My Child’s Ribs Stick Out: Understanding Rib Flare

Do your child’s ribs stick out from the rest of their chest? This condition is a worry for any parent. However, it is not as uncommon as you may first think. But what causes rib flare? Is it a serious condition? And how can it be treated? Read on to find out possible reasons for this occurrence and potential treatments. 

Possible Reasons for an Uneven Rib Cage

Why are your child’s ribs poking out? This condition is known as rib flare, or rib flaring deformity, and is characterized by the lower ribs protruding from the rest of the chest. 

So what are the possible reasons for rib flare? Most often, this results from a structural deformity or abdominal weakness. One common cause in children is pectus carinatum, a congenital condition that results in overgrowth of the breastbone cartilage. In turn, this pulls the lower ribs further upward and outward than normal, resulting in the ribs sticking out. 

However, there are other possible causes of rib flare. These can include: 

• Congenital rib flare deformity (occurring without pectus carinatum). However, this is relatively rare.[1]
• Abdominal muscle injury — this occurs more commonly in adults than children. For example, muscle injury may occur in postpartum women or from an acute abdominal injury. However, it is unlikely to occur in healthy children. 
• Abdominal muscle weakness — this may result from bad breathing habits (using chest muscles to breathe) rather than fully utilizing the diaphragm when breathing. 
• Poor posture — such as excessive spine curvature. This can be true for both front-to-back curvature (hyperlordosis) and side-to-side curvature (scoliosis). 

Signs and Symptoms of Rib Flare

The most obvious sign of rib flare is a protrusion of the ribs. Flaring can be unilateral (occurring on only one side of the chest; most commonly, the left side) or bilateral (occurring on both sides of the chest). Some patients with rib flare may also have flattening in the upper part of their chest. However, in congenital cases of rib flaring, it will not usually be obvious at a younger age but becomes more prominent during puberty when the chest bones and cartilage are growing and developing. In these cases, the warning signs for pectus carinatum may provide an early warning of rib flare. These include chest pain, shortness of breath, a highly curved spine shape, and a fast heart rate. 

Other symptoms which may point to rib flare include poor posture, weak abdominal muscles, back soreness and tightness, and shallow breathing. These result from anterior pelvis tilt, a side-effect of having flared ribs. 

Testing and Diagnosis for Rib Flare

Rib flare is usually diagnosed by a doctor following a physical examination. In some cases, this may require a chest X-ray. If you cannot see a doctor, then a physiotherapist or similar health professional may be able to provide advice.

However, there are two easy ways to check if your child may have rib flare. The first is to examine the amount of rib protrusion with their arms by their sides and compare this to the amount of protrusion when their arms are raised above their head. If the flaring increases significantly when their arms are raised, then this may point to rib flare. 

The second way is to ask your child to lie down on their back. If there is a large gap between their lower back arch and the floor, this suggests that rib flaring may be an issue. However, it is important to caution that any diagnosis should be confirmed by your doctor.

Rib Deformity Treatment

In most people, bracing is recommended as the first choice for treating rib flare. This treatment method uses specially designed orthotic braces, compressing the lower ribs into the desired shape. It is most effective in younger children (pre-teen to early teens), as the breastbone and rib cartilage is still pliable and can be re-trained to grow in the correct shape. However, bracing can also help train the abdominal muscles to hold the lower ribs in the right position. Consequently, benefits can also be seen when used in older children or adults. 

To be successful, the brace must be worn consistently and for extended periods. Typically, it will take 6-12 months of continuous bracing to realign the ribs, with up to several more years of maintenance bracing. Due to the length of time which a brace must be worn in order to be effective, custom-fitted braces, such as our Rider Brace for pectus carinaum, should be used.

Additionally, the brace should be specifically designed for treating rib flare. Other braces, such as rib binders or pectus carinatum braces, will not help the rib flare and may actually worsen it.[2]

For children suffering from both pectus carinatum and rib flare, custom braces like our Bison brace for pectus carinatum and rib flare, are available to treat both conditions simultaneously. 

In very mild cases of rib flare, the abdominal muscles may be strengthened through physiotherapy exercises or stretches. Again, this can help train these muscles to hold the lower ribs in the right position. This will minimize the appearance of the flaring, but will not change the underlying rib structure/shape as a brace does. 

Finally, surgery may be required for the most severe cases of rib flare deformity. However, this is usually a last line of resort as it is generally quite invasive and has relatively long recovery times.

Conclusion

Are you ready to take the first steps toward regaining your child’s confidence and health? Click here to get a free consultation with Dakota Brace today, as well as $75 off your first order. We make two brace types specifically for treating rib flare: a Custom Pectus & Two Rib Flare Brace (The Bison Brace), which is suited for patients with both pectus carinatum and rib flare, and a Custom Rib Flare Brace (The Rider Brace), which is designed for patients with only rib flare. Our experienced team can provide remote consultations, making it easier to fit into your schedule. 

References:

1. Haleem, A., Hanif, M. S., Majeed, F. A., Wyne, A., & Rahim, K. (2015). Frequency of anomalies associated with chest deformity in physically fit male candidates reporting for military recruitment. PAFMJ, 65(2), 170-174.
2. Haje, S. A., & Haje, D. P. (2006). Overcorrection during treatment of pectus deformities with DCC orthoses: experience in 17 cases. International Orthopaedics, 30(4), 262-267.