Pectus Carinatum In Children: Why Child’s Breastbone Stick Out?

Imagine noticing that your child’s chest looks different from other children’s. This could be pectus carinatum in children.

The breastbone seems to stick forward, the ribs appear prominent, or one side of the chest looks more raised than the other.

Perhaps you first noticed it while your child was swimming, changing clothes or wearing a fitted school uniform.

Naturally, questions follow.

Is this normal growth? Is something wrong with the bones? Can exercise correct it? Will the condition become worse during adolescence?

One possible explanation is pectus carinatum, commonly called pigeon chest.

It is a chest-wall deformity in which the breastbone (sternum), together with the cartilage connecting the ribs to it, projects outward.

The important thing parents should understand is that this condition is usually related to the development and growth of the chest wall, not something a child has done incorrectly.

It may become more noticeable during puberty, when the skeleton undergoes rapid changes.

As a physiotherapist, I would encourage parents not to panic, but also not to dismiss a progressively prominent chest as simply a posture problem.

Early assessment can help establish the type of deformity, check chest-wall flexibility and identify the most appropriate treatment while the child is still growing.

The good news is that many children with pectus carinatum can be managed without surgery, particularly when the chest wall is flexible and a properly fitted compression brace is used.

What Exactly Happens in Pectus Carinatum?

The chest wall is a carefully arranged structure made up of the sternum, ribs, costal cartilage, muscles and connective tissues.

These structures protect the heart and lungs while allowing the chest to expand during breathing.

In pectus carinatum, the front portion of the chest develops an outward prominence.

The breastbone may project forward, and the cartilage connecting the ribs to the sternum can also appear unusually prominent.

This produces a characteristic raised appearance.

It is the opposite of pectus excavatum, in which the breastbone sinks inward and produces a hollow or sunken chest.

One detail worth understanding is that not every child develops the same chest shape.

Some have a symmetrical prominence, while others develop a noticeable difference between the two sides.

A 2024 narrative review published in the Journal of Thoracic Disease explains the different forms of pectus deformity and highlights how variations in the sternum and costal cartilage contribute to their appearance. (Journal of Thoracic Disease).

Two common forms of pectus carinatum

1. Chondrogladiolar type

This is the more common form. The middle or lower part of the sternum and the adjacent costal cartilages project forward.

The prominence may appear like a small ridge or a broad outward bulge in the middle of the chest. It can be symmetrical or more pronounced on one side.

2. Chondromanubrial type

This is less common. The upper portion of the sternum, called the manubrium, becomes more prominent.

The chest can have a different overall contour compared with the more common lower sternal prominence.

This distinction matters because the shape and flexibility of the chest influence the treatment approach.

Identifying the pattern is more useful than simply describing a child’s chest as unusually prominent.

Why Does a Child Develop Pectus Carinatum?

The exact cause has not been established.

However, researchers believe that abnormal growth or development of the cartilage connecting the ribs to the breastbone plays an important role.

There are several factors worth understanding.

1. Abnormal growth of the rib cartilage

The ribs connect to the breastbone through costal cartilage. This cartilage provides flexibility and helps the chest move during breathing.

In pectus carinatum, abnormal development or growth of these structures is thought to contribute to the outward projection.

However, it would be inaccurate to say that every affected child has simply developed excess cartilage.

Researchers still do not fully understand the underlying biological mechanism.

The 2024 review by Janssen and colleagues discusses the proposed relationship between costal cartilage growth disturbances and pectus deformities. (Janssen et al.,).

2. Rapid growth during puberty

Parents often notice the condition becoming more visible between approximately 11 and 15 years of age.

This is understandable because the chest wall is changing during adolescence.

A prominence that was previously subtle can become much easier to see when the child experiences a growth spurt.

The deformity may also become more noticeable as the shoulders, ribs and trunk change in proportion.

A particularly interesting finding comes from a retrospective cohort study of 430 children with pectus carinatum.

