Scoliosis may be congenital, neuromuscular, degenerative, or idiopathic. The spine should be examined in all pediatric patients as part of routine newborn and annual exams. Idiopathic scoliosis is seen in otherwise healthy, rapidly growing preadolescent and adolescent children (typically grades 5–9). Females require treatment five to eight times more frequently than males. It is important to ask about scoliosis when obtaining a family history, as there is a 20 times more frequent occurrence of scoliosis in patients with an immediate family member affected.

During the examination, the child’s back should be fully exposed. The pediatrician should instruct older children to stand up straight with feet together, shoulders back, and hands hanging at their sides, head up and looking straight ahead. Signs of scoliosis include asymmetry of shoulder height, scapulae, or flanks (sometimes seen as a bony prominence) or misalignment of spinous processes. After inspecting the back in an upright position, the examiner should ask the child to bend forward at the waist (with feet and palms together) and check again for asymmetry. This forward-bending test to check for thoracic asymmetry is the single most important screening technique.

The American Academy of Pediatrics recommends that infants, children, and adolescents with severe scoliosis be referred to a pediatric orthopedic surgeon. The orthopedist will conduct a standing anteroposterior roentgenogram of the spine to confirm the diagnosis. Treatment recommendations will depend on the degree, flexibility, and location of the curve. Current guidelines are to follow closely every 3 to 6 months with spinal radiographs and photographs for <15- to 20-degree curvature; to use a
Milwaukee brace for between 20 and 40 degrees; bracing or surgery between 40 and 50 degrees; and spinal fusion for >50 degrees.