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Six-Year-Old with Scoliosis
Q: My wife and I were advised today that our six-year-old daughter may have scoliosis, based on a slight curve noticed in her back as she bent over to touch her toes during a routine physical examination. The recommendation was to keep an eye on my daughter's spine at her yearly physicals. Not much information was offered by the pediatrician. My wife and I would like to get a second opinion and we were wondering what type of doctor or specialist we should see. Another pediatrician, an orthopedic surgeon, or a chiropractor? Also, is a "sit and wait" approach the right thing to do for scoliosis, or does early diagnosis result in better and fuller correction?
A: Scoliosis in a six-year-old is a bit unusual and, in my opinion, warrants an evaluation by an orthopedic surgeon. Curvatures of the spine are fairly common and particularly in girls, but the young age is what has me somewhat concerned. I am assuming that your child is otherwise quite healthy and does not have any other medical problems that would be associated with a slight curve. Remember also that bending forward to touch toes during a routine physical exam is not the most precise method for identifying a curve. Since your daughter's pediatrician has raised the concern, I would want a specialist to also take a look and make an accurate diagnosis. I don't think a chiropractor would be of benefit at this stage because I am also assuming that your daughter is totally asymptomatic and able to run around, keeping up with all her friends.
You are correct in wondering whether an early diagnosis is beneficial--this is true. Realize that our spines do have natural curves. As you know, while our necks allow us to look up to the sky and our shoulder areas are somewhat rounded, scoliosis is actually a curving to one side or the other. Once this is identified, particularly in a child who is still growing, it may in fact get worse before it gets better. We would not want it to compromise your child. An orthopedist may want x-rays as part of a second opinion, but he/she may decide to just "sit and wait." More commonly, spinal deformities need only close observation and non-surgical management.
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Henry Bernstein, M.D., is currently the associate chief of the Division of General Pediatrics and director of Primary Care at Children's Hospital, Boston. He also has an academic appointment at Harvard Medical School.