Infantile Scoliosis

What is infantile scoliosis?

Infantile scoliosis is an abnormal sideways curve of the spine that affects infants and toddlers. The condition refers to scoliosis that occurs in children younger than 3 years old.

Infantile scoliosis is a type of idiopathic scoliosis. “Idiopathic” means the cause is unknown. While idiopathic scoliosis is the most common type of scoliosis, fewer than 1 percent of children with idiopathic scoliosis have infantile scoliosis.

Children with infantile scoliosis are not born with skeletal abnormalities that can be seen on an x-ray. (By comparison, children are born with congenital scoliosis.) Symptoms typically appear when an infant is around 6 months old. More boys than girls develop infantile scoliosis.

Generally, infantile scoliosis is not painful. However, it is important to monitor the condition closely. Though most cases of infantile scoliosis get better on their own, in rare cases the condition can cause severe deformity.

Most children who need treatment for infantile scoliosis can be treated with casting and bracing. A very small number of children need spine surgery.

What are the symptoms of infantile scoliosis?

If your child has infantile scoliosis they may appear to always be leaning to one side. Other symptoms include:

  • ribs appear more prominent on one side than the other
  • one shoulder appears lower than the other
  • one shoulder blade protrudes further out than the other
  • one leg appears longer than the other
  • the waistline appears tilted

What causes infantile scoliosis?

Researchers and doctors don’t know what causes infantile scoliosis. The condition seems to run in families. Research has not yet uncovered a gene or genes that could cause the condition.

Beating the odds and infantile scoliosis

After treatment for severe infantile scoliosis, Colin was finally strong enough to play with his sisters. “The more he played, the stronger he became.”

Colin Newton with his sisters, Somerby and Ailie.

How is infantile scoliosis diagnosed?

Infantile scoliosis is typically diagnosed during a standard medical check-up. If your child’s doctor sees signs of an abnormal spinal curve, they will order follow-up tests, which may include x-rays, MRI, and a neurological exam. The results of these tests will help determine if your child has scoliosis, and if so, to what degree their spine is curved.

What are the treatments for infantile scoliosis?

Treatment for infantile scoliosis depends on the degree of the curve of the spine and the ribs. Very often, the spines of children with infantile scoliosis become straighter as they grow. If the curve becomes more severe, early treatment may help slow or reverse the curve’s progression.

  • Children with mild infantile scoliosis, a curve of 30 degrees or less, are typically monitored on a regular basis for several years.
  • Children with moderate infantile scoliosis, a curve between 30 and 50 degrees, are usually successfully treated with a brace or casting.
  • Children with severe infantile scoliosis, a curve of 50 degrees or greater, may be treated with a brace or cast and usually need spine surgery when they get older.

How are casting and bracing used to treat infantile scoliosis?

The goals of casting and bracing are the same: to stop infantile scoliosis from progressing, and in some cases, to correct the curve, either fully or partially. If your child struggles against being put in a brace, their doctor may recommend casting instead. The cast will be changed every two to three months. Your child will be under anesthesia while the old cast is removed and a new one is applied.

Cast care and maintenance is important to keep the cast dry. You will need to give your child sponge baths. It’s also best to keep your child from overheating during the summer months by planning activities in places or at times of day when temperatures are cooler.

The length of your child’s treatment with casting or bracing depends on their age, severity of the curve, and response to treatment. Many children who start off in a cast can later wear a scoliosis brace instead.

Boston Children’s has developed a new brace design that applies corrective forces to the spine much like a cast, without the need for cast application under anesthesia. The brace must be initially worn for 22 hours a day. It can be removed for daily bathing or if your child is ill. Your child’s doctor will use x-rays to measure the success of the brace. If they see signs that the scoliosis is becoming more severe, they may recommend casting instead.

What are the surgical treatments for infantile scoliosis?

The goal of surgery in very young children with scoliosis is to straighten the spine without interfering with the child’s growth. The most typical surgery for infantile scoliosis involves growing rods.

Growing rods are temporary implants that can be lengthened as a child grows. During an initial surgery, surgeons will attach the rods to the child’s spine above and below the curve. Every six months or so after the first procedure, a surgeon will lengthen the rods by about one centimeter to give the spine more room for growth. Lengthening is done through a small incision in the back and is typically an outpatient procedure.

In recent years, traditional growing rods have been improved with magnetic technology, which can be used once your infant reaches an acceptable size. The MAGEC (MAGnetic Expansion Control) System eliminates the need for repeat incisions. After an initial operation to attach the MAGEC System to the spine, a surgeon can lengthen the rods by an external controller that signals the implanted device to expand.

Whether traditional or magnetic, the growing rods will remain in place as long as your child continues to grow. Your child will need to wear a cast or brace throughout this period to protect their spine. After your child’s final growth spurt in late adolescence, the rods will be surgically removed and your child will have spinal fusion surgery to permanently stabilize their spine.

What is VEPTR™ technology?

VEPTR™ treatment: A device is implanted and lengthened to expand and straighten the rib cage.

In some cases, children with infantile scoliosis have underdeveloped chest walls. The Expansion thoracostomy/VEPTR™ is an expandable titanium rib that expands the chest wall and creates room for the lungs to develop. In some cases, VEPTR also helps the spine to grow straight.

What is the long-term outlook for infantile scoliosis?

Most children with infantile scoliosis can look forward to normal, active lives. Your child’s outlook depends in large part on the severity of their scoliosis. Early diagnosis and treatment can improve the outlook for many children with infantile scoliosis.

How we care for infantile scoliosis

The Spine Division at Boston Children’s Hospital is the largest and busiest pediatric spine center in the United States. Our spine specialists see thousands of spine patients every year. We treat all types of scoliosis and other spine conditions, from the most common to the most complex.

Whenever possible, we treat infantile scoliosis without surgery. For children who need surgery, our surgical team includes surgeons, anesthesiologists, and nurses with specific skills and expertise in spine surgery. Each member of our team performs hundreds of spine surgeries a year and helps ensure quality and safety before, during, and after surgery.