Spine & Chest

Scoliosis in Children and Adolescents: When to Worry

Assessing a spinal curve: classification, bracing criteria and when a specialist referral is needed.

Updated: September 2026·Medically reviewed by Dr. Daniele Priano
A clothed teenager viewed from behind, with the shoulders at slightly different heights.

Notice asymmetry

An uneven shoulder or waist may deserve attention. Appearance alone cannot confirm scoliosis.

Read all the illustrated explanations →

Classification by Age

1

Infantile Scoliosis(0-3 years)

Infantile idiopathic scoliosis may resolve or progress. Prognosis depends on curve characteristics and changes during follow-up; the child's sex alone cannot establish the outcome. The long period of remaining growth calls for specialist monitoring.

Prognosis: Some curves reduce spontaneously; progressive curves need early specialist management. Resolution should not be assumed from age alone.

2

Juvenile Scoliosis(4-9 years)

It develops before age 10 and the pubertal growth spurt. Remaining growth may allow progression: curve magnitude, pattern and changes over time guide follow-up and treatment.

Prognosis: Higher risk of progression due to the long remaining growth period. Often requires a more structured pathway.

3

Adolescent Scoliosis (AIS)(10-18 years)

Adolescent idiopathic scoliosis is the most common idiopathic form. Progression risk depends on remaining growth and curve magnitude; female predominance is greater in more substantial and progressive curves and cannot be represented by one ratio for all curves.

Prognosis: Progression depends on skeletal maturity and curve magnitude. Mild curves rarely progress after maturity.

Adolescent idiopathic scoliosis is a three-dimensional curvature of the spine associated with vertebral rotation. It typically develops between ages 10 and 16, with a strong female predominance in curves that require clinical attention.

Diagnosis starts with a careful clinical evaluation and, when indicated, targeted radiographic imaging. The risk of progression is estimated by considering curve magnitude, age, skeletal maturity, and pubertal stage.

During the visit we discuss the most appropriate path together: periodic monitoring for mild curves, specific exercises as supportive care, possible bracing in evolving forms in skeletally immature patients. In selected progressive cases the pathway includes referral for assessment by a dedicated paediatric spine surgeon. Sports are encouraged in most cases.

Dott. Daniele Priano - Ortopedico Pediatrico

📐Not All Curves Require a Brace

A mild curve under 20° often requires only monitoring. I evaluate degrees, skeletal maturity, and progression potential to define the right path.

Assessment and treatment

When to seek evaluation

  • Shoulder or pelvis asymmetry
  • Visible dorsal hump on forward bending
  • Visible spine curves from behind
  • Family history of scoliosis
  • Report from pediatrician or during school screening
  • Rapid growth during puberty

What is evaluated

  • Clinical and family history
  • Spine examination in standing and forward-bending position
  • Clinical assessment of trunk symmetry
  • Clinical assessment of skeletal maturity and pubertal stage
  • Radiographic imaging only when clinically indicated
  • Consideration of remaining growth potential

Treatment options

  • Periodic clinical monitoring for mild curves
  • Specific exercises as supportive care
  • Possible brace in evolving forms in skeletally immature patients
  • Referral to a dedicated paediatric spine surgeon in selected progressive cases

About Surgical Treatment

For scoliosis and spinal conditions, I focus exclusively on conservative management: observation, bracing, and specific physiotherapy. Cases requiring spinal surgery are referred to specialized vertebral surgeons with whom I collaborate.

Frequently Asked Questions

Can my child play sports with scoliosis?▼
Physical activity is generally encouraged, and scoliosis does not automatically require giving up sport. Sport choice and any adjustments depend on symptoms, treatment and recovery stage; after surgery, follow the surgeon’s instructions. Sport does not replace prescribed bracing or other treatment.
Is the brace painful or limiting?▼
A brace requires an adaptation period and can cause pressure or discomfort, but significant pain, skin injury or poor tolerance should not simply be accepted: fit needs review. Indication, brace design and wear time depend on the curve, remaining growth and treatment goals.
Does scoliosis always get worse?▼
No. Mild curves often remain stable or even improve. The risk of progression depends on curve magnitude, age, and remaining growth potential. Curves under 20° in patients at the end of growth rarely worsen.
Is scoliosis hereditary?▼
There is a genetic component: having a family member with scoliosis increases the risk of developing it. However, it is not a direct transmission and many children with family history do not develop significant scoliosis. Screening is still recommended in case of family history.
How long does brace treatment last?▼
The brace is generally worn until skeletal maturity is reached, rather than to a fixed age: the decision to wean off the brace is based on remaining growth, skeletal maturity markers and stability of the curve over time, assessed individually. Daily wearing time (hours/day) is personalized based on the curve and growth phase.
Can orthotics correct scoliosis?▼
No, orthotics do not correct scoliosis. Scoliosis is a spinal deformity that cannot be influenced by foot supports. However, a leg length discrepancy can cause a compensatory spinal curve that mimics scoliosis. Learn more about Limb Length Discrepancy
Can scoliosis be caused by one leg being shorter?▼
Yes. Limb length discrepancy (difference in leg lengths) can cause pelvic tilt and a compensatory spinal curve that may be mistaken for true scoliosis. It is essential to distinguish between true (structural) scoliosis and postural curvature secondary to leg length difference, as treatments are very different.
How many hours a day should the brace be worn?▼
This depends on the brace type, curve size and growth stage. Some braces are designed for most of the day and others for night-time use only. The choice and daily wearing time are individualised, with adherence to the programme having the greatest influence on results.
When should monitoring around puberty begin?▼
Monitoring is generally proposed at the start of puberty and then at regular intervals. Rapid pubertal growth is the period of greatest risk of progression, so closer follow-up may be helpful during this time, according to the individual case.
Can the curve improve?▼
Mild curves may remain stable or decrease by the end of growth. When worn correctly, a brace mainly aims to **slow curve progression** and may partly reduce the curve in some cases. Specific exercises can improve posture and respiratory function, but on their own have a limited effect on curve size.

Important Notice: The information on this page is for educational and informational purposes only and does not constitute medical advice. Each clinical case is unique: the appropriate treatment is determined during the specialist consultation, based on a thorough clinical examination and, where necessary, diagnostic imaging. For any doubts or concerns, please consult a specialist.