My Child’s Chest Bone Sticks Out. What Should I Do?

Does your child’s chest bone stick out? This is a worrying situation for any parent, but it is important not to panic. A protruding chest is more common than many think, although getting a correct diagnosis is still essential. This will allow your doctor to determine the optimum treatment method for your child. 

One likely cause is pectus carinatum, a congenital condition that results in overgrowth of the breastbone region. Fortunately, pectus carinatum can usually be successfully treated without resorting to surgery. 

This article will discuss possible reasons for a protruding chest bone, other signs and symptoms of pectus carinatum, when you should see a doctor, and how to treat a protruding chest bone. 

Reasons for Protruding Chest Bone

What can cause a protruding chest bone? There are several possible causes of this condition. However, the most common cause is a condition known as pectus carinatum or pigeon chest. This is a congenital condition, meaning that it is present from birth. However, it is not very obvious in most sufferers until their early pre-teen or teenage years, when their bodies undergo the most rapid growth phase of puberty.[1] Although some cases may be diagnosed at an earlier stage, this is the exception rather than the rule. Further complicating the issue, children will naturally become more self-conscious of their bare chest during puberty, meaning that parents will often be unaware of any abnormalities developing. 

At an anatomical level, the underlying cause of pectus carinatum is an overgrowth of the cartilage forming the breastbone region. Although the exact causes are not fully understood, it appears to have some hereditary component [2] as well as some element of chance.[3] Males are affected roughly four times more frequently than females.[3] 

However, pectus carinatum is not the only possible reason for a protruding chest bone. Other potential causes can also include: 

• Tietze syndrome — a rare acute condition that causes swelling of the cartilage forming the breastbone and upper ribs. It most commonly occurs in young adults. 
• Xiphoid syndrome — another rare condition that produces swelling and pain in the lower sternum. It usually occurs following some form of mechanical injury to the chest. 

Signs and Symptoms of Pectus Carinatum

As noted previously, the principal sign of pectus carinatum is if the sternum pokes out. This may occur in either the upper breastbone (chondromanubrial prominence) or lower breastbone region (chondrogladiolar prominence). 

However, many other signs may be associated with pectus carinatum. These include: 

• Chest pain (although this is relatively rare)
• Tachycardia (unusually fast heart rate)
• Having poor posture, such as a hunched back or rounded shoulders
• Having a very curved spine
• Rib flare
• Feeling fatigued, lethargic, or short of breath, particularly after exercise

Many of these signs are not specific to pectus carinatum, as they can also result from other conditions or diseases. However, when occurring in combination, they can provide warning signs which point toward pectus carinatum. 

In addition to these signs, the chance of having pectus carinatum can be significantly increased in people suffering from other syndromes, such as Marfan syndrome, Noonan syndrome, Morquio syndrome, Poland's syndrome, Ehlers-Danlos syndrome, osteogenesis imperfecta, homocystinuria or Coffin-Lowery syndrome. 

When to See a Doctor

Although pectus carinatum can be a significant condition, it is important to remain calm and remember that it is not as rare of a condition as it may appear. Around 1 in every 1500 children suffer from some form of pectus carinatum.[4] In most cases, the largest problem is the unwanted appearance of the chest, with minimal or no impact on their overall health. Furthermore, most cases can be successfully treated through non-surgical methods, principally orthotic bracing. 

Cases of chondromanubrial prominence (where the upper breastbone region sticks out) are considerably more severe than chondrogladiolar prominence, and medical advice should be sought before treatment in these cases.[5] Rarely, severe cases of pectus carinatum (particularly chondromanubrial prominence) can affect breathing and heart function. However, it is always best to see your doctor and obtain a clinical diagnosis if you think your child may have pectus carinatum, regardless of the type. 

Treatment With a Chest Brace

Treatment using a compression chest brace is recommended for most pectus carinatum patients.[6] The most effective results are obtained when this treatment is started during the pre-teen years when the breastbone cartilage is more malleable. However, beneficial results can be seen even when starting bracing in the late teenage years. 

There are two broad phases of pectus carinatum brace treatment: the corrective and maintenance phase. In the first, a lightweight chest brace is worn for up to 23 hours per day for around 6-12 months. The brace provides compression around the protruding chest region, pulling the breastbone cartilage into the desired shape. It is very important to wear the brace regularly during this period for the best results. Having the correct brace to suit your child’s condition is also crucial.

At Dakota Brace, we offer a Custom Pectus Brace, which is based on a 3D scan of the body, and 3D printed to exactly fit your child’s body shape.

Additionally, we can provide a Custom Pectus & Two Rib Flare Brace, suited to children suffering from pectus carinatum with associated rib flare. 

In the maintenance phase of bracing treatment, the time wearing the brace is decreased to around 8-12 hours per day. The maintenance phase usually lasts until skeletal growth slows and the breastbone cartilage begins to harden in the desired shape. For most patients, this may be 1-2 years. The primary goal of the maintenance phase is to prevent relapse. However, once the bracing program is successfully completed, recurrence of pectus carinatum is quite rare. 

Conclusion

Do you need more information on treating pectus carinatum using orthotic bracing? Or are you ready to purchase a brace for your child? Get a free consultation with Dakota Brace today and $75 off your first order, and get evaluated for either our Custom Rib Flare Brace (The Rider Brace) or our Custom Pectus & Two Rib Flare Brace (The Bison Brace). 

References:

1. Abdullah F, Harris J (2016) Pectus excavatum: more than a matter of aesthetics. Pediatr Ann, 45:e403–e406.
2. Shamberger, R. C. (1996). Congenital chest wall deformities. Current Problems in Surgery, 33(6), 469-542.
3. Cobben, J. M., Oostra, R. J., & van Dijk, F. S. (2014). Pectus excavatum and carinatum. European Journal of Medical Genetics, 57(8), 414-417.
4. Robicsek F, Watts LT. Pectus carinatum. Thorac Surg Clin. 2010;20:563–74.
5. Frey, A. S., Garcia, V. F., Brown, R. L., Inge, T. H., Ryckman, F. C., Cohen, A. P., ... & Azizkhan, R. G. (2006). Nonoperative management of pectus carinatum. Journal of Pediatric Surgery, 41(1), 40-45.
6. Frey, A. S., Garcia, V. F., Brown, R. L., Inge, T. H., Ryckman, F. C., Cohen, A. P., ... & Azizkhan, R. G. (2006). Nonoperative management of pectus carinatum. Journal of Pediatric Surgery, 41(1), 40-45.