Scoliosis Bracing for Children and Teens
Children and teens who have scoliosis may be prescribed bracing to prevent the spine from curving even more. At CHOC, we prescribe bracing for children and teens whose spine curves more than 25 degrees, and the patient is still growing.
To see if your child is finished growing, the doctor or orthotist may use the Risser sign. The Risser sign uses an X-ray to measure how much mature bone has developed in the upper rim of the pelvis, on a scale of 0 to 5. If your child is at a 5, then bracing most likely will not be successful because the child is already skeletally mature.
The decision about which brace to wear depends on the type and location of curve. The most common brace we prescribe is the Boston Brace, which can be custom made by using molds of the body. The brace uses the hips as a base point and goes up to the shoulder blades. It is designed to keep the lower part of the spine in a flexed position by pushing in at padded pressure points. This brace should be worn for 16-23 hours a day, depending on your doctor’s orders.
Compliance with a bracing plan is most successful with support from others. We encourage patients to bring family members and a friend to a brace appointment. The better a patient sticks to the plan, the more effective the brace will be.
Does bracing work for scoliosis?
A small percentage of curves can still get worse after bracing, even if the brace was worn correctly. That’s why it’s important to have close follow-ups with your orthopaedic doctor and regular X-rays, and keep up with your scoliosis exercises. In some cases, surgery may be needed in addition to bracing. Learn more about scoliosis surgery at CHOC.
Scoliosis Bracing Process and Treatment
The bracing process will start with a visit to the orthotist. He or she will evaluate your curve and review your goals for treatment. Your orthopaedic doctor will most likely have already chosen which brace you will wear, and the orthotist will take measurements and casts that are needed to custom build your brace.
Step 1: Brace fitting appointment
Once the brace is created, you will have an initial fitting with the orthotist. He or she will make final adjustments and make sure it fits comfortably. You will also be given instructions on wearing and caring for the brace.
Step 2: Easing into a schedule wearing a back brace
We recommend taking several days to ease into a schedule before you are able to wear the brace for the full prescribed time.
Day 1: Wear the brace for two hours.
Day 2: Wear the brace for four hours, broken into shorter times if desired.
Day 3: Wear the brace for six hours.
Day 4: Wear the brace for eight hours.
Day 5: Begin wearing the brace for the amount of time prescribed.
A line will be marked on the brace’s strap to show how tight it should be worn for the first week. A second line will be marked to show how tight to wear the brace the second week, as tolerated.
Step 3: Follow-up appointments
After two weeks, you will have an appointment with the orthotist. This is a chance to check the fit of the brace, address any issues and make adjustments. A week later, your orthopaedic doctor may have you get a follow-up X-ray to see if the brace is fitting correctly. You will have additional follow-up visits according to your doctor’s orders.
Wearing and Caring for a Back Brace
A Boston Brace can usually be concealed under loose-fitting clothes. The brace will feel uncomfortable at first, but you will get used to it after several days.
It is important to clean the foam liner of the brace daily. Clean the foam with rubbing alcohol, which will disinfect the liner and evaporate quickly.
How to wear a back brace
Your doctor or orthotist will teach you how to wear your brace. These are general guidelines and are not meant to replace instructions from your doctor or orthotist.
- Make sure all straps are outside the brace.
- Place the brace around your body by holding each side and spreading it open so you can twist into it. The brace is stiff when new, so you may need help at first.
- The opening of the brace should be centered on your back, so that the bumps on the spine and the crease between the buttocks are in the middle of the opening of the brace.
- Push the brace down by placing your hands on your hips. The waist pads on the inside of the brace should rest just above your hips and below your ribs.
- Rest your forearms on a table or counter and lean forward. Your helper will thread the straps through the buckles.
- On the side opposite of the buckle, your helper should apply pressure with the flat of one hand. At the same time, your helper will pull the strap toward the opposite side.
- Secure the middle strap first, then the bottom straps, then the top straps. Then stand up straight.
Skin care: Reduce skin irritation from a back brace
It is very important to prevent the skin from becoming sore, red and raw from the brace. To protect the skin:
- Bathe daily.
- Apply rubbing alcohol with your hands to all parts of the skin that your brace covers. Alcohol plus the friction of your hand on your body will toughen the skin and prevent serious irritation. Continue this procedure until your skin toughens, which usually takes 2-3 weeks.
- Pay close attention to pink areas of the skin where the brace is tightest. The pink color should disappear within 30 minutes of removing the brace. If the skin remains pink longer than 30 minutes, adjustments may be required. Skin irritations and pressures should be reported to your orthotist when they occur.
- Always wear a snug-fitting T-shirt without side seams under your brace. Your orthotist can help you purchase a comfortable shirt.
- Wear the brace as tightly as possible. A loose brace will rub and cause skin irritation.
- A dusting of cornstarch may be helpful in hot weather, or on skin that is sensitive to alcohol.
- Do not use creams, lotions or powder under the brace initially because they tend to soften the skin and can lead to skin breakdown.
- Sometimes the skin over the waist and hips gets darker. This is common and is not a problem. When the brace treatment is over, this color will go away.
A Teen's Guide to a Scoliosis Brace
During the teenaged years, it is very normal to feel sensitive about fitting in with your peers. It may be especially hard if you have a medical condition that makes you feel different, like scoliosis. Wearing a scoliosis brace can be a difficult adjustment, but your health care team at CHOC is here to help you. We know many teens who share the same concerns as you.