Pigeon chest in children, medically termed pectus carinatum, can cause concern for parents and adolescents. While it is not always a serious issue, knowing when to seek medical advice is important for your child’s health.
Pigeon chest can require careful monitoring, bracing and in some cases surgery.
What is Pigeon Chest?
Pigeon chest, also known as pectus carinatum, is a chest wall problem where the front of the chest sticks out more than it should. The cartilage that connects the ribs to the sternum (breastbone) does not grow in a normal way, which then causes the ribs and sternum to grow outward more than usual. This can create a bowed or rounded appearance of the chest, resembling the breast of a pigeon (hence the name “pigeon chest”).
What Causes Pigeon Chest and Who is Affected?
Though the cause of pigeon chest is unknown, we do know that the condition mostly affects boys and that it gets worse during adolescence, especially during growth spurts and the teen years.
Signs and Symptoms of Pigeon Chest
Signs and symptoms vary depending on the severity of the condition. The majority of cases will not have any symptoms. Signs and symptoms may include:
- Excessive growth of cartilage in the chest: The appearance of which makes the chest look rounded.
- Chest pain or discomfort: The discomfort tends to occur during physical activities or when lying on the stomach.
- Psychological impact: Embarrassment or self-consciousness in children, particularly as they reach adolescence.
When to Seek Medical Advice
While pigeon chest does not always require immediate attention, there are signs indicating a need for medical evaluation.
Consult your pediatric doctor for a referral to a chest wall clinic if your child:
- Has a protrusion that worsens over time
- Experiences breathing problems, though this is less likely related to pigeon chest
- Complains of chest pain
Pigeon Chest Treatment
Treatment for pigeon chest can help correct the protrusion of the breastbone and improve the appearance of the chest. Treatment depends on the severity of the condition, the child’s age and growth stage, and individual preferences. Some children may only have mild protrusions that do not require treatment. If a child or teenager does not seem to be affected by their pigeon chest, they may choose not to treat the condition, however, it will not correct itself or go away on its own.
Bracing
Bracing is well established in many countries. The American Pediatric Surgical Association recommends bracing as the first line therapy for pectus carinatum. Bracing is considered the most effective treatment for pigeon chest in younger patients (around 14 years old) because they have flexible chest walls that can be permanently corrected.
At what age should a pectus carinatum be treated with a brace?
The average age of patients having bracing at the Chest Wall Clinic is 14 years old. Bracing is most effective in younger patients with flexible chest walls and offers a more permanent correction.
What is the success rate of the pectus carinatum brace?
Approximately 71 percent of patients are successful with a good outcome. Following a successful assessment, generally results after bracing end in a positive outcome across age groups. Bracing more than 11 hours per day is the most likely to correct.
The results of bracing are dependent on the child’s participation; the more dedicated the patient is to wearing the brace, the sooner they will see an improvement in their pectus carinatum. Encourage your child to wear the brace exactly as recommended by your healthcare provider.
How long does it take to fix pectus carinatum with a brace?
Most patients will wear a brace for 6 months to a year, though some will need it for longer. The brace can be removed for sports, showering and other activities, but it is recommended to be worn for 12 hours a day or longer. The more dedicated the patient is to wearing the brace, the sooner they will see an improvement in their pectus carinatum.
When you have your brace, it will need to be fitted and corrected. Adjustments will be made for a proper fit and maximum comfort prior to the start of bracing. A chest wall clinic physician will recommend a bracing regimen and make adjustments to the brace as needed.
Once the breastbone (sternum) moves back to a normal position with bracing, your child may need to wear the brace for another year to help make sure it stays in place. This is similar to braces for teeth with a retainer.
Due to the effective nature of bracing, a need for pigeon chest surgery is rare.
With Stony Brook Children’s Division of Pediatric Surgery, you’ll find the highest level of pediatric surgical care at our Children’s Hospital and six facilities across Long Island. Our Chest Wall Clinic focuses on common adolescent conditions, including pectus carinatum.
