Understanding Funnel Chest in Children

Funnel chest, scientifically known as pectus excavatum, is a relatively common chest wall deformity that affects children. This condition occurs when several ribs and the sternum grow abnormally, resulting in a sunken or caved - in appearance of the chest. It is important to note that this deformity can vary in severity, from mild cases where the indentation is barely noticeable to severe ones that can impact the child's physical and psychological well - being. Approximately 1 in 300 to 1 in 500 adolescents are affected by funnel chest (Children's National Hospital).

Causes of Funnel Chest

The exact cause of funnel chest remains unclear, but research suggests a genetic component. While most children with funnel chest do not have a family history of the condition, there are enough cases with a family link to make doctors suspect that genes play a significant role. Scientists are actively investigating this genetic aspect to gain a better understanding of the root cause. Sometimes, funnel chest can be a congenital defect, present at birth, or it may develop within the first few months of life. In some mild cases, it may correct itself before the child turns three, but in moderate and severe cases, the condition often worsens as the child grows, especially during the rapid bone - growth phase of early teenage years (SSM Health Cardinal Glennon Children's Hospital).

Symptoms of Funnel Chest

The symptoms of funnel chest can vary depending on the age of the child and the severity of the condition. In infants, a common symptom is a hollow depression in the chest, which can have different shapes - it may be broad and shallow, deep and narrow, or irregular. Infants may also breathe more rapidly than normal. As children get older, symptoms can include shortness of breath upon exertion or exercise, chest pain, a lateral curvature of the spine, absence of the curve of the upper back, hooked shoulders, and a broad, thin chest (Boston Children's Hospital). In severe cases, the sternum and ribs can press on the heart and lungs, which may affect their function, particularly during extreme exercise. About 15 percent of children with funnel chest also develop scoliosis, and in rare cases, it can be associated with connective tissue disorders such as Marfan syndrome or Ehlers - Danlos syndrome (Boston Children's Hospital).

Diagnosis of Funnel Chest

Funnel chest is usually first detected during a physical examination. A doctor can visually inspect the child's chest and notice the characteristic indentation. To confirm the diagnosis and assess the severity, additional tests may be recommended. X - rays of the chest can help provide a better view of the skeletal structure and the extent of the deformity. Some hospitals, like Boston Children's Hospital, also use a white light scanner, a type of three - dimensional (3D) camera, to measure the chest wall depression accurately and monitor the child's response to treatment over time. Other tests such as an echocardiogram (cardiac ultrasound) to check the heart function, a pulmonary function test (PFT) to evaluate lung function, and a cardiopulmonary exercise test (CPET) may also be conducted, especially in more severe cases or when there are concerns about the impact on the heart and lungs (Boston Children's Hospital).

Treatment Options for Funnel Chest in Children

Non - Surgical Treatment

Customized Bracing

Customized bracing is a non - surgical treatment option that uses gentle pressure to remold the chest. Some centers, like the Center for Pectus and Chest Wall Abnormalities at Children's Health℠, have a dedicated team trained to complete customized measurements of the chest, supply the brace, and provide follow - up. For pectus carinatum (a related chest wall deformity), a child may use two different types of braces: a circular brace that is not customized and a dynamic compression brace that is made according to the child's measurements. When a child first receives the brace, they start by wearing it for just a few hours a day and gradually build up to wearing it all day. Once the chest begins to reach the desired shape, the child wears the brace less and less to retain the shape. The duration of bracing can range from as little as six months to as many as 20 months (Children's Health℠).

Physical Therapy

Physical therapy is another non - surgical approach. It focuses on improving posture and upper body strength. By strengthening the muscles around the chest, it can help to counteract the effects of the deformity and potentially improve the appearance and function of the chest. Physical therapists can design a personalized exercise program for the child, which may include exercises for the back, shoulders, and chest muscles. These exercises can also help with the overall physical development of the child and may improve their ability to participate in physical activities (Children's Health℠).

Vacuum Bell Therapy

Vacuum bell therapy is a non - invasive treatment method that is more commonly used for mild cases of funnel chest in younger children with flexible chest walls. It uses a device worn on the outside of the body that creates suction to lift the breastbone forward over time. The child needs to wear the device for a total of four hours every day. The therapy usually takes at least two years, and the duration may depend on the child's growth. This method has shown promise as an alternative to surgery in some cases, as demonstrated by Jesse's treatment at Boston Children's Hospital, where vacuum bell therapy made surgery unnecessary (Boston Children's Hospital).

Surgical Treatment

Nuss Procedure

The Nuss procedure is a minimally invasive surgical option for treating funnel chest. Surgeons make two small incisions on the sides of the chest. Through these incisions, they insert a curved metal bar behind the sternum. The bar, which is shaped to fit the contours of the child's chest, is then flipped to push the sternum forward. Sometimes, more than one bar may be required. The bar usually remains in the chest for about two to three years while the breastbone grows around it. Once the bones have solidified into place, the bar is removed in a relatively simple procedure. This procedure has become very popular because it has a lower complication rate compared to more invasive surgeries, and many patients can be discharged from the hospital the same day or soon after the operation. For example, at CHOC, around 65% of patients who undergo the Nuss procedure are sent home the same day for recovery. Additionally, advanced techniques such as cryoablation are sometimes used during the Nuss procedure to manage pain. Cryoablation freezes the nerves causing a pain sensation to the chest, shortens hospital stays, and reduces the need for opioids (CHOC, Cleveland Clinic Children's).

