Pectus Excavatum

Funnel Chest or Sunken Chest

Call for an Appointment 855-855-6484

Children diagnosed with or suspected of having pectus excavatum receive expert care from Duke pediatric surgeons and nurse practitioners who specialize in treating this chest wall deformity. While your child may not require a procedure to correct pectus excavatum right away, our pediatric specialists will educate you and your family on how to live comfortably and safely with the condition until it requires surgical correction.

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About Pectus Excavatum

Pectus excavatum is a disorder of the chest wall that appears as a depression in a child’s breastbone at the center of the chest. Because the breastbone doesn’t fully form, it’s often called a “funnel chest” or “sunken chest.”

If your child has pectus excavatum, it is important to know that nearly all cases do not impact their growth, development, or activity level. Most cases of pectus excavatum do not have serious medical implications. Children breathe normally, and their heart and other organs are protected. Almost all children can still be active and do not experience any problems with breathing or lung capacity.

If needed, a minimally invasive surgery can fix the structure of your child’s chest to ensure that they stay healthy and active. In very rare cases, pectus excavatum can affect the function of organs.

Active Surveillance by Experts Is Important
Active surveillance is an important part of tracking all aspects of your child’s wellness. Our providers are trained in testing, monitoring, and treating a sunken chest. We involve you in all decisions about your child’s care and carefully explain our recommendations.

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Testing for Pectus Excavatum in Children

Pectus excavatum can be identified in some toddlers but typically isn’t fully diagnosed until children are 10 to 13 years old. This is because cartilage grows as children’s bodies develop, and the appearance of a sunken chest does not guarantee it’s a chest wall disorder. A physical exam helps your child’s provider make a diagnosis. We also conduct follow-up tests to determine the full extent of your child’s condition.

CT Scan

This advanced X-ray procedure creates 3D images of your child's lungs and heart, which allows our providers to make measurements that show the extent of the pectus excavatum. We use a formula called the Haller Index to calculate the size and shape of your child’s chest and quantify a depression.

Echocardiogram

Using sound waves, we can see live images of the heart to determine if your child’s breastbone is near the organ or could compress the heart in any way.

Pulmonary Function Test

The strength of your child’s lungs is measured as they blow into a machine. It measures how much air their lungs can hold and the lungs’ ability to force out a heavy breath.

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855-855-6484

Treating Pectus Excavatum in Children

Minimally invasive surgery may be needed to repair pectus excavatum. Recovery can be painful as bones adjust and settle. We will work with you and your child to keep them as comfortable as possible in the days after surgery and will monitor their progress as they heal. We often recommend surgery during a summer or holiday break from school to allow for recovery time without missing classes.

Nuss Procedure

Your child’s CT scan is used to create a custom-fit metal bar. During surgery, the bar is placed under the ribs through two incisions made on each side of the chest. The bar resets the chest wall to reverse the sunken chest. Your child will in the hospital for up to four days so our providers can help them manage pain and movement.

The metal bar will stay in place for about three years to ensure your child’s sternum doesn’t revert to its original position. Your child will typically return for appointments one and six months after surgery to observe their progress. Additional checkups may be recommended.

Intercostal Cryoablation

Depending on the extent of your child’s needs for resetting their chest and their tolerance for pain, we may use this treatment as part of the Nuss procedure. Before the metal bar is placed, your child’s surgeon will insert a thin probe into their chest to numb the nerves with extreme cold. This can decrease pain for up to six weeks as they heal. It can also result in shorter hospital stays and less pain medication.

Best Children's Hospital in NC

Duke Children's Hospital & Health Center is proud to be nationally ranked in 10 pediatric specialties.

Recovery from Pectus Excavatum Surgery

Medication

We’ll prescribe your child medication to help with common side effects of the surgery. This includes medicine to minimize pain and laxatives to prevent constipation and bloating, which can cause abdominal discomfort. Children usually stop taking medication within a month.

Physical and Occupational Rehabilitation

In the days following surgery, our physical and occupational therapy teams will begin work with your child to help them stand and move on their own comfortably. Additional therapy after your child leaves the hospital is optional. We make sure they regain a safe range of motion, so they can return to regular childhood activities as soon as possible.

Activity Restrictions for Six Months

Following the Nuss procedure, your child’s activities and participation in sports will be restricted for at least six months. This will ensure they avoid damage to their breastbone or disruption to the metal bar in their chest. They must avoid contact sports and twisting or pulling heavy weights during this time. Walking and running are safe, but they should still avoid activities that require sudden twisting.

Why Choose Duke

Comprehensive Care for Pediatric Surgery
In preparation for surgery, we make sure you understand what will take place, how you and your child can best prepare, and what to expect for your child's recovery. You will meet with a board certified pediatric anesthesiologist or certified nurse anesthetist ahead of the procedure so you can ask questions and discuss any concerns. On the day of surgery, you can speak with the surgeon before surgery begins and receive updates during the procedure in our surgical waiting area. Your child’s surgeon will find you there following the surgery to update you and let you know when you can see your child in recovery.

High-Quality Surgical Care
Duke is one of the two hospitals in North Carolina verified as a Level I children’s surgery center by the American College of Surgeons. This Level I designation recognizes our commitment to providing the highest-quality surgical care to our young patients. To achieve Level I certification, centers must offer multiple medical and surgical specialties, with procedures for major congenital anomalies and complex diseases, including those that are uncommon or require significant coordination among multiple specialties.

Support Before and After Care
Our care coordinators and social workers can help you navigate the medical system, schedule appointments, and coordinate the variety of health services your child needs. We help you work with insurance providers, connect you with resources, and assist you in managing details related to your child’s care.

This page was medically reviewed on 05/24/2022 by

Caitlin Curtis, MSN, CPNP-AC | Nurse Practitioner - Hospital Medicine