Tired child: Is it funnel chest?

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There are two forms of chest wall deformities that can be found in children. The most common is pectus excavatum, or funnel chest. This causes the chest to sink in and pushes the breastbone inward.

Luckily, there are ways to deal with this disorder.

Funnel chest occurs in one out of every 300 to 400 kids. It's more common in boys than girls.

But how can you tell?

"The first symptom that parents usually notice is that they're on the field with other kids and they're getting more winded than the other children that they're playing with," pediatric surgeon Dr. David M. Notrica said.

This could lead to chest pain, rapid heartbeat, coughing and fatigue.

According to Boston Children's Hospital, symptoms could show up by the age of 1, but Notrica recommends waiting to go see the doctor.

"The typical age that we'll first see a patient with pectus excavatum is maybe 10 or 11 years of age," he said.

Ways to improve the conditions of this disorder include exercise.

David M. Notrica, MD, FACS,

"A lot of kids we will put on an exercise program if they're simply having mild excavatum or mild indent," Notrica said.

Push-ups, Superman, seated twist, and camel and bow pose are kid-friendly activities they can participate in. If the symptoms are more than mild, surgery may be required.

The surgery can take up to six hours for a child. Also, there is no way to prevent the disorder, as the main cause is still unknown. But kids with Poland syndrome, scoliosis or rickets could develop the disorder. It is believed to run in families.

RESEARCH SUMMARY
TIRED CHILD: IS IT FUNNEL CHEST? REPORT #2681

BACKGROUND: Pectus excavatum is a medical term that describes an abnormal formation of the rib cage that gives the chest a caved-in or sunken appearance. It can occur in a baby who is developing in the womb or after birth, and the condition can be mild or severe. Pectus excavatum is due to too much growth of the connective tissue that joins the ribs to the breastbone (sternum). This causes the sternum to grow inward. As a result, there is a depression in the chest over the sternum, which may appear quite deep. If the condition is severe, the heart and lungs can be affected. Children with a chest wall deformity may have no symptoms at all, other than feeling self-conscious about their appearance. However, some children have trouble breathing during exercise and are prone to respiratory infections and asthma. Children with either type of chest wall deformity are at increased risk of developing scoliosis. And, depending on the type and severity of the deformity, chest wall deformities are often treated with surgery, a brace or no treatment at all. (Source: https://www.mountsinai.org/health-library/symptoms/pectus-excavatum and http://www.childrenshospital.org/conditions-and-treatments/conditions/c/chest-wall-deformities)

PROCEDURES AND BENEFITS: The primary goal of surgery for pectus excavatum is to correct the chest deformity to improve a patient's breathing and cardiac function. Repositioning the sternum to a more normal, outward position lessens pressure on the heart and lungs, allowing them to function more normally. The Nuss procedure inserts a tiny camera into the chest to guide where two small incisions are made on either side of the chest, and a curved steel bar is inserted under the sternum. The steel bar is individually curved for each patient and used to correct the depression. It is secured to the chest wall on each side. The Ravitch procedure, also known as the "traditional" or "open" surgical repair of pectus excavatum, involves an incision on the front of the chest with removal of the cartilaginous part of the ribs which have overgrown and caused the sternum to be pushed backwards. This allows the sternum to be pulled forward, away from the heart and lungs and into the normal plane of the chest wall. A small plate and tiny screws are often used to stabilize the sternum in its new position. These repairs typically lead to improvements in breathing, exercise intolerance and chest pain. (Source: https://my.clevelandclinic.org/health/diseases/17328-pectus-excavatum/management-and-treatment)

NEW EXPERIMENTAL TREATMENT: The vacuum device was approved by the U.S. Food and Drug Administration as a medical device, but it's considered an experimental treatment, therefore not covered by insurance. Marshall Kapp, a Florida State University College of Medicine professor who has studied medical ethics, said the vacuum bell device exists in a gray area he calls the "innovative phase" because it's beyond the research phase, hence the FDA approval, but not yet considered standard care. "His goal presumably is to gather enough data so that someday what he's doing will be standard of care," Kapp said of Corey Iqbal, Overland Park Regional Medical Center surgeon in Kansas City. "But it's not there yet." Most of the research on it comes from a study out of Switzerland with about 140 patients. Those results are enough to make Iqbal comfortable trying it, as long as the risks and benefits are understood. If the device works, it might help future patients avoid surgery. (Source: https://www.kansascity.com/news/business/health-care/article178746361.html)