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Have you ever instructed your child to “stand tall” or “stand up straighter”? Maybe you said this while trying to get a good snapshot. And for some reason, this child would not stand up straight. Maybe they cocked their head to the side a funny way or leaned a strange way. But when you said “Please don't do that. Stand up right” they answered “I am, Mother. I am standing straight.” Guess what: to the child with scoliosis, they are standing straight, and in their brain or neurological system, they neurologically “feel” they are in alignment. The brain sends out messages to the spinal column and the legs and they stand in alignment in their own sense. They do not sense the lean to the right or left. However, when you get those photos developed, you may notice the crooked standing child again. And you can show the snapshot to the child, who can then “see” the leaning or crooked posture. This may be how scoliosis is first noticed in your family. Another way scoliosis may be first diagnosed is through the school nurse. Many public schools screen for scoliosis by having the child bend forward at the waist, arms extended toward the floor. The nurse runs their finger over the spinal column and inspects for alignment of each spine. In the early stages, scoliosis may be easily overlooked. Once it has progressed significantly, you may be given fewer options for treatment. If you can get early treatment for your child, the progression of the scoliosis can be slowed or stopped. What happens next, if I suspect that my child may have scoliosis? Tell your pediatrician or primary care physician and they will do an exam and x-ray. If the x-ray is abnormal , you will be referred to a pediatric orthopedic surgeon. Scoliosis is defined as a lateral S or C-shaped curvature of the spine. Scoliosis affects only 2% of the population, but the incidence is increased with certain syndromes. Idiopathic scoliosis occurs most often in girls between the age of 10 and 13 years. No two people's scoliosis will be exactly the same. The curving of the spine and the twisting or compensatory curve will vary greatly from person to person. Therefore, the treatment of the scoliosis is very individualized. However, generally speaking, a curve between 10 degrees - 20 degrees warrants exercise to improve posture, muscle tone, and flexibility and close follow up. For curves of 20 - 40 degrees, bracing with a Boston or Milwaukee brace, will be utilized. An orthotic company will measure the child for the brace and will actually make the brace, according to the degree and location of the curve. The construction of the brace is both an art and science, and is dependent upon the skill and experience of the orthotist. The child needs to wear a swimsuit for all measuring appointments. For bracing to be effective, it requires high compliance (i.e., they have to wear it consistently) Sometimes, they will allow kids to go to school without the brace, but sleep in it and wear it during all other hours. Severe scoliosis is defined as a curve from 40 degrees or more and usually requires surgery (spinal fusion). Some helpful tips for kids wearing a brace: 1. Wear a cotton tee-shirt underneath the brace. The
braces are very hot and do not “breathe”. 2. During the warmer months, change the tee-shirt several times during the day. 3. If the brace fits over the abdominal area, it will apply pressure to their bladder and they will feel need to void frequently. Suggest asking them to void before strapping on the brace. 4. The first week of wearing a new brace is usually the most difficult. Most kids adjust to wearing it, especially if you as a parent remain nonchalant about the brace. 5. Save sedentary activities for “brace-time”; such
as Gameboy, reading or television watching. 6. With some braces, it is uncomfortable to wear jeans or shorts that have buttons and clasps. 7. The orthotics company will mark on the velcro straps, where to snug up the brace. This is very important so you can be sure it is being worn properly. 8. Inspect the skin under the brace daily for rashes or rubbed areas. Report to physician prn. 9. Remember to take the x-ray from the orthopedic doctor's office to the appointments at the orthotic company. 10. As your child grows, they will out-grow the brace.
On the average, they will need a new brace about once a
year. However, if your child is on growth hormones, they
may have spurts of growth requiring adjustment of the
brace more often. 11. If you have managed care insurance, be sure you obtain all the necessary referrals because the braces are expensive. A Boston brace averages $2000.00. So for many HMO families, they will have to pay 20% of this bill or $200.00 for each brace. 12. Depending on the child's age, enuresis (bed-wetting) may be an issue, which compounds the difficulties of wearing a brace at night. Use Desitin ointment, or some type of barrier ointment, to protect the skin from irritation. Pullups may be needed also, otherwise, urine can be trapped under the brace during sleep and cause skin breakdown. 13. Parents should encourage and brag on their child for wearing their brace. As the child faces puberty, and the increased desire to “fit in” with their peers, wearing a large scoliosis brace can be humiliating to the teenager. 14. Stress to the scoliosis child/ teen-ager that “everyone has something” proverb. That every person has struggles and challenges, but others may not be so obvious as a scolisosis brace. When you are out in the community and see other youngsters with casts, crutches, or wheelchairs, talk about their challenges. This discussion can help the scoliosis child feel less ostracized and different. 15. In the long run, wearing a scoliosis brace, (persevering thru this difficulty) may make your child a more compassionate and empathic person. There is always good that can come from tough situations. References Lewis, S.; Collier, I.; & Heitkemper, M. (1996). Medical Surgical Nursing: Assessment and Management of Clinical Problems. (Fourth edition). St. Louis: Mosby. Neustadt, Jeffrey, MD, Affiliate Associate Professor, Department of Surgery and Pediatrics, University of South Florida, College of Medicine. & Children's Orthopedic & Scoliosis Surgery Associates, Tampa & St. Petersburg, Florida. (2003). “Scoliosis and Turner Syndrome,” National Turner Syndrome Conference. For More Information MMFK is available for fee-based private consultation, lectures, and speaking engagements. For more information and fee schedule, please contact us. |
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