Pectus Carinatum and Its Psychological Effect on Kids

Pigeon chest, often called by the medical name pectus carinatum, is a congenital condition in which the breastbone protrudes from the rest of the chest. There are two main categories: chondromanubrial prominence (where the upper part of the breastbone sticks out) and chondrogladiolar prominence (where the lower part of the breastbone sticks out). The former class of this condition is much more severe, but fortunately also much rarer. 

Pectus carinatum is moderately rare, occurring around 1 in every 1500 births, and usually only becomes noticeable during puberty [1]. During this time, the rapid growth of the body — including the breastbone region, makes the overgrowth of the breastbone cartilage appear much more obvious. This produces the characteristic jutting-out chest which gives pectus carinatum its common name: pigeon chest. 

However, one aspect which does not receive as much attention is the psychological aspect. If you are interested in learning how pectus carinatum can affect your child’s mental health and what you can do about it, then read on. 

Difficulties That Children With Pectus Carinatum Experience

Fortunately, pectus carinatum is not a life-threatening condition. Furthermore, most sufferers will only experience mild physical symptoms, aside from the chest protrusion. However, in more severe cases, then some physical problems can also arise. These can include: 

• Lateral curving of the spine (scoliosis) or outward curving of the spine (kyphosis)
• Poor posture, such as hunching of the upper back and rounded/hooked shoulders
• Shortness of breath or rapid breathing, particularly during exercise. Up to 25% of teenagers with pectus carinatum have reported experiencing asthma-like symptoms [2]. 
• A fast heartbeat (tachycardia) due to the chest region being compressed 
• Chest pain 
• Feeling fatigued and lethargic
• Increased risk of respiratory infection [3]

This can make participating in sports and other physical activities difficult, particularly in children with more severe forms of this condition. If your young child is showing several of these symptoms, then you should consider having them checked for pectus carinatum. 

Most sufferers of pectus carinatum will aim to hide their chest due to the risk of embarrassment or teasing from others. Consequently, they may not participate in activities such as swimming or team sports, where their chest could be exposed. This means that they are missing out on the range of opportunities afforded to other children. Other sufferers may try to camouflage their condition with intentionally poor posture or folded arms. Some children may shun the company of other children altogether, making them withdraw from all types of social activities. 

Making the situation more challenging is the fact that the onset of pectus carinatum usually coincides with the beginning of puberty, when many children will naturally become more self-conscious of their chest region (particularly for girls) and less likely to want to show their chest to others. Consequently, it is important to distinguish between a normal level of self-consciousness and purposefully avoiding any exposure of their chest — which may be due to a chest deformity such as pectus carinatum. 

Psychological Impact of Pectus Carinatum

In general, most children with pectus carinatum will experience minimal physical problems. However, this does not mean that the condition can be ignored as a cosmetic concern, as the psychological impact can be significant [3]. 

Children with pectus carinatum will intuitively have a high level of self-consciousness due to their body image (the way they feel about their body). This comes alongside reduced self-esteem. One clinical study has shown that 95% of pectus carinatum patients listed ‘cosmetic’ reasons as one of the major reasons for seeking treatment [4], underscoring the significant impact that this condition can have on patients’ self-esteem and their social interactions. The same study found that pectus carinatum sufferers had significantly poorer perceptions of all aspects of their body image, as well as significantly lower scores for their quality of life [4]. This is partly due to the challenge of hiding the chest protrusion under their clothes [5], which makes it difficult to engage socially with others. 

Sufferers’ low self-esteem and stigmatization from others can lead to high levels of anxiety and depression. Although few studies have investigated this aspect, one report has suggested that pectus carinatum may be associated with a higher risk of mental distress [5]. There are even reports of children attempting to commit suicide due to harassment and abuse they have received from schoolmates [3]. Others regard their appearance as an obstacle in future relationships [4]. However, treatment of pectus carinatum has been shown to improve this situation, as it significantly improves patient self-esteem and quality of life [6]. 

How Can Pectus Carinatum Be Fixed? 

Pectus carinatum will not improve if left alone; however, effective treatment methods are available. The first line of treatment recommended for most patients is an orthotic compression brace, which applies pressure to the chest.

Over time, this retrains the breastbone cartilage to grow in the correct shape, thus correcting the outgrowth. The majority of patients show successful results, with over 90% responding to treatment [7,8]. The best results are shown when treatment is started at a younger age, when the breastbone cartilage is more pliable and malleable. So if your child has this condition, don’t delay — seek the advice of a health professional as soon as possible. 

Conclusion

Are you ready to restore your child’s health and confidence? Or would you like more information on treating pectus carinatum with a specialized orthotic brace? Click here to schedule a free consultation with a Dakota Brace health professional. Get evaluated for the Custom Pectus Brace (The Dakota Brace), and we’ll give you $75 off your first order! 

References

1. Robicsek F, Watts LT. Pectus carinatum. Thorac Surg Clin. 2010;20:563–74.
2. Fonkalsrud, E. W. (2008). Surgical correction of pectus carinatum: lessons learned from 260 patients. Journal of Pediatric Surgery, 43(7), 1235-1243.
3. Croitoru, D., & Nuss, D. (2004). Chest wall anomalies: pectus excavatum and pectus carinatum. Adolesc Med, 15, 455-471.
4. Steinmann, C., Krille, S., Mueller, A., Weber, P., Reingruber, B., & Martin, A. (2011). Pectus excavatum and pectus carinatum patients suffer from lower quality of life and impaired body image: a control group comparison of psychological characteristics prior to surgical correction. European Journal of Cardio-Thoracic Surgery, 40(5), 1138-1145.
5. Fokin, A. A., Steuerwald, N. M., Ahrens, W. A., & Allen, K. E. (2009, March). Anatomical, histologic, and genetic characteristics of congenital chest wall deformities. In Seminars in thoracic and cardiovascular surgery (Vol. 21, No. 1, pp. 44-57). WB Saunders.
6. Knudsen, M. V., Grosen, K., Pilegaard, H. K., & Laustsen, S. (2015). Surgical correction of pectus carinatum improves perceived body image, mental health and self-esteem. Journal of Pediatric Surgery, 50(9), 1472-1476.
7. Colozza, S., & Bütter, A. (2013). Bracing in pediatric patients with pectus carinatum is effective and improves quality of life. Journal of Pediatric Surgery, 48(5), 1055-1059.
8. Emil, S., Sévigny, M., Montpetit, K., Baird, R., Laberge, J. M., Goyette, J., ... & Courchesne, G. (2017). Success and duration of dynamic bracing for pectus carinatum: A four-year prospective study. Journal of Pediatric Surgery, 52(1), 124-129.