Researchers found differences in the age of presentation between boys and girls.

Girls presented at a younger median age, and the majority of children had asymmetrical, isolated chest-wall deformity.

This reminds parents that pectus carinatum does not follow exactly the same developmental pattern in every child. (Springer Link)

3. Family history and genetic influence

Have you noticed a similar chest shape in a parent, sibling or another family member?

There may be a familial component. Studies have reported a positive family history of chest-wall deformities in a proportion of affected children.

However, this does not mean that every child inherits the condition from a parent.

Nor has one single genetic cause been established for isolated pectus carinatum.

A family history becomes particularly relevant when the child also has unusual skeletal or connective-tissue features.

4. Associated connective-tissue and skeletal conditions

Pectus carinatum can sometimes occur alongside other conditions, including:

• Marfan syndrome.
• Noonan syndrome.
• Ehlers-Danlos syndrome.
• Scoliosis.
• Certain cardiac or skeletal abnormalities.

This does not mean that a child with a prominent chest automatically has one of these conditions.

However, a clinician should pay attention to the complete musculoskeletal picture rather than examining the chest in isolation.

For example, a child with significant spinal curvature, unusual joint flexibility, disproportionate limb length or a relevant family history may require further assessment. (NIH)

What Are the Early Signs Parents Should Look For?

The most noticeable feature is usually the outward projection of the breastbone.

However, there are other changes that can help parents recognise the condition.

A visibly prominent breastbone

The middle portion of the chest appears to push forward rather than following the usual chest contour.

The prominence may be noticeable when the child stands upright or wears fitted clothing.

One side of the chest looks different

Some children have an asymmetrical chest. One side may project further forward, while the other appears relatively normal.

Do not assume that all asymmetry represents scoliosis. The rib cage and sternum themselves can develop asymmetrical contours.

Prominent or flared ribs

The lower ribs may appear more noticeable or project outward.

This can occur alongside the central sternal prominence and may change the overall appearance of the chest.

Chest tenderness or discomfort

Some children complain of tenderness around the prominent area, particularly when lying on their stomach or when external pressure is applied.

Persistent pain should be evaluated rather than automatically attributed to the chest deformity.

Reduced exercise confidence or stamina

Certain children report discomfort during physical activities or believe that they cannot participate comfortably in sports.

It is important to distinguish actual cardiopulmonary limitation from fear, embarrassment, reduced conditioning or unrelated respiratory problems.

A study involving adolescents with pectus deformities found differences in physical function, posture and psychosocial measures compared with healthy controls.

Interestingly, the severity of the chest deformity did not necessarily correspond to the degree of physical or psychosocial difficulty. (PubMed)

Does Pectus Carinatum Affect Breathing and Heart Function?

This is one of the most common concerns parents have.

The reassuring point is that most children with uncomplicated pectus carinatum do not develop significant heart or lung problems simply because the breastbone protrudes outward.

Unlike certain severe cases of pectus excavatum, where inward chest-wall displacement can affect the space available for the heart and lungs, pectus carinatum generally has a different physiological profile.

Nevertheless, some children report:

• Breathlessness during exercise.
• Reduced exercise tolerance.
• Chest discomfort.
• Palpitations.
• Occasional wheezing or asthma-like symptoms.

These complaints deserve proper assessment.

A common mistake is assuming that every episode of breathlessness is caused by the chest shape.

Asthma, anaemia, cardiovascular conditions, deconditioning and other respiratory problems can produce similar symptoms.

A doctor may recommend lung-function testing, cardiac assessment or exercise testing when the child’s symptoms or clinical findings justify it.

The purpose is to identify the actual reason for the symptoms, not to assume that the visible deformity explains everything. (UCSF)

How Is Pectus Carinatum Diagnosed?

Diagnosis usually begins with a detailed medical history and physical examination.

A paediatrician or paediatric chest-wall specialist may assess:

Chest shape: The clinician examines the sternum, ribs, prominence and overall chest symmetry.