Ravitch Procedure

The Ravitch procedure is an open - surgery option. In this procedure, the surgeon makes an incision across the front of the chest. They then remove the abnormal rib cartilage that is causing the funnel chest. After that, the surgeon reshapes the breastbone and may place a metal bar to hold it in the correct position while it heals. The bar usually remains in place for six to 12 months in the case of pectus excavatum, or for a longer period in some cases, until the cartilage grows back and can support the chest in a normal position. Once the healing is complete, the bar is removed during a same - day operation. This procedure is often used in more severe cases or when other treatments have not been effective (Children's National Hospital).

Top Ten Treatment Centers in New York City for Funnel Chest in Children in 2025

While specific updated top - ten lists for treating funnel chest in children in New York City in 2025 may not be readily available, we can look at well - known and respected medical institutions in the area that are likely to be on such a list based on their reputation, expertise, and available resources in treating chest wall deformities.

1. NewYork - Presbyterian Hospital

NewYork - Presbyterian Hospital is a world - renowned medical center that offers comprehensive pediatric care. It has a team of highly skilled pediatric surgeons, cardiologists, and orthopedists who are experienced in treating funnel chest. They have access to the latest diagnostic and treatment technologies, including advanced imaging techniques for accurate diagnosis and minimally invasive surgical procedures. The hospital also provides a multidisciplinary approach to treatment, ensuring that all aspects of the child's health are considered, from physical to psychological well - being.

2. Children's Hospital at Montefiore

This hospital is recognized for its pediatric specialty services. It has a dedicated team for treating chest wall deformities. Their surgeons are well - versed in both non - surgical and surgical treatment options for funnel chest. The hospital offers customized treatment plans based on the individual needs of each child. They also focus on providing support to the child and their family throughout the treatment process, which is crucial for a successful outcome.

3. NYU Langone Health - Hassenfeld Children's Hospital

NYU Langone Health's Hassenfeld Children's Hospital has a strong reputation in pediatric medicine. Their specialists in the field of pediatric surgery and orthopedics are at the forefront of treating funnel chest. They conduct research on new treatment methods and incorporate the latest advancements into their practice. The hospital also offers educational resources for families to help them understand the condition and the treatment options available.

4. Mount Sinai Kravis Children's Hospital

Mount Sinai Kravis Children's Hospital is known for its innovation in pediatric care. Their team of experts in chest wall deformities provides high - quality care, from diagnosis to treatment and long - term follow - up. They use a patient - centered approach, tailoring treatment plans to each child's unique circumstances. The hospital also has a strong focus on patient and family satisfaction, ensuring that the child and their loved ones are actively involved in the decision - making process.

5. Columbia University Irving Medical Center - Morgan Stanley Children's Hospital

This medical center combines world - class research with exceptional clinical care. The pediatric surgeons at Morgan Stanley Children's Hospital are skilled in performing complex surgical procedures for funnel chest, such as the Nuss and Ravitch procedures. They are also involved in clinical trials to explore new and improved treatment options. The hospital offers a supportive environment for children and their families, with dedicated resources for pediatric patients.

6. Northwell Health - Cohen Children's Medical Center

Cohen Children's Medical Center has a comprehensive pediatric chest wall program. Their team includes specialists from multiple disciplines, such as pediatric surgery, cardiology, and pulmonology. They work together to provide integrated care for children with funnel chest. The hospital offers state - of - the - art facilities for diagnosis and treatment, and they also have a strong emphasis on patient education and follow - up care.

7. St. John's Episcopal Hospital - South Shore

St. John's Episcopal Hospital - South Shore provides high - quality pediatric services in the local community. Their pediatric department has experience in treating chest wall deformities. They offer a range of treatment options, including both non - surgical and surgical approaches. The hospital focuses on providing personalized care to each child, taking into account their specific needs and circumstances.

8. Staten Island University Hospital - Pediatric Services

The pediatric services at Staten Island University Hospital are dedicated to the well - being of children. Their team of doctors and nurses are trained to handle cases of funnel chest. They provide comprehensive care, from initial diagnosis to long - term follow - up. The hospital offers a family - friendly environment and works closely with families to ensure the best possible outcome for the child.

9. Jamaica Hospital Medical Center - Pediatric Division

The pediatric division at Jamaica Hospital Medical Center offers a wide range of services for children with medical conditions, including funnel chest. Their specialists are knowledgeable about the latest treatment methods and provide individualized care. The hospital also has a strong community outreach program, which helps to raise awareness about pediatric chest wall deformities and provides support to families in the area.

10. Coney Island Hospital - Pediatric Department

Coney Island Hