Detection and Treatment of Pigeon Chest in Children

Pectus carinatum affects roughly one in every 1,500 children. Generally referred to as ‘pigeon chest,’ it is a non-life-threatening condition. There are two types of pectus carinatum. One type is called chondrogladiolar prominence. It is a deformity of the breast bone in which the middle and the lower sections of the breastbone push forward, giving the appearance of a pigeon. The majority of the children get affected by this more common type. 
The second type, called chondromanubrial prominence, is more complex to treat and not so common in children. Pigeon chest occurs more in boys than girls. Most often, it develops during childhood and becomes evident as the child goes through puberty. Generally, pectus carinatum develops in children aged between 11 and 16, undergoing a growth spurt.
Newborns can also exhibit the condition in the form of a rounded chest wall. Vitamin D deficiency in children can also lead to pectus carinatum. At times, pectus carinatum can occur in children following open-heart surgery. Even those with less-controlled bronchial asthma are prone to developing pigeon chests. Pectus carinatum can develop due to genetic predisposition in certain people. However, not all cases are due to genetics.
Symptoms
Often, the only symptom is the pushing outward of the breastbone. Children with the condition develop a normal heart and lungs. However, when they create a barrel-like chest, the normal movement of the chest wall is changed. Some experience breathlessness on exertion. They may experience shortness of breath, especially during exercise, have a fast heartbeat, feel tired, or have chest pain. Some may develop asthma or get a lot of respiratory infections. 
In some children, the chest wall may bulge on one side and appears concave on the other side. This condition is pectus excavatum. The position of the heart remains unaffected, though. 
Diagnosis
If the case is mild, treatment is not required. Through a series of tests, doctors can determine the severity of the condition. An X-ray of the chest will check for scoliosis or any other abnormalities of the bones. Scoliosis is a condition in which there is an abnormal curvature of the spine. A CT scan of the chest is done to check if surgery is required. An electrocardiogram (ECG) and echocardiogram (echo) are performed when a child’s heartbeat is irregular. A blood test can check for risk for Marfan syndrome and Noonan syndrome. None of the tests involve pain. So the child can undergo the examinations without fear.
Treatment
If the severity of the condition is mild for a child, then surgery is ruled out. Wearing a brace is an effective corrective option as a child is malleable and can be re-shaped. Made of light-weight aluminum, the brace could be adjusted according to the measurement and shape of the protrusion. The brace would apply pressure on the child’s protruding breastbone and cartilage and slowly reshape the chest wall. 
The child has to wear the brace at home, sleep at night, and be removed while bathing. The process of correction will take about a year. This is possible only if the child wears the brace consistently. There would be no pain, and the child could go about his routine of going to school. They can wear loose clothes if the child is conscious about his friends or strangers noticing the brace. Usually, there are no problems in wearing a brace except that the skin can get a little red and sensitive. It will turn normal after some time. Along with wearing a brace, the child can practice breathing exercises to improve the condition of the lungs.
In severe cases where surgery is required, wearing a brace could be the first step. At times, the brace can improve the appearance of the chest bone, and surgery may not be required. If the brace is not adequate, then surgery is done. Surgery will involve giving general anesthesia to the child. There will be postoperative pain. A visible scar will also be present. There are two types of procedures. One is the Ravitch technique, and the other is the Reverse Nuss procedure. Under the former procedure, an incision is made across the chest, and the defective cartilage is removed. The breastbone is then fixed in the normal position.
Psychological Health
The doctors also pay attention to the child’s mental health. When the shape of the body changes due to pectus carinatum, it will lead to body-image issues. Counseling sessions will help the child to cope with the condition. Mental health must not be ignored at the cost of treating the physical body. Parents of the child can also attend sessions to help the child improve self-esteem and reduce self-consciousness. Often, it is an important reason to seek treatment at the earliest.
If you know a child with pectus carinatum, book an appointment to meet our specialists at Align Clinic. Every patient is provided with individual care, and our staff offers the best possible treatment.

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