Pectus Carinatum (Pigeon Chest): Causes, Symptoms, and Treatment Options

Pectus carinatum, also known as pigeon chest, is a chest wall deformity that causes the breastbone (sternum) to stick out. This condition often appears during childhood or adolescence and can affect a child’s confidence and quality of life.

Most cases can be treated successfully without surgery using a specially fitted brace. Early diagnosis and proper management lead to excellent outcomes.

What Is Pectus Carinatum?

Pectus carinatum is caused by the overgrowth of cartilage between the ribs and the sternum, pushing the chest wall outward. It typically develops during puberty when the body grows rapidly.

Key facts:

  • Most common in boys

  • Usually noticed after age 11

  • Often becomes more visible during teenage growth spurts

  • Not life-threatening, but can cause emotional and physical discomfort

Common Signs and Symptoms

Many children and teens with pectus carinatum don’t experience pain, but they may notice physical or emotional changes, such as:

  • A visibly protruding breastbone or chest wall

  • Chest asymmetry (one side more prominent than the other)

  • Shortness of breath during physical activity

  • Chest tenderness or sensitivity

  • Frequent respiratory infections

  • Feeling easily fatigued

  • Low self-esteem or body image concerns

When to See a GP

If you suspect your child has pectus carinatum, it’s important to see your GP for an assessment. Early intervention often leads to better results.

Diagnostic steps may include:

  • Physical examination

  • Chest X-ray

  • Lung function testing or exercise tolerance test

  • Evaluation for related conditions (such as scoliosis or Marfan syndrome)

Your GP may refer your child to a paediatric surgeon or orthotist for further evaluation and treatment.

Treatment: Chest Orthosis (Bracing)

Most children with pectus carinatum are treated using a chest orthosis, also known as a pectus brace. This custom-made device gently compresses the chest to encourage normal shape over time.

Bracing has two phases:

1. Corrective Phase:

  • Worn 23 hours a day

  • Lasts 3 to 6 months

  • Helps flatten the chest

2. Maintenance Phase:

  • Worn 8 to 10 hours each night

  • Lasts another 3 to 6 months

  • Prevents the chest from reverting

If the chest begins to protrude again during maintenance, your child may need to return to wearing the brace full-time.

Brace Care and Monitoring

To ensure success and reduce skin issues:

  • Wear a singlet or T-shirt under the brace

  • Clean the skin daily, especially under the front and back pads

  • Check for irritation: Mild redness is normal, but rashes or sores are not

  • Avoid high-intensity sport while wearing the brace

  • Contact your orthotist if your child experiences pain or discomfort

Follow-up schedule:

  • Initial review one week after fitting

  • Regular reviews every four weeks

  • Progress monitored with 3D photographs

  • Ongoing reviews every 6 months once treatment ends

When Is Surgery Needed?

Surgery is rarely required but may be considered for:

  • Severe cases not responding to bracing

  • Late-diagnosed cases where bones have already matured

Surgical correction usually produces a normal chest appearance, although it may leave scars.

Living With Pectus Carinatum

Although pectus carinatum doesn’t usually affect organ function, it can impact a child’s social life, especially when changing clothes or going to the beach. Effective treatment can significantly boost confidence and wellbeing.

Common Questions from Parents

Will the brace affect my child’s asthma?

No, but if your child is having an asthma attack, remove the brace temporarily and let them recover fully before putting it back on.

Can we skip the brace for a special occasion?

Yes, it’s okay to remove the brace for short periods. However, consistent wear improves the treatment outcome.

Will my child’s chest look completely normal after treatment?

In most cases, yes. Bracing usually achieves excellent cosmetic results. In rare cases, surgery may be required for full correction.

Key Points to Remember

  • Pectus carinatum is a treatable chest wall deformity

  • Chest orthosis (brace) is the preferred treatment

  • Bracing is non-surgical, safe, and effective

  • Regular follow-ups are essential for success

  • Surgery is a backup option for severe or resistant cases

For More Information

If you are concerned about your child’s chest shape, speak to your GP, paediatrician, or orthotist. Early assessment can make a significant difference in treatment outcomes.

References

  • Desmarais TJ, Keller MS. Pectus carinatum: An undertreated chest wall deformity. Curr Opin Pediatr. 2013;25(3):375-381. PMID: 23657247

  • Royal Children’s Hospital Melbourne – Pectus Carinatum Care and Orthotic Information

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