In this section
Pectus carinatum (PC, or pigeon chest) is a chest wall deformity where there is overgrowth of the cartilage between the ribs and the sternum (breastbone), causing the middle of the chest to stick out.
PC is most common in adolescent males, and 90 per cent of cases are diagnosed after children are 11 years old. The condition becomes more noticeable during puberty when the body goes through a growth spurt. PC continues until the bones stop growing, usually around 18 years of age.
PC does not usually affect the internal organs or cause any problems in the way the body functions, although some patients will become short of breath more easily during exercise. PC can impact on your child's social life or self-esteem, especially when they are at the beach, pool or
PC is usually treated with a brace called a chest orthosis; however, occasionally surgery is required.
If your child has PC, they may have a distorted chest wall with their breastbone sticking out of their chest. Sometimes only one side is affected, making the chest asymmetrical (uneven). In most cases there are no other symptoms, but some children also experience:
If you think your child has PC, see your GP. They will examine your child and refer you to a paediatric surgeon. Diagnosis is confirmed by doing an X-ray and sometimes an assessment of your child's lung function and tolerance to exercise. PC is sometimes associated with other
conditions, and your child will need to be assessed for these.
Although some cases will require surgery, most children with PC will need a chest orthosis, also known as a brace, to help correct the shape of their chest wall. The brace compresses (squeezes) the overgrown ribs or breastbone back to a 'normal' position. An orthotist will fit your child’s
brace, which is worn until the chest has flattened and the chest wall can stay in position by itself – this can take many months.
There are two main stages of wearing the orthosis: corrective and maintenance.
Your orthotist will show your child how to wear the orthosis correctly and adjust it appropriately. The orthosis should not be worn during high-intensity activities, such as sport.
Contact your orthotist if you have any questions or concerns regarding your child's treatment with a chest orthosis.
Treatment is monitored by frequent orthotic reviews and with the use of 3D photography. The chest orthosis is reviewed one week after fitting and then every four weeks after that. Your orthotist will arrange reviews to monitor the progress of your child's chest and will adjust the
orthosis as required.
Following the removal of the orthosis, your child will have an orthotic review and 3D photographs taken every six months, until their chest is stable.
My son has asthma. Will the orthosis cause any problems?
Usually this is not a problem, but if your child has an
asthma episode and is having difficulty breathing, you should remove the
orthoses until he has fully recovered. An orthosis should not be worn during
In the corrective phase, is it OK to remove the orthosis for
longer than an hour if it’s a special occasion?
It is OK to remove the orthoses for brief periods, like
during a special occasion, but in general, the longer it is worn, the quicker
and better the outcome will be.
After treatment will my child’s chest look completely
Chest orthoses often
achieve excellent results, but in extreme circumstances, surgery may be
required to correct the deformity. Despite scarring, your child's chest will
usually achieve a normal shape following this procedure.
Developed by The Royal Children's Hospital Orthotic and Prosthetic department. We acknowledge the input of RCH consumers and carers.
Reviewed May 2021.
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