Understanding Your Child’s Spine

A healthy spine does more than hold us upright. It protects the spinal cord, supports movement, and shapes how a child sits, stands, walks, and grows. Spine Health Awareness Month, recognized each October, is a reminder to pay attention to spine health at every age.

Scoliosis is a condition in which the spine develops an atypical, three-dimensional curve and rotation. Curves are usually described by their size, measured in degrees, and by the region of the spine involved — thoracic (upper/mid back), lumbar (lower back), or both. 

Scoliosis is not a single disease with one cause. It's a description of a spinal shape that can result from several different underlying conditions. Knowing which type of scoliosis a child has is essential, because it shapes how the curve is expected to behave and which treatments make sense.

MOST COMMON

Idiopathic Scoliosis

Idiopathic scoliosis has no single identifiable cause and accounts for the large majority of pediatric scoliosis cases. It's typically grouped by the age it appears — infantile, juvenile, or adolescent — with adolescent idiopathic scoliosis (AIS) being by far the most common, often appearing around the growth spurt before puberty. Curves can progress quickly during rapid growth, which is why screening during these years matters.

PRESENT FROM BIRTH

Congenital Scoliosis

Congenital scoliosis results from vertebrae that didn't form or separate correctly while the spine was developing before birth. Because the atypical bone structure is present from birth, this type of scoliosis is often identified earlier than idiopathic scoliosis, sometimes through imaging done for unrelated reasons. It may also occur alongside other congenital differences affecting the heart, kidneys, or spinal cord.

SECONDARY TO ANOTHER CONDITION

Neuromuscular Scoliosis 

Neuromuscular scoliosis develops because of an underlying neurological or muscular condition, such as spina bifida, cerebral palsy, or muscular dystrophy. Muscle weakness or imbalance reduces the ability to support a growing spine, which becomes curved and twisted over time. These curves are more likely to progress rapidly during adolescent growth spurts and, depending on their severity, can affect breathing, sitting balance, and skin health from pressure.

LINKED TO A BROADER SYNDROME

Syndromic Scoliosis

Syndromic scoliosis occurs as one feature of a broader genetic syndrome or connective tissue disorder — for example, Down syndrome or neurofibromatosis. Because these curves are tied to differences in bone or connective tissue quality throughout the body, care teams often coordinate spine treatment with management of the syndrome's other effects.

Some clinicians also use “nonidiopathic scoliosis” as an umbrella term for congenital, neuromuscular, syndromic, and other curves with an identifiable cause, to distinguish them from idiopathic scoliosis.

Because early curves often don't cause pain, scoliosis can be easy to miss without a deliberate check. Signs to watch for include:

• Uneven shoulders, shoulder blades, or waistline
• One hip appearing higher than the other
• The rib cage appearing like it ‘sticks out’ on one side, especially when bending forward
• Clothes that seem to hang unevenly

Why early detection matters: The sooner a curve is identified, the more treatment options — often including non-surgical ones — remain on the table. Routine screening during well-child visits can catch curves while they're still small and easier to manage.

Diagnosis typically starts with a physical exam, including the Adams forward bend test, where a child bends forward at the waist so the care team can look for asymmetry in the back and ribs. If a curve is suspected, an X-ray confirms it, and a clinician measures its size using the Cobb angle — the standard measurement used to track curves over time.

Treatment depends on the type of scoliosis, the size and location of the curve, the child's remaining growth, and how the curve is affecting daily function. Most children with small, stable curves need only monitoring; larger or progressive curves may call for bracing or surgery.

Bracing

A spinal brace applies targeted pressure to the torso to help slow curve progression in a growing spine. The most common type is a thoraco-lumbo-sacral orthosis (TLSO), a custom-molded brace extending from the armpits to the pelvis. There are two general wear schedules:

• Full-time TLSO — worn roughly 18 to 23 hours a day, removed for activities like sports, therapy, and bathing.
• Nighttime hypercorrective TLSO — worn for 8-10 hours a day while lying down during sleep, taking advantage of relaxed muscles and changes in gravity’s forces on the spine while lying down during sleep to apply greater corrective force.

