You might remember lining up outside the school nurse's office to have your spine checked when you were in middle school. That test looked for scoliosis, a curvature and rotation of the spine that, if untreated, can lead to breathing or heart problems, chronic back pain, and even disability. An estimated 6 to 9 million people in the U.S. have scoliosis.
Schools don't always check for it these days, but parents might assume their child is still being screened—or might not even realize they should be. Here's how to make sure your child is getting looked at, and why it's important to catch the condition now.
1. Early detection is crucial.
Scoliosis is a progressive disorder, and usually first shows up in children as they enter the preteen and teenage years. "It is most likely to progress during fast periods of growth, such as the onset of puberty," says John M. "Jack" Flynn, M.D., Chief of the Division of Orthopaedics at Children's Hospital of Philadelphia (CHOP). "With early detection, progression can usually be prevented."
Catching it early opens up a whole range of treatment options, says Amer Samdani, M.D., Chief of Surgery, Shriners Hospitals for Children in Philadelphia. "Some children may just need to be watched with low-dose radiation X-rays to make sure it's not getting any worse," he says. "There are some kids now that we can treat with just physical therapy, exercises, and posture control—but it has to be caught early." If the disorder has progressed, wearing a brace might be necessary, and the final option for severe cases is surgery. "We don't want these kids thinking about their scoliosis—we want to keep it in check so they can continue to be kids," Dr. Samdani says. "If we're able to get it early, we can allow them to do that."
2. Screenings are inconsistent.
Regular checks for the condition would seem to make sense, since treating it early is key. "Screenings by a capable school nurse or pediatrician are extremely effective, and allow us to prevent surgery in many children," Dr. Flynn says. So why aren't they necessarily being done? "The extent of screening that's performed varies from state to state—many times we find that at schools, probably secondary to resources, it doesn't occur on a yearly basis," Dr. Samdani says. "Similarly it can be part of well-child [pediatrician] visits, but again it's just inconsistent." If you're not sure whether your child is being screened at school, ask the nurse or your child's teacher—and if it's not being done, request a yearly screening from your pediatrician.
3. Look for these signs:
In the meantime, it's always good to know what symptoms to watch out for. "You may note an unevenness in the shoulder—perhaps one is higher than the other," Dr. Samdani says. One hip could appear to stick out more than the other, or the ribs on one side may be more visible. Dr. Flynn suggests to Google the Adams Forward Bend test—looking from the back, you may be able to see if one side of your child's body is higher. Summer is a great time to take a closer look at your kids, because they're in bathing suits and outfits where their spines may be more easily seen. But, Dr. Samdani warns that if these symptoms are visible to the eye, the condition might be more serious. "The downside with these signs is that by the time they show up sometimes it has already progressed to a fairly moderate or severe point," he says. In more advanced cases, the spine may also appear as a "c" or "s" shape.
4. It runs in families.
Although doctors don't know why it develops, there is evidence of a genetic link. "We do know that scoliosis has a genetic basis for it, so for example if a mother has it the chances of her daughter getting it can range anywhere from 20 to 30 percent," Dr. Samdani says. Although in many cases the condition appears without warning, if someone in your family has been treated for it, it's even more important to keep up annual screenings.
5. A smartphone app may help you.
Technology could make it even easier to check your kids as home. Although Dr. Flynn doesn't recommend parents use an app to take full responsibility of their child's spine health (best to leave that to the experts!), this could be useful in helping to monitor it. "Parents can try out the phone app, and if it appears there might be some scoliosis, visit their pediatrician promptly to evaluate and determine if an X-ray is warranted," he says. Shriners Hospitals for Children is releasing a new, free app called SpineScreen in August 2017 that Dr. Samdani says was developed to raise awareness and help parents have a hand in early detection. The app works by sliding your phone along your child's back to take readings, and Dr. Samdani suggests parents use it as part of their yearly back-to-school routine. "What really sets this app apart is that we had a team put it together with input from surgeons and families to make it work efficiently, be easy to use, and really provide very valuable data," he says. In addition, there's an accompanying website that's full of useful info and resources.