Chest-wall flexibility: The specialist evaluates how readily the protruding area can be moved towards a more normal position using controlled external pressure.

This is an important consideration because flexible chest walls generally respond better to compression bracing.

Spinal alignment: The clinician checks for scoliosis and other postural or skeletal abnormalities.

Associated features: Family history, joint mobility and other physical findings may indicate whether additional assessment is necessary.

Does every child need a CT scan?

No.

A CT scan is not automatically necessary for every child with a visibly prominent sternum.

In many uncomplicated cases, clinical examination is sufficient to establish the diagnosis and guide initial management.

Additional investigations may be considered when the appearance is unusual, symptoms need investigation, an associated condition is suspected or surgery is being planned.

Where possible, unnecessary radiation exposure should be avoided. Imaging decisions should be based on the individual clinical situation.

The 2024 study on current bracing practices highlights the importance of clinical examination and documents how different centres use imaging and radiation-free assessment approaches. (MDPI)

Pectus Carinatum Treatment: What Actually Works?

Treatment depends on the child’s age, chest-wall flexibility, degree of prominence, symptoms and personal concerns.

Some children with mild deformity may be monitored without immediate correction.

For children who want treatment and have a sufficiently flexible chest wall, compression bracing is generally the preferred non-surgical approach.

1. Compression bracing

A compression brace is specially designed to apply controlled pressure over the prominent part of the chest.

The objective is to gradually remodel the chest-wall contour while the child continues growing.

The brace is usually fitted and adjusted by a trained orthotist or specialist team.

Treatment generally involves two stages:

Correction phase: The brace applies controlled pressure to gradually reduce the outward prominence.

Maintenance phase: Once sufficient correction has been achieved, the treatment schedule may be modified to help maintain the improved chest shape.

The child needs regular follow-up so that pressure, comfort and fit can be assessed.

How long does chest brace treatment take?

There is no single treatment duration for every child.

Some children require several months, while others need a year or longer depending on the chest-wall flexibility, prominence, initial correction pressure and adherence.

A particularly useful study by de Beer and colleagues examined 740 patients receiving dynamic compression treatment.

Researchers found that every additional centimetre of carinatum height was associated with approximately 1.9 additional months of treatment. A higher initial correction pressure was also associated with longer treatment.

The finding is important because it explains why two children of the same age can have very different treatment timelines. (Elsevier)

Does the brace need to be worn throughout the day?

The prescribed wearing schedule varies.

Some centres use intensive protocols, while others use more practical schedules involving fewer daily hours.

The evidence does not establish one universal schedule suitable for every child.

A 2024 international survey of chest-wall treatment centres documented this variation and highlighted the difference between recommended and actual brace-wearing time.

Parents should not increase pressure or wearing duration independently to achieve faster correction.

The treating specialist should select the schedule based on the child’s chest-wall characteristics, tolerance and progress. (PMC)

2. Physiotherapy alongside brace treatment

This is where physiotherapy can contribute meaningfully.

A compression brace addresses the structural prominence. Physiotherapy addresses the child’s broader musculoskeletal and physical-function needs.

A child with pectus carinatum may benefit from an individually designed programme addressing thoracic mobility, shoulder positioning, trunk strength, breathing coordination and general physical conditioning.

Importantly, exercises should complement the brace rather than replace it when structural correction is indicated.

A preliminary randomised controlled study involving 30 boys aged 11-18 compared compression bracing alone with compression bracing combined with physiotherapy.

Both groups improved, but the group receiving physiotherapy showed additional improvements in certain chest measurements, posture, deformity perception, psychological quality of life and treatment satisfaction.

The study is encouraging, but its small sample size means that larger studies are needed before making strong claims about long-term structural correction. (NCBI)

What Exercises Can Help a Child With Pectus Carinatum?

I would first assess the child’s posture, shoulder movement, spinal alignment, breathing pattern, strength and activity level before selecting exercises.