Surgical Treatment

When a curve is severe or continues to progress despite bracing, surgery may be recommended. The most common procedure is spinal fusion, which joins two or more vertebrae along the curve to reduce the curve and stop further progression. For younger children who still have significant growth ahead, “growth-friendly” surgical systems — using expandable rods — can control the curve while allowing the spine to keep growing, with the hardware lengthened periodically as the child grows.

In cases involving related conditions such as neuromuscular scoliosis, the care team also weighs factors like sitting balance in a wheelchair, respiratory function, and skin health when deciding on the timing and extent of surgery.

Spine health goes well beyond scoliosis. One of the most common causes of low back pain in active kids and teens is spondylolysis — a stress fracture in the pars interarticularis, a thin bridge of bone that connects the joints at the back of a vertebra. It usually develops from repeated stress on the lower back, especially in sports that involve frequent arching, twisting, or impact, such as gymnastics, dance, football, diving, and wrestling. About 5 to 6 percent of kids and teens have had spondylolysis by age 18. If the fracture occurs on both sides of a vertebra, that vertebra can sometimes slip forward over the one below it, a condition called spondylolisthesis.

Many young people with spondylolysis never have symptoms. When they do, signs to watch for include:

• Low back pain that gets worse with activity or with bending backward, and eases with rest
• Tight hamstrings
• Soreness when standing or walking for long periods

Clearer Answers, Without the Radiation

An X-ray is usually the first step in looking for a pars stress fracture, but these small fractures don’t always show up. At many centers, the next step to get a detailed look at the bone is a CT scan, which uses significantly more radiation than an X-ray. That matters for growing kids, who are more sensitive to radiation and may need more than one scan over time.

Gillette Children's offers BoneMRI, an imaging technology that creates high-resolution, three-dimensional, CT-like images of bone from a standard MRI scan. That means families can skip the CT scan and its radiation altogether. And because it’s an MRI, the same exam also shows soft tissue, such as swelling in the bone that can signal an early or active injury, along with the nerves and discs around it.

One exam, zero radiation: BoneMRI gives the care team the bone detail of a CT and the soft tissue detail of an MRI in a single scan, with no radiation exposure for a growing child.

Care Built Around Young Athletes

Most spondylolysis improves without surgery. Treatment typically includes a break from the activities that cause pain, physical therapy to build core strength and flexibility, and, in some cases, a back brace. At Gillette Children's, that care comes together in one place:

• Physical therapy focused on adolescent athletes — therapists who specialize in sports-related injuries in teens help build strength, improve movement patterns, and guide a safe, step-by-step return to sport.
• Orthotics on site — when a brace is part of the plan, it can be custom-fit and adjusted in the same place the child receives the rest of their care.

Surgery is rarely needed and is generally reserved for pain that continues despite nonsurgical treatment, or for spondylolisthesis in which the vertebra has slipped significantly.

Learn more about spondylolysis care at Gillette Children's

Spine Health Awareness Month is also a good moment to reinforce everyday habits that support a healthy spine for every child, whether or not scoliosis is a concern:

• Encourage regular movement and age-appropriate physical activity to build core and back strength
• Support good posture during long periods of sitting, including for schoolwork and screen time
• Make sure backpacks are worn with both straps and sized appropriately for a child's frame
• Bring any new back pain, uneven posture, or changes in movement to a pediatrician's attention rather than waiting to see if it resolves on its own

For families and clinicians who want a comprehensive, book-length resource, Gillette Children's Healthcare Press — co-published with Mac Keith Press — has released two titles in the Gillette Children's Healthcare Series dedicated entirely to scoliosis:

HEALTHCARE SERIES

Idiopathic Scoliosis: Understanding and Managing the Condition

Led by Gillette spine specialists, this guide walks families through idiopathic scoliosis from diagnosis through adulthood, pairing evidence-based treatment information with lived family experience.

Read more at Mac Keith Press

HEALTHCARE SERIES

Scoliosis: Congenital, Neuromuscular, Syndromic, and Other Nonidiopathic Types

A companion volume focused on the nonidiopathic forms of scoliosis discussed above, covering the underlying causes, evaluation, and management approaches for congenital, neuromuscular, and syndromic curves.

Read more at Mac Keith Press

Both titles are also part of the full Gillette Children's Healthcare Series, which covers other childhood-acquired brain, bone, and movement conditions.

Every child's spine tells a different story, and every family deserves a care team that takes the time to understand it. Because every body has value.