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What is scoliosis?
Scoliosis is a sideways curve in the spine. The curve can look like the letters “C” or “S” when viewed from behind.
About 1 in 25 adolescent girls and 1 in 200 teenage boys develop scoliosis.
Signs You Might Notice at Home:
A more noticeable curve in the upper body
Uneven or rounded shoulders
A sunken chest or ribs that look uneven
Leaning to one side
Waist, hips, or shoulders that look tilted or uneven
Most of the time, scoliosis does not cause pain. Back pain is rare in children and teens with scoliosis.
Children with scoliosis do not have any sports or physical activity restrictions.
What causes scoliosis?
Scoliosis can develop quietly over months or years. It’s often first noticed by a pediatrician during a routine checkup.
The curve may get worse quickly during growth spurts, especially during puberty. Once your child stops growing taller, the curve usually stops changing.
Idiopathic Scoliosis
This is the most common type of scoliosis.
“Idiopathic” means the cause is unknown.
It usually shows up during puberty, when kids go through growth spurts.
It tends to run in families, suggesting a genetic link.
Girls are more likely than boys to develop severe curves that need treatment.
Myth buster: Scoliosis is not caused by bad posture, heavy backpacks, sports, or anything kids do. It’s not their fault — it’s in their genes.
Congenital Scoliosis
Caused by abnormal development of the spine before birth.
Vertebrae may be misshapen or fused, leading to uneven growth.
It’s often discovered during early childhood, especially during growth spurts.
May be linked to genetic mutations.
Neuromuscular Scoliosis
Happens when the spine lacks proper muscle or nerve support.
Seen in kids with conditions that affect how the spine is held upright, like:
Cerebral palsy
Muscular dystrophy
Spina bifida
Marfan syndrome
Osteogenesis imperfecta
Other Causes
Rarely, scoliosis can result from:
Spinal cord abnormalities
Tumors or growths
Surgery on the chest wall or spine during infancy
 Idiopathic Scoliosis |
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How is scoliosis diagnosed?
Early diagnosis allows for your child’s doctor to track changes during growth and can help prevent serious problems like breathing issues or spinal pain in the future.
Physical Examination
Your child’s doctor will check their back during routine visits looking for: uneven shoulders or waist, ribcage stick out more on one side, leaning posture
Adam’s Forward Bend Test
The doctor will stand behind your child while your child bends forward at the waist.
The doctor will check for a “rib hump” or a curve in the back from behind.
A scoliometer may be used to measure the angle of the curve.
X-rays
The most common way to confirm scoliosis and measure how severe it is.
The x-ray will include the entire spine from neck to pelvis and views from the back and the side.
Sometimes bending views to check flexibility.
The degree of the curve will be measured to determine how severe it is and help decide whether any treatment is needed.
A mild curve is less than 20 degrees.
A moderate curve is between 25 degrees and 40 degrees.
A severe curve is more than 50 degrees.
X-rays can also show how mature a child’s skeleton is. If the bones appear more mature, there is less time left for growth, making it less likely for scoliosis to get worse.
If there are concerns about scoliosis on your child’s exam, their primary care provider might order x-rays to evaluate their back OR they might directly refer your child to orthopedics for a physical examination, with x-rays to be done at that time.
Why Treatment Matters
In severe cases, scoliosis can:
Make it hard to breathe
Affect heart function
Cause joint damage and back pain in adulthood
Doctors recommend treatment when the curve is progressive—meaning it’s getting worse over time.
How is scoliosis treated?
Most kids with scoliosis have a mild curve and don’t need treatment.
About 1 in 7 kids with scoliosis have a curve that needs treatment.
Doctors choose treatment based on:
Type of scoliosis
Size of the curve
Where the curve is
How much the child is still growing
There are three main options:
Observation
If your child’s scoliosis is minor the specialist might decide follow-up appointments and x-rays at certain periods of time is best to monitor for significant changes.
Bracing
Braces are usually used for moderate curves between 25–40 degrees in kids who are still growing.
Braces are worn most of the day, until bone growth is complete - this is usually around age 17–18 for girls, and 18–19 for boys.
Braces are now less bulky and can be hidden under clothes. They are custom-made for your child.
Most kids can still do normal activities—only contact sports and trampolines are off-limits.
Doctors use X-rays every 3–4 months to check how well the brace is working.
Only about half of kids wear their braces as directed.
Surgery
Surgery is usually needed for:
Severe curves (50 degrees or more)
The curve is too big for a brace
The child is done growing
The type of scoliosis can’t be helped by a brace
The most common surgery is called posterior spinal fusion:
Doctors use metal rods and screws to hold the spine straight while the bones fuse together - this can take 6-12 months.
The rods stay in place but don’t cause harm
After Surgery
Most kids go back to school in 2-3 weeks.
They will need to skip sports and physical education while they are healing.
Some kids may need physical therapy.
Special Cases
Congenital scoliosis: Starts at birth. Doctors watch with X-rays. If the curve gets worse, surgery may be needed. Bracing is rarely used.
Neuromuscular scoliosis: Seen in kids with other medical conditions. Braces may help with sitting balance, but don’t stop curve progression. Surgery depends on many factors like lung health and curve size.
What doesn’t work
There’s no proof that exercise or spinal manipulation can stop scoliosis from getting worse.
Call Your Doctor If:
You are noticing a new or worsening curve in your child’s back.
Your child has back pain.
You have other questions or concerns
📚 References
This content was adapted from American Academy of Pediatrics Pediatric Patient Education, The American Academy of Pediatrics Parenting Website, and patient education materials from the orthopedics department at Rady Children’s Health. Images from Rady Children’s Health.
Reviewed by AR D.O., Patient Education Committee | 08/2025