What is pectus excavatum in infants and children?

Pectus excavatum, also known as a sunken chest, is a condition in which the breastbone (sternum) and the middle part of the chest are depressed inward to varying degrees. This chest indentation may be present from birth, or it may become more noticeable as the child grows during childhood or adolescence.

The severity varies from one child to another. In some cases, the deformity is mild and causes no significant functional problem, while in other cases it may be more severe and affect the appearance of the chest, physical endurance, breathing, or the child’s psychological comfort as they grow older.

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Does pectus excavatum appear from birth?

Usually, pectus excavatum becomes more clearly noticeable during puberty. However, yes, parents may notice a chest depression during the first months of life, and it may be visible in an infant or young child. In other cases, the deformity is mild at first and then becomes more apparent with growth, especially during periods of rapid growth.

For this reason, noticing the deformity early may be a sign that it could become more pronounced during puberty and may even become severe, which makes proper evaluation and follow-up important when needed.

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Is every chest depression dangerous?

No, not every chest depression is dangerous. Many cases are mild and do not cause major symptoms, and the only requirement may be periodic follow-up and clinical evaluation.

However, some cases need more careful assessment, especially if the depression is obvious or worsens over time, or if it is associated with symptoms such as shortness of breath, easy fatigue, chest pain, or reduced ability to exercise compared with other children of the same age.

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What causes pectus excavatum in children?

The exact cause of pectus excavatum is not fully understood in all cases, but it is believed to be related to abnormal growth of the chest wall cartilages, which pulls the sternum inward.

Sometimes, similar cases may be noticed within the family. Pectus excavatum may also be associated in some patients with other chest wall deformities or, more rarely, with connective tissue disorders.

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How does pectus excavatum look in a child?

Parents may notice one or more of the following:

• A depression or hollow in the middle of the chest

• Asymmetry in the shape of the chest wall

• Relative prominence of the front ribs around the depressed area

• The deformity becoming more obvious during deep inspiration or in a thin child

• An unusual chest appearance that becomes noticeable while changing clothes or swimming

In some children, the depression is central and well defined, while in others it is asymmetrical and more pronounced on one side than the other.

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What symptoms may accompany pectus excavatum?

Many children, especially those with mild cases, do not have obvious symptoms. However, in more severe cases, some symptoms may appear, such as:

• Shortness of breath with exertion

• Easy fatigue during play or sports

• Chest pain or discomfort

• Reduced exercise tolerance compared with other children of the same age

• Emotional or psychological distress because of chest appearance, especially in older children and adolescents

The presence of these symptoms does not always mean the child needs surgery, but it does mean the condition deserves specialist evaluation. In some cases, the specialist may suggest starting conservative treatment early in an attempt to improve the deformity as much as possible and potentially avoid major surgery in the future.

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When does a child need medical evaluation?

It is advisable to have the child evaluated if parents notice one or more of the following:

• An abnormal chest shape, whether sunken or protruding

• A clear depression that increases with growth

• Complaints of shortness of breath or easy fatigue

• Recurrent chest pain

• Noticeable impact on physical activity

• Significant parental concern about the shape of the chest or how it is evolving

• A family history of similar cases or chest wall deformities

Medical evaluation helps determine the severity of the condition, reassure the family, and establish a follow-up or conservative treatment plan when needed.

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How is pectus excavatum evaluated in children?

Evaluation of pectus excavatum is based on several factors, including:

• A detailed medical history

• Clinical examination

• Assessment of the degree of chest depression and overall chest shape

• Evaluation of symptoms and their impact on the child’s life

• Imaging studies or tests when needed

In some cases, the child may need chest imaging, CT scanning, or evaluation of heart and lung function, especially if the condition is advanced or symptoms are clearly present.

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Does every child need imaging and tests?

No, not every child needs all investigations. In some mild cases, clinical examination and follow-up are sufficient. If the deformity is severe, or if symptoms are present or there is concern about functional impact, some tests may be requested depending on the child’s age and the severity of the condition.

The decision should be individualized for each child, and there is no single test that is necessary for every case.

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Can pectus excavatum worsen with growth?

Yes, pectus excavatum in children can become more pronounced with growth, especially during periods of rapid growth. For this reason, cases that appear mild at an early age may need reevaluation later, particularly if the chest shape becomes more obvious or symptoms begin to appear.

That is why proper follow-up is important, even in cases that do not require immediate treatment at first.

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Can pectus excavatum affect the heart or lungs?

In mild cases, there is usually no significant effect on the heart or lungs. In more severe cases, however, the depression may place varying degrees of pressure on the structures inside the chest, which may be reflected in exercise capacity or in some findings during medical evaluation.

This cannot be judged from the external appearance alone; specialist assessment is needed when functional impact is suspected.

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Is treatment of pectus excavatum in children always surgical?

