That which is left unspoken: infantile scoliosis on the rise

Once upon a time (Winter 2005), I researched the rising number of infantile scoliosis (IS) cases, and whether there was a link between this and “Back to Sleep,” the campaign initiated in the early 1990s to prevent Sudden Infant Death Syndrome (SIDS).

Joe O’Brien, executive director of the National Scoliosis Foundation, had given me anecdotal evidence -- from parents’ inquiries to the NSF -- that the incidence of IS was increasing. A recent email inquiry to him confirmed that is still the case.

Now, as you might imagine, this is an emotionally-charged issue – and rightly so. As a parent, if I had to choose between preventing my baby’s death and sparing her from developing IS, uh, I choose the former and “Back to Sleep” she would go.

And, indeed, my notes indicate I was unable to find a medical authority willing to go on record to confirm a connection between “Back to Sleep” and the incidence of IS. However, (thanks to Joe) I did find Martha Hawes.

A scoliosis patient herself, Hawes wrote a book in 2003: Scoliosis and the Human Spine: A critical review of clinical approaches to the treatment of spinal deformity in the United States, and a proposal for change.

In an excerpt from her book, Hawes notes that research has found a link between plagiocephaly, IS and “Back to Sleep.” She also shows that, before “Back to Sleep,” the U.S.’s infantile scoliosis rate was practically nonexistent, unlike in Europe:

“The same asymmetric forces that cause the postural molding of the head also cause a similar molding of the child's immature plastic torso, resulting in scoliosis. In the past, babies in England traditionally were placed on their backs ('supine position') to sleep, whereas in the U.S. babies are placed face down ('prone'). In his 1985 review McMaster states that ‘in the last decade, there has been an increasing tendency toward the prone position and because of more frequent central heating the infants are less restricted by blankets. Could this account for the decreased incidence of the condition seen in Edinburgh?’ A similar decrease in infantile scoliosis in association with adoption of the prone sleeping position for babies has been reported to occur in Germany (Mau 1981). Thus, Mau (1981) stated that, 'Following the widespread introduction of the prone-lying position for babies in Germany some ten years ago infantile scoliosis has now become a rare entity, so that further studies have been restricted.' McMaster (1985) recommends that in cases of resolving curves, the babies should be 'laid prone when in their cots, and this may encourage a more speedy resolution.'"

Hawes explains that, as Europe’s rate of IS declined, the U.S.’s rate increased following the advent of “Back to Sleep:”

“…In recent years, in correlation with increased awareness of the dangers of the prone sleeping position and increasing compliance with the supine position there has been a reported decrease in SIDS from 153 deaths per 100,000 live births in 1980 to 64 per 100,000 live births in 1998 (Hauck et al. 2002). No one could argue with such positive results. However, if McMaster and Wynne-Davis are right in their speculation about the relationship between the supine position and infantile scoliosis, this new policy can be predicted to reverse the U.S. : European ratio of infantile scoliosis…”

Although some cases of IS resolve without treatment, others have been documented to progress to severe curves of 70+ degrees. Such extreme curves can twist the rib cage and stress internal organs, and this is when scoliosis can become life-threatening.

Hawes concludes:

“The possibility that an epidemic of a lethal childhood disorder is in progress in our country should be explored by all possible methods. If such research reveals that infantile scoliosis incidence has increased since the 'back to sleep' campaign began in the early 1990s, then education and practical strategies to protect babies from SIDS and infantile scoliosis need to be provided to parents immediately.”

A postscript about treatment
Regardless of age of onset, early detection is key to effective scoliosis treatment. And, since fused vertebrae generally stop growing, it is imperative that nonsurgical treatments for IS be explored. Dr. Min Mehta pioneered the use of plaster casting to treat IS, a method that is still being used to great success.