When deciding the best strategy for managing a child’s scoliosis, parents are presented with three options: 1) observation or “watch and wait”, 2) non-operative methods to include bracing and physical therapy, and 3) surgery. Most parents would like to avoid invasive surgery for their young and adolescent children if possible. As well, they might want to protect their children from the anxiety and trepidation that wearing a brace can initially cause. For those reasons, a passive treatment option of watching and waiting will seem appealing. However, it is important that parents take into consideration several different factors when deciding on the most appropriate plan, understanding that there are risks to watching and waiting.
While many aspects of the child’s condition should be reviewed when deciding on treatment for scoliosis—including the type of scoliosis, age of onset, and if there is a family history of scoliosis—the most critical element to determining whether to put off treatment or not will be the size of the child’s curve. Whether a curve is mild, moderate, or severe will inform the most favorable solution.
A mild curve gives the parents more latitude in their choices. If the curve remains small watching and waiting could potentially be an appropriate approach. Progression of curves can be unpredictable though and various complications can arise as a curve increases in degree. Diligent monitoring of the patient will be essential as starting treatment at the earliest indication of a worsening curve would achieve the most successful outcome.
A curve above 50 degrees can present a number of problems including a potential intensification of pain and the increased onset of spine rotation. Many times there is a noticeable asymmetry as the curve worsens. These significant changes in appearance could include uneven hips, one shoulder appearing higher than the other or the child’s ribs might stick out farther on one side of the body than the other.
The issues that curves of 50-70 degrees (or more) are increasingly worrisome. At 50-70 degrees there can be an impact on the respiratory system. Potential interference with heart and lung function can occur with curves above 70 degrees. In rare cases, the rib cage might press against the heart and lungs making breathing difficult and having an impact on the heart’s ability to pump.
It is, of course, wise and prudent for parents to thoroughly review all of the treatment options available to their child when faced with a scoliosis diagnosis. It is of utmost importance that they consider the type of scoliosis, the age of the child, a family history of scoliosis, and especially the severity of the curve when determining the best course of action. Having this information as well as continuing an open line of communication with all professionals on the team will help parents rest assured that they are seeking the most optimal outcome for their child’s physical and emotional health.