Scoliosis diagnosed before the age of 10 is often considered “early-onset scoliosis.” The youngest cases, those diagnosed before the age of 3, are subcategorized into infantile scoliosis.
When scoliosis is diagnosed at birth of before the age of three, it’s very possible that the curvature will correct all by itself, without any treatment. The majority of infantile scoliosis cases will resolve by the age of three, although some may persist later into childhood. However, it’s important to understand that those cases which do not get better stand a very high chance of progressing to severe levels and causing problems in adulthood.
Unlike other forms of scoliosis, infant males tend to be diagnosed with scoliosis more often than females. Furthermore, infantile scoliosis is often associated with other disorders; MRI’s are typically recommended for all children under the age of three with Cobb angles greater than 20 degrees. Scoliosis in infants is often congenital – caused by a malformation of the bones of the spinal column. In cases where one part of the body didn’t develop properly, it’s common for there to be other areas that did not do so, as well. For this reason, a comprehensive review of all systems is always necessary in cases of infantile congenital scoliosis.
Most young infants with scoliosis, particularly in the absence of any other developmental or congenital disorders, tend to be very cheerful and happy babies, exhibiting few signs of outward distress. If they appear uncomfortable or irritable, it’s worth investigating if something besides the scoliosis could be the cause.
The CLEAR protocols are generally intended to be applied in individuals over three years of age, due to the fact that they involve exercises and active patient participation. It is possible to provide young infants with a modified version of the CLEAR protocols; this could certainly be beneficial in helping to reduce misalignments of the upper cervical spine (torticollis, etc.), reducing cranial malformations (plagiocephaly), or reducing tension on the spinal cord (Arnold Chiari malformations, etc.). However, CLEAR would not recommend this as the sole treatment. Co-management with an orthopedic specialist is highly recommended in the case of infantile scoliosis. It is certainly possible for a child to go through the full CLEAR protocols once they are older.
EDF casting (elongation/de-rotation/flexion, also known as Mehta casting) is generally regarded as the most effective non-surgical treatment for progressive infantile scoliosis. Understanding the Rib-Vertebral Angle Difference (RVAD) is very important when caring for a young child with scoliosis; this measurement, made on an x-ray, can help distinguish between which cases will probably get worse, and which will most likely improve.
Surgical procedures are also an option for infantile scoliosis. Traditionally, this involved multiple surgeries conducted over 10 years or more as the child’s spine continues to grow. The newest surgical procedure for infants is commonly known as “growing-rods;” this approach reduces the surgical stay for the repeat operations necessary to lengthen the rods. Scientists are continuing to explore this concept with magnetic growing-rods that would not require an incision in order to control. However, these surgical techniques are very new and access to them is limited. According to the Scoliosis Research Society, infantile scoliosis surgery remains a long, difficult therapy for the child with a high rate of complications.
There was some very interesting research conducted in England that linked scoliosis in babies (infantile scoliosis) with malformations in the bones of the skull (plagiocephaly). For more information, pick up a copy of Scoliosis and the Human Spine by Martha Hawes PhD from the National Scoliosis Foundation.
Additional sources for information on infantile scoliosis can be found at the Infantile Scoliosis Outreach Program, which details the life’s work of Dr. Min Mehta, one of the world’s foremost experts on scoliosis in very young children.