoliosis. Conditions such as Marfan’s Syndrome, Ehlers-Danlos, osteogenesis imperfecta and other connective tissue disorders are considered Syndromic Scoliosis.
Idiopathic Scoliosis Identified by the age of diagnosis Affects 5.2% of all children aged 0-18	Infantile Scoliosis 0-3yrs	Curve development with no apparent cause before the age of 3. Approximately 1% of infants develop scoliosis. This type of scoliosis is variable and occasionally children under two years old, curves less than 35 degrees may resolve spontaneously without treatment. Though, observation throughout child years is recommended to ensure no ongoing issues or progression occurs.
	Juvenile Scoliosis 4-10yrs	About 10-15% of idiopathic scoliosis cases occur in children aged 4-10 which is known as Juvenile Scoliosis. Issues with respiratory muscle strength and pulmonary function are most common with juvenile scoliosis. These children are at a higher risk of curve progression, especially during their adolescent growth spurt.
	Adolescent Scoliosis 11-18yrs	Curve development with no apparent cause between the ages of 11-18 years. Please note that this is not considered a type of Early Onset Scoliosis (diagnosed before age 10). Please click here to learn more about Adolescent Idiopathic Scoliosis that is diagnosed in teens.

As the child’s skeleton is still growing, there is a higher risk of progression; therefore, it’s more urgent to seek treatment as soon as your child is diagnosed with scoliosis.

There may be medical concerns during growth such as pulmonary (lung) changes, developmental delays, neurological differences, functional difficulties, and skeletal abnormalities in addition to a child’s curve. Psychosocial factors such as one’s perception of their body may also be a factor in children growing up with scoliosis.

What causes scoliosis in infants and children?

Infantile, juvenile and adolescent scoliosis are idiopathic which means that the exact cause of the scoliosis is unknown. Even though the cause of the scoliosis is unknown, there are many effective treatments for idiopathic scoliosis that range from physiotherapy to surgery depending on the curve(s).

Non-idiopathic scoliosis types have common causes. In congenital scoliosis, genetics are behind the developmental abnormalities.

Neuromuscular cases of scoliosis are typically secondary in nature which can happen due to conditions such as cerebral palsy, spina bifida, brain or spinal cord injuries, spinal muscular atrophy, and muscular dystrophies.

Conditions such as Marfan’s Syndrome or Ehlers-Danlos are often accompanied by Syndromic Scoliosis.

How can you tell if your infant/child has scoliosis?

Scoliosis may present as:

• uneven shoulders
• a shoulder blade that appears to stick out
• uneven waist or hips
• a ‘bump’ on the back when the child bends forward
• the appearance of a tilted head or head not appearing centered on body
• ribs that look to be sticking out in the front/back
• body leaning over to one side

If you suspect your child has scoliosis, please bring him/her to your family doctor for a proper assessment. Your doctor may request an X-Ray to confirm if a spinal curve is present.

What should you do if your infant or child has scoliosis?

If your child receives a positive diagnosis of scoliosis, it is important to seek conservative treatment early to try to prevent progression of their curve(s) as they grow. You should connect with your family doctor to determine if a referral to a specialist is recommended. Sometimes a diagnosis of scoliosis can be scary for your child and your family but it does not have to be.

The “wait and see” observation approach for children’s curves that are between 10 and 25 degrees may not be the only option for children with scoliosis. The physiotherapists at The ScoliClinic utilize evidence-based knowledge and treatment methods that can be effective in supporting your child’s journey with their scoliosis. They learn about your child and work with your child and family to create fun ways to incorporate scoliosis exercises at home. The ScoliClinic physiotherapists can help your family navigate the system to determine which treatments may be the most appropriate for your child.

What’s the goal of physiotherapy treatment for infants or children with scoliosis?

The goals of physiotherapy for infants or children are holistic and are specific to each individual. Physiotherapy Scoliosis Specific Exercises have been shown to be effective in treating mild to moderate curves. Many people believe that physiotherapy is simply about getting people to exercise and while exercise prescription is a common goal of physiotherapy, there are many goals outside of exercise prescription for individuals with scoliosis. Goals for physiotherapy may include:

• Education families and clients about their specific curve and treatment options
• Monitor for curve progression
• Advocate for families within the medical system and collaborate as part of multidisciplinary care teams
• Promote symmetrical milestone development in infants
• Promote symmetrical muscular and functional skill development in children
• Slow curve progression and improve aesthetics through Physiotherapy Scoliosis Specific Exercises and 3D postural correction exercises
• Improve breathing mechanics
• Increase activity and functional ability
• Screen/flag any possibilities of underlying diagnoses
• Promote healthy relationships with one’s body (self image & self esteem), exercise, healthcare professionals and the medical system
• Decrease pain

What types of treatment are available for infants or children with scoliosis?

• Observation
  • The curve is monitored and repeatedly examined at various time-points throughout growth periods to watch for progression of the curves. Observation and physical examinations can be performed by physiotherapists. If the curve(s) progress, additional treatment methods may be indicated.
• Physiotherapy
  • Exercise is important to maintain strength in the muscles that support the spine and trunk. For infants and young children, the goal is to promote symmetrical muscle development. Throughout treatments, scoliosis-trained Physiotherapists also play an important role in monitoring the infant/child’s alignment and spinal curve, to track for progression and provide updates to involved physicians.
• Serial casting or bracing
  • Aimed to minimize curve progression through periods of growth, bracing or serial casting has been shown to delay curve progression and reduce the need for surgery. Note that in congenital scoliosis cases, casting or bracing may not be helpful though it is important to discuss each individual case with an orthopedic surgeon or qualified orthotist.
• Surgery
  • Surgery may be indicated for larger or rapidly progressing curves. The two most common types of surgery include vertebral body tethering or spinal fusion.

How is Schroth Physiotherapy used in treatment for children with scoliosis?

Schroth Physiotherapy is a 3-dimensional exercise approach for scoliosis treatment. The exercises aim to promote symmetrical muscle development in a curve-specific way, to prevent progression as much as possible.

For children, play-based Physiotherapy is important for children to foster positive relationships with their body, exercise, physiotherapy, and the medical system in general, since the scoliosis journey is a long road. At The ScoliClinic, we incorporate pediatric physiotherapy principles with Schroth exercises to create customized fun treatment sessions for your child.