What is external brace therapy

External bracing may be recommended for children up to 17 years of age who have mild to moderate pectus carinatum. The concept of the brace is to re-shape your child’s chest similar to how braces re-align your child’s teeth.

Brace therapy is most effective when started early, before the chest wall becomes too rigid (stiff) to respond to therapy. Starting brace therapy early enough also allows for evaluation and later surgery if the brace is not successful.

The custom fitted brace has 2 cushioned plates. One rests on the most “bowed out” part of the chest and the other is in the middle of the back. The plates are connected to an aluminum bar with adjustable ratchets. The front of the brace puts pressure on the chest wall while the back of the brace keeps it stable. The constant pressure slowly molds the chest wall into the correct position.

The brace is designed to be worn either on top of or under a t-shirt, depending upon what is most comfortable for your child. The brace should be worn at least 12 hours during every 24-hour period. It does not need to be worn continuously, but must be worn regularly day or night for two years or until growth is complete.

Your child will need to be highly motivated to wear the brace, and the more it is worn, usually the better the results.

For questions regarding the fit and comfort of your child’s brace, contact Boston Orthotics & Prosthetics (O&P) of Philadelphia at 215-634-9399. If your child is seen at the CHOP Care Network in King of Prussia or Voorhees, there are Boston O&P clinics conveniently located near those locations as well.

Preparing for external brace therapy

The specialists (orthotists) in the clinics will custom fit the brace for your child, which can be adjusted as needed. Boston O&P will check with your insurance company to see if the brace is covered.

If your insurance does not pay for care at Boston O&P, we have access to other vendors that make the device. We can provide medical documentation to your insurance company if needed.

What to expect during brace therapy

Your child will need to return to the brace shop and the surgery clinic 4 to 6 weeks after the initial brace fitting. After that, your child should have the brace adjusted as necessary. Your child will continue to be monitored at our clinic every 4-6 months while he or she is using the brace.

It takes some time to get used to the brace, but your child should not be uncomfortable. Your child will begin using the brace for short periods of time at first. He will wear it a little bit longer each day. If your child complains about the brace hurting, make an appointment with the brace shop or the surgery clinic to have it checked.

You and your child will need to make sure there is enough pressure on the chest. There should be a red mark over the chest where the cushioned plate is. This mark should be visible for several hours after your child removes the brace.

You should not see skin breakdown such as open skin ulcers or blisters. If you see skin breakdown, remove the brace and call the specialist that fitted the brace. Don’t use lotion on skin where the pads rest because this could soften the skin and cause skin breakdown.

You can clean the pectus carinatum brace with rubbing alcohol or mild soap and water. Heat will ruin the brace. Do not put it in the dryer or use a blow-dryer on it.

While wearing the brace, your child should not swim or participate in other sports.

Children’s Hospital of Philadelphia created a printable resource to help you better understand pectus carinatum and brace therapy. See Caring for Your Child: The Pectus Carinatum Brace for details.

Outcomes

We have treated more than 200 children with pectus carinatum in this type of brace since 2006 and have found the brace to be very effective when used correctly. To get the best results, your child needs to wear the brace exactly as the doctor orders.