There is no single exercise routine that suits every child.

Some useful exercise categories include:

1. Thoracic extension exercises

Gentle thoracic extension movements can help children who have developed a stiff upper back or a habit of slouching.

The purpose is to improve spinal mobility, not force the breastbone backwards.

2. Scapular stabilisation exercises

Exercises that strengthen the muscles around the shoulder blades can improve shoulder control and upper-body function.

Examples include controlled rowing movements, wall slides and appropriately progressed scapular retraction exercises.

3. Pectoral muscle mobility

Some children have restricted anterior shoulder mobility or tight chest muscles.

Gentle, supervised pectoral stretches may improve comfort and shoulder movement.

Aggressive stretching or pressure over the prominent sternum is unnecessary.

4. Thoracic breathing exercises

Breathing exercises can help children become more aware of rib movement and coordinate chest expansion with diaphragmatic breathing.

They are particularly useful when an assessment reveals an inefficient breathing pattern.

However, there is no evidence that repeatedly performing deep-breathing exercises will independently reverse the structural deformity.

5. General strengthening and aerobic conditioning

Age-appropriate activities such as walking, cycling, swimming and recreational sports can support general fitness.

Strengthening the trunk and shoulder muscles may also improve physical confidence and movement quality.

Children should not be unnecessarily restricted from normal activities solely because they have pectus carinatum.

Participation should depend on symptoms, medical advice and any brace-related restrictions.

Lesser-Known Things Parents Should Know During Treatment

The success of conservative treatment is not determined only by how prominent the chest looks.

Several less obvious factors can influence the child’s experience.

Brace comfort can influence treatment success

Skin irritation, pressure discomfort, sleeping difficulties and embarrassment can reduce adherence.

Rather than repeatedly reminding the child to wear the brace, understand why they are finding it difficult.

A 2019 study of dynamic compression bracing found that discomfort was a major barrier to compliance, while appearance-related improvement was an important motivation. (Sage Journals)

Do not ignore changes during puberty

Even after improvement, the chest wall can change as the child continues growing.

A 2024 international survey reported that recurrence during puberty remained a concern across treatment centres.

Different centres reported different recurrence rates, reinforcing the need for follow-up rather than assuming correction is permanent immediately after brace treatment.

The child’s emotional experience matters

Some children are more bothered by the appearance than by physical symptoms.

They may avoid swimming, changing clothes in public or participating in activities where their chest is visible.

A recent 2026 study involving 50 children undergoing orthotic treatment found meaningful body-image and psychosocial concerns, with greater reported disturbance among female participants.

Parents should therefore ask children how they feel rather than assuming that a mild-looking deformity is emotionally insignificant. (PMC)

When Is Surgery Required?

Most children with flexible pectus carinatum do not need surgery as their first treatment.

Surgery may be considered when:

• The chest wall is too rigid for effective compression bracing.
• The deformity is particularly severe or significantly asymmetrical.
• A properly supervised bracing programme has not achieved satisfactory correction.
• The child cannot tolerate or is unsuitable for conservative treatment.
• The specialist identifies an individual reason for operative management.

Two approaches are commonly discussed.

Abramson procedure: This is a minimally invasive technique in which a corrective bar is placed in front of the sternum to apply pressure and gradually reshape the chest.

Ravitch procedure: This is an open surgical approach involving correction of abnormal cartilage and chest-wall structures.

The choice depends on the child’s chest-wall anatomy, rigidity, deformity pattern and the surgeon’s assessment.

A systematic review of six cohort studies involving 396 patients assessed minimally invasive Abramson repair.

It reported favourable aesthetic outcomes, but also documented postoperative complications and the need for further intervention in some patients.

This is why surgery should involve a careful discussion of expected benefits, possible complications, recovery and long-term follow-up. (Elsevier)

Things Parents Should Do and Avoid

There are several practical steps that can make the management journey easier.

Do:

• Arrange a medical assessment when you notice a persistent or increasing chest prominence.
• Keep track of changes during growth using consistent photographs, with the child’s consent and privacy respected.
• Ask whether the chest wall is sufficiently flexible for bracing.
• Follow the brace-fitting and pressure instructions provided by the specialist.
• Report persistent pain, skin problems or difficulty tolerating the brace.
• Encourage normal age-appropriate physical activity.
• Discuss concerns about body image, confidence and school participation.
• Attend follow-up appointments, including during puberty.

Avoid:

• Trying to flatten the breastbone by pressing it with your hands.
• Using tightly wrapped elastic bandages or homemade compression devices.
• Buying an unmeasured chest brace without a professional fitting.
• Increasing brace pressure to speed up correction.
• Assuming that push-ups or chest workouts will reverse the deformity.
• Blaming the child’s posture, backpack habits or sleeping position.
• Restricting sports without a clinical reason.
• Ignoring persistent respiratory or cardiovascular symptoms.

One important point: there is currently no established exercise, food, supplement or lifestyle routine proven to prevent pectus carinatum.

Parents should focus on early recognition, appropriate assessment and evidence-based treatment rather than searching for preventive exercises that have not been scientifically validated.

When Should Parents Seek Medical Attention?

Arrange a consultation with a paediatrician or an appropriate chest-wall specialist when you notice:

• A progressively prominent breastbone.
• New or increasing chest asymmetry.
• Persistent chest tenderness.
• Breathlessness or reduced exercise tolerance.
• Palpitations or unexplained dizziness.
• Associated spinal curvature or other unusual skeletal features.
• A family history suggesting a connective-tissue or inherited cardiovascular condition.

Severe or sudden chest pain, fainting, significant breathlessness at rest or blue discoloration of the lips requires urgent medical assessment.

Do not assume these symptoms are simply part of pectus carinatum.

Can Pectus Carinatum Be Prevented?

At present, there is no scientifically established method to prevent pectus carinatum.

Because its precise cause is not completely understood and it is believed to involve abnormal chest-wall development, parents cannot reliably prevent it through posture correction, exercise, diet or changes in sleeping habits.

However, recognising the deformity early has practical advantages.

When a child is assessed while the chest wall is still relatively flexible, the treating team can determine whether observation or compression bracing is appropriate.

This is particularly relevant during periods of rapid growth.

The aim is not to make parents anxious about every change in the chest.

It is to help them recognise a persistent structural prominence and seek an appropriate assessment.

The Physiotherapy Perspective: A Chest Shape Should Never Define a Child

Pectus carinatum can be concerning for parents, especially when the chest prominence becomes more noticeable during adolescence.

However, a protruding breastbone does not automatically mean that a child has poor lung function, reduced physical capacity or an underlying serious disease.

The most useful approach is to understand the structure of the deformity, identify associated conditions when indicated and choose treatment according to chest-wall flexibility and the child’s needs.

Compression bracing remains an important non-surgical treatment for suitable children.

Physiotherapy can add value by improving movement, posture, physical conditioning and confidence, particularly when combined with an appropriately supervised brace programme.

Most importantly, listen to the child.

Their comfort, confidence and willingness to participate in treatment matter just as much as the measurements recorded during an examination.

A child should be encouraged to play, exercise, attend school and enjoy everyday activities without feeling that their chest appearance defines their abilities.

Early evaluation, appropriate treatment and a supportive family environment can make a meaningful difference to the child’s overall experience.

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Medical Disclaimer!

This article has been reviewed and written under the guidance of our Head Physiotherapist, Dr. Kruti Raj (PT, MUHS,CPT,CMPT). The information shared is intended for educational purposes only and should not be considered a substitute for personalized medical advice, diagnosis, or treatment.

Please consult us or any other qualified healthcare professional before beginning any exercise program, especially if you are experiencing pain, recovering from injury, or managing a medical condition.