Kids Health Info

Pectus carinatum (pigeon chest)

  • 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 changing room. 

    PC is usually treated with a brace called a chest orthosis; however, occasionally surgery is required.

    Signs and symptoms of PC

    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:

    • shortness of breath during exercise
    • tenderness or pain in the area of overgrowth
    • more frequent respiratory infections (e.g. colds)
    • becoming tired easily.

    When to see a doctor

    If you think your child has PC, see your GP. They will examine your child and refer you to an orthopaedic (bone) specialist. 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. 

    Treatment with a chest orthosis

    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.

    Chest orthosis

    There are two main stages of wearing the orthosis: corrective and maintenance.

    • Corrective phase – in the first three to six months the orthosis is worn 23 hours a day.
    • Maintenance phase – when the chest overgrowth has flattened enough, the orthosis is worn for eight to 10 hours each night. The maintenance phase usually lasts another three to six months. If the protrusion reappears during the maintenance phase, your child will need to restart the corrective phase and wear the brace for 23 hours a day.

    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.

    Care at home

    • When the orthosis is removed each day, check the skin to make sure there is no rubbing or skin breakdown on the protruding chest. Mild redness over the protruding chest is normal and to be expected, but there shouldn’t be sores or rashes. Wearing a singlet or T-shirt under the brace will stop the skin from rubbing and becoming damaged or sore.
    • Your child's chest will become sweaty under the orthosis. They will need to wash the skin every day beneath the front and back pads (remove the brace while your child is washing, and dry the skin thoroughly).
    • Feeling slight pressure while wearing the orthosis is normal. However, if your child feels any pain while wearing the orthosis, contact the orthotist for a review.

    Contact your orthotist if you have any questions or concerns regarding your child's treatment with a chest orthosis.

    Follow-up

    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.

    Key points to remember

    • Pectus carinatum (PC) is a chest wall deformity that usually does not affect the internal organs.
    • A chest orthosis (brace) is used to treat PC. In the corrective phase, the orthosis is worn 23 hours a day, and in the maintenance phase, for eight to 10 hours a day.
    • Treatment is monitored by frequent orthotic reviews.

    For more information

    • See your GP, paediatrician, surgeon or orthotist.

    Common questions our doctors are asked

    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 strenuous exercise/sport.

    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 normal?

    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 2018.

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.

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Disclaimer
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.