News from the Pediatric Chest Wall Clinic

Pediatric Pathways

News from the Pediatric Chest Wall Clinic

UW Health's Pediatric Chest Wall Clinic at American Family Children's Hospital in Madison offers comprehensive, individualized care for children with pectus carinatum and pectus excavatum, conditions that result in abnormally shaped chest walls.

Pediatric surgeon Daniel Ostlie, MD, leads the Pediatric Chest Wall Clinic and works alongside fellow surgeons Ankush Gosain, MD, and Peter Nichol, MD, and nurse practitioners Laura Resch, Margaret Helin and Kirstin Monroe to determine the best course of treatment for patients. Options include braces or surgery in severe cases. UW Health pediatric rehabilitation specialists also play an important role within the chest deformities team as we provide a multidisciplinary approach to children's needs.

Pectus Carinatum

In this condition, a child's sternum and rib cartilage protrude from the chest. It is sometimes referred to as "pigeon chest" because the bowed-out chest can have an appearance similar to that of a bird's chest. Pectus carinatum occurs in approximately 1 in 1,500 children and is four times more common in boys than girls.

Many children who have pectus carinatum do not need surgery to correct the condition, which can cause pain during exercise and other times of increased respiration and generally worsens during growth spurts. While most children with the condition have normally developed hearts and lungs, pectus carinatum can keep the organs from functioning properly at all times. There also is a psychological impact for many children with the condition.

In some cases, a custom-fitted compression brace can be used in much the same way as orthodontic braces work for crooked teeth, pushing the chest wall back into its normal position. The brace must be worn as often as possible, with children removing it only for showering/bathing and athletic activity. Most children will need to wear the brace for six to 20 months.

Our multidisciplinary approach to treating pectus carinatum involves a physician, nurse practitioner and physical therapist, who assesses the progress of the brace correction. In severe cases and if use of the brace does not bring the chest wall to its normal position, surgery might be needed to correct pectus carinatum.

Pectus Excavatum

In this condition, the opposite of pectus carinatum occurs, as the breastbone and rib cartilage are formed in a way that makes the chest appear dented. This condition affects approximately one in 1,000 children and also is known as "sunken chest" or "funnel chest."

Much like pectus carinatum, pectus excavatum can affect the function of children's hearts and lungs and occurs five times more often in boys than girls. Some children show effects of this condition immediately at birth, while in others it might not be evident until a growth spurt, including as late as puberty.

For children with mild pectus excavatum, common treatments include exercises aimed at improving posture and upper-body strength. In moderate to severe cases, a minimally invasive surgery can be performed. In this procedure, a stainless steel bar is placed under the sternum and over time pushes the breastbone out to its normal position. Generally, the bar remains in place for approximately three years and then is removed.

Our multidisciplinary approach to treating pectus excavatum involves a physician and nurse practitioner, and a physical therapist in mild cases in which specific exercises are prescribed.