How do I know if I have scoliosis?
Children will almost never feel any pain when scoliosis is first developing, so regular checks are very important. If scoliosis is detected early by your school, family, or doctor, individuals with scoliosis can receive treatment that may control the condition and prevent other problems.

All children should be screened every 6-9 months, from age 9 until their bones do much of their growing (skeletal maturity). Skeletal maturity in girls is usually reached by age 16 1/2, and in boys by age 18. Generally, scoliosis progression slows (but does not always stop) by the time an individual is fully mature.

Is back pain a symptom of scoliosis?
With adults, pain is often associated with scoliosis, and may be a sign of a progressive curve. Most adults carry over their curves from their teenage years, however, and usually know if they have scoliosis or not. More information specific to adults who have scoliosis is in a separate section of the packet entitled Adult Scoliosis.

With children, however, back pain is not a feature of adolescent idiopathic scoliosis, and may be a sign of a tumor, infection, trauma or some other underlying cause of scoliosis.

How do you check for scoliosis?
At Home: Parents can be a big help in checking for early warning signs of scoliosis. Sometimes the legs of pants or hems of skirts look uneven, but the earliest signs can only be seen with a clear look at the back. Parents should look at the following:

1. Is one shoulder higher than another?
2. Does one should blade stick out more and the other?
3. Does one arm rest farther from the side of the body than the other arm does?
4. Have the child bend over, with their back parallel to the floor. Is there a bulge on one side of the back?

Other symptoms of scoliosis can include significant physical deformity and cardiopulmonary (heart and lung) problems, including shortness of breath, and frequent chest colds.

At School: Nearly half the states require that public elementary schools screen for scoliosis from fifth grade on. Every 6-9 months, these screening tests, or "forward bending tests", are performed by school nurses. Another tool used is called the "plumb line", pictured to the right, which creates a straight line with which to compare the child’s spine.

These school screening tests are controversial however, perhaps explaining why only half the states fund them. School screening programs have low rates of accuracy, with up to 2/3 of students identified as potentially having scoliosis were later found to have no abnormality. In 1993, the US Preventative Services Task Forces found that "there is insufficient evidence to make firm conclusions about the effectiveness of screening adolescents for idiopathic scoliosis," but did not recommend getting rid of the screenings, since many children do not have access to regular health care.

What if I suspect scoliosis?
Even if one or more of the signs listed above are spotted, the child does not necessarily have scoliosis. They should be confirmed by physical examination and X-rays, usually done by an orthopedic surgeon with special training in spinal problems. The "Cobb Method", calculated with an x-ray taken of the child’s back, is the most widely used method of determining the curve size.

The inclinometer and other physical means of measuring the height of the rib hump on the forward bending test have also been used. However, most of these techniques are not widely employed. Since a decision to treat or not to treat scoliosis is largely based upon documentation of progression, it is crucial that x-rays or other documentation be made.

One thing that is very important to determine is whether the curve is progressive or not. There are certain factors that put children more or less at risk for progression than others.

Who is more likely to have a progressive adolescent idiopathic curve?
The risk of progression is primarily based on two factors: future skeletal growth (how many years of growing left) and the size of curve at diagnosis. Curves over twenty degrees are more likely to progress than curves smaller than twenty degrees. Premenarchal (have not yet had their period) girls at a higher risk of curve progression, as are girls relative to boys in general. The more time a child has left to grow, the more at risk they are of having their curves progress.

What happens in the physician’s office when you are examined?
Probably the first thing the doctor will do would be to examine in the back and front, and notice any unevenness in the neck, waist, shoulders, hips, breasts or distance between the arms and body. They may look to see if both legs are of equal length, and perform their own "forward bending test", looking for obvious curves or a rib hump. She or he will mostly likely look closely at the skin, seeing if there are any lesions or marks that would indicate one of the less common causes of scoliosis, such as spina bifida or neurofibromatosis.

Since the risk of progression is related to the amount of growth a child has left, it is important for the physician to know the skeletal maturity. This is measured in a number of ways, either by actual age (not very precise), whether or not menses (period) has occurred, or the Risser sign. The Risser sign measured the amount of calcification (buildup) on the hip bone, and is widely accepted as a good way to approximate bone age.

If back pain is present in children, this may be a sign of underlying causes of the scoliosis, such as a tumor, infection, or trauma. A bone scan would be recommended, and if any abnormalities show up, an MRI (magnetic resonance image) would most likely be ordered.