No, treatment of pectus excavatum in children is not always surgical. Many mild cases do not require an operation and only need follow-up and monitoring over time. In some cases, the doctor may recommend starting conservative treatment, such as vacuum bell therapy, to help prevent progression.

Surgery is usually considered only in selected cases, when the deformity is obvious or severe, when symptoms are present, or when there is significant psychological or functional impact, and only after full evaluation.

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When do we consider surgery?

Surgery may be considered in the following situations:

• A clear or severe chest depression

• Progression of the deformity with growth

• Symptoms such as shortness of breath or reduced physical endurance

• Significant psychological impact because of chest appearance

• Evidence of functional effect after evaluation

The decision depends on the child’s age, the severity of the deformity, symptoms, and imaging and examination findings, not on appearance alone.

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What is surgery for correction of pectus excavatum?

There are well-known surgical procedures for correcting pectus excavatum. The most common is the technique that uses a metal bar to elevate the sternum and reshape the chest wall. The most appropriate method is determined according to the patient’s age, the shape of the deformity, the severity of the condition, and the specialist surgeon’s assessment.

It is important to emphasize that not every child with pectus excavatum needs surgery, and that the decision for surgery should be carefully considered and based on a complete evaluation.

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Is it better to evaluate the condition early?

Yes, early evaluation is very helpful, even if the child does not need direct treatment at that time. Early assessment helps to:

• Determine the severity of the condition accurately

• Reassure parents when the case is mild

• Monitor progression with growth

• Identify the right time for intervention if needed

• Avoid delay in evaluating cases that may benefit from treatment

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Our experience in evaluating and treating chest wall deformities

At Dr. Mohammad Al-Tarshihi’s clinic in Jordan, we have extensive experience in the evaluation and treatment of chest wall deformities. We consider our clinic among the most experienced in Jordan in chest wall deformities, including pectus excavatum in children, adolescents, and adults, while carefully distinguishing between cases that only need follow-up and those that may benefit from advanced evaluation or treatment.

Our main goal is to provide a clear and accurate assessment for each case and to help families understand the available options in a scientific and reassuring way.

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When should you consult a specialist surgeon?

It is advisable to consult a specialist surgeon if the child has:

• A clear chest depression

• Increasing severity of the deformity with growth

• Pain, shortness of breath, or reduced endurance

• Psychological distress due to chest appearance

• Parents who want an accurate evaluation and a clear plan for follow-up or treatment

Early evaluation helps ensure the right decision is made at the right time.

Book an evaluation

If you have noticed a chest depression in your child, or if you would like to know whether the condition is mild or requires follow-up or treatment, specialist evaluation can clarify the picture and help determine the most appropriate plan for each case.

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FAQ / Frequently Asked Questions

Frequently asked questions about pectus excavatum in infants and children

Is pectus excavatum in infants normal?

A mild chest indentation may sometimes be noticed in some infants, but no, it should not simply be considered normal. The best approach is clinical evaluation to determine whether it is just a minor observation or true pectus excavatum that requires follow-up.

Does every child with pectus excavatum need treatment?

No. Many mild cases do not require treatment and only need periodic follow-up and assessment depending on the child’s age, severity of the deformity, and the presence of symptoms.

Does pectus excavatum worsen with growth?

Yes, pectus excavatum may become more noticeable with growth, especially during periods of rapid growth, so some cases may need reevaluation over time.

Is pectus excavatum in children dangerous?

In many cases it is mild and not dangerous, but some cases may be more severe and deserve specialist assessment, especially if symptoms are present or the deformity is obvious.

Does pectus excavatum affect breathing?

In mild cases there is usually no obvious effect, but in severe cases symptoms such as shortness of breath or reduced exercise tolerance during exertion may appear.

Can pectus excavatum affect the heart?

In severe cases it may have varying degrees of effect, but this cannot be judged from appearance alone and requires medical evaluation and appropriate tests when needed.

Is treatment of pectus excavatum in children always an operation?

No. Treatment is not always surgical. Some cases only require follow-up or conservative treatment using certain devices, while surgery is discussed in selected cases after full evaluation.

When should a child be seen by a specialist surgeon?

When there is a clear deformity, progression of the depression, symptoms such as fatigue or shortness of breath, or if the parents are concerned about how the condition is developing.

What is the right age to evaluate pectus excavatum?

The condition can be evaluated at any age once it is noticed. Early assessment is useful to determine severity and the need for follow-up or treatment. The younger the age at evaluation, the greater the potential for treatment and improvement.

Can the condition improve on its own?

Usually not. Some mild cases may remain stable, but true pectus excavatum does not usually disappear completely on its own, so follow-up and assessment remain important.

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Dr. Mohammad Al-Tarshihi
Consultant Thoracic Surgeon

00962779794141

Amman, Jordan