Who should pediatric patients with pectus carinatum (pigeon chest) consult initially?

Initial Consultation for Pediatric Pectus Carinatum (Pigeon Chest)

Pediatric patients with pectus carinatum should be initially referred to a pediatric surgeon or pediatric surgical specialist at a comprehensive, multidisciplinary clinic at a specialized pediatric center. 1

Rationale for Pediatric Surgical Specialist Referral

The American Academy of Pediatrics specifically recommends that when a surgical condition like pectus carinatum has been identified in a child, a pediatric surgical specialist should be consulted to address issues related to this condition with the family and the primary care pediatrician 1. This ensures optimal management from the outset.

Evaluation Process

The initial evaluation by a pediatric surgeon typically includes:

• Assessment of the severity and type of pectus carinatum (symmetric vs. asymmetric)
• Evaluation of chest wall compressibility
• Determination of psychological impact on the patient
• Screening for associated conditions

Treatment Options

The pediatric surgeon will determine the most appropriate treatment approach:

1. Conservative Treatment (First-Line):

   • Custom-fitted bracing is highly effective in compliant patients, especially in children and young adolescents 2
   • Best results occur with daily brace-wearing time above 14 hours 2
   • Treatment duration is typically 7-12 months 2

2. Surgical Intervention (When Conservative Treatment Fails):

   • Minimally invasive techniques using intrathoracic compression 3
   • Ravitch procedure or modified techniques for more severe cases

Multidisciplinary Team Involvement

Depending on the severity and associated conditions, the pediatric surgeon may coordinate care with:

• Pediatric pulmonologist (to assess any respiratory impact)
• Pediatric cardiologist (to rule out associated cardiac conditions)
• Pediatric psychologist (to address body image concerns)

Importance of Psychological Support

Pectus carinatum can significantly impact a child's self-image and quality of life:

• Studies show statistically significant improvement in body self-image after successful treatment 4
• Psychological support should be considered as part of comprehensive care

Follow-Up Care

After initial consultation with a pediatric surgeon:

• Regular follow-up visits at 3-6 month intervals are recommended 1
• For patients undergoing bracing, compliance monitoring is essential
• Post-correction follow-up to ensure maintenance of results

Special Considerations

• In communities where access to pediatric surgical specialists is limited, the primary care pediatrician should consult with the nearest pediatric surgical specialist to determine if referral is necessary 1
• For complex cases or those with associated conditions, treatment at a specialized center with multidisciplinary expertise is strongly recommended

Pitfalls to Avoid

• Delaying referral to a pediatric surgical specialist, as early intervention (especially before puberty) often yields better outcomes
• Failing to address psychological aspects of the condition
• Not monitoring for potential complications like reactive pectus carinatum after treatment 5

By following this referral pathway, pediatric patients with pectus carinatum can receive comprehensive care that addresses both physical and psychological aspects of this condition.