Understanding the Options for Treating Sunken Chest Syndrome in Children

​Pectus Excavatum is a malformation of bone that occurs in your child’s chest wall.

The name means ‘hollow chest’ in Latin. It causes a visible concave deformity and might cause the ribs to grow in a wayward manner. Due to this, it is also known as the sunken chest syndrome or funnel chest.

If you suspect that your child has Pectus Excavatum, confirming its presence and getting treatment is relatively easy. After all, it’s the most common chest wall abnormality observed in children.
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We layout your next course of action in chronological order.

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Detecting It

Unlike the case of Pectus Carinatum, this condition can be detected when your child is as young as 2 or 3. But they can only determine its severity with growth spurts.

The figures suggest that male children are more susceptible to the condition. At least 1 in every 300-400 children develops this ailment to various degrees of severity.

Nearly 15% of the children who have Pectus Excavatum develop scoliosis - a spine curvature ailment. So, it becomes all the more important to pay attention to signs of a sunken chest.
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Consult your physician and understand the severity of the issue. If required, talk to an orthopedist to get detailed insights into your child’s condition.

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Causes

​Unfortunately, researchers haven’t been able to pinpoint the reasons for its occurrence.

Some academics from Boston University have discovered genetic markers associated with the condition. Others tend to relate sunken chests with Marfan Syndrome, Noonan Syndrome, and the likes. 
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In children with spinal muscular dystrophy, diaphragmatic breathing can also cause Pectus Excavatum.​

Treating It

When mild Pectus Excavatum is detected, no medical intervention is needed. At most, your child may need a few regulated physical activities to overcome the condition’s effects.

In cases where there is a threat of lung damage or cardiorespiratory issues, surgery might be the best recourse. Read on to find out about the various methods and their possible implications.

Non-Surgical Methods

1. Exercise

• Many trainers and organizations have come up with treatments that look to exploit the elastic chest walls. 
• Aerobic exercises aim at improving body posture and are crucial for preventing relapse at a later stage. With strengthened chest and back muscles, breathing patterns improve, and the indentation is hidden. 
• It could be more effective in pre-teens and adolescent kids who are yet to see a growth spurt. Besides, breathing exercises could help in expanding the chest naturally. 
• Remember, exercise or Yoga can only resolve mild issues of sunken chest. At best, it can supplement clinical treatment for the condition. 

2. Vacuum Bell

• This method was introduced in 2006 and gained traction in the following decade.
• A cup-like device covers the chest cavity, and slowly, the excess air gets pumped out. As a result, there is an upward movement in the sternum. It reduces the sunken area’s diameter and removes the Pectus Excavatum altogether. 
• Prolonged use of the device combined with physiotherapy can be beneficial.
• Usage of vacuum bell shows promise, but there is no conclusive evidence of its effectiveness.

​3. Orthoses

• Orthotists can customize a brace for your child that would gradually help in reducing the sunken chest. It’s a low-maintenance device that you can wear over or beneath clothes.
• It’s a reasonably reliable method that has been prescribed by doctors for nearly three decades now. While the results do take some time to show, this is a passive and straightforward treatment method.
• The only challenge is to make orthosis a part of your child’s lifestyle.

Surgical Methods

1. Ravitch Technique

• The Ravitch Method is one of the oldest procedures for treating severe Pectus Excavatum. 
• It involves the removal of the cartilage bone and the insertion of a temporary reinforcement. A titanium or nickel rod is used to hold the sternum in its proper place. 
• In 1-2 months, the cartilage bone will grow once again, and this time around, there is no sunken chest.
• Due to its invasive nature, doctors do not recommend it for kids in most cases.

2. Nuss Procedure

• Developed in Virginia, it’s a popular method that involves the use of bars.
• A concave shape bar is pressed against the deformity to bring the bone to its natural position. The entire process could take anywhere between two to five years, depending on the severity.

3. Robicsek technique

• It starts with a tiny incision, and slowly, the muscles are detached from the sternum, removing the cartilage bone.
• The sternum is forcefully held in the correct position with a mesh’s help in the next step.
• While it seems less invasive, there are major relapse concerns whenever this technique is used. 

​4. Lipofilling

• We know what you are thinking! It’s a procedure associated with cosmetic surgeries. At times, you can use it to fill the cavity caused by the Pectus Excavatum too. 
• In this process, some amount of fat is taken from your child’s body. The same gets reinjected in the required areas after centrifugation. It’s relatively straightforward, provided the cavity isn’t extensive.

Following Up

After undergoing any surgical procedure, you can expect your child to be kept under observation for 3-4 days. They could be under pain-control medication for up to a month after the operation. It’s best if they skip school and all other physically draining activities during this period. 

Amidst all this, understanding the psychological repercussions becomes essential. Attempt to attend all follow-up sessions with your physician, orthotist, or physiotherapist.

Teens especially feel awkward or embarrassed to talk about their feelings. Try to find out if their friends and other family members are being sensitive while broaching the topic.

Additionally, ensure that your child is comfortable during the prognosis and treatment phase. Without their willingness, it would be impossible to achieve the desired results.

Want to know more about the other kinds of chest wall disorders? We have listed them in this all-inclusive blog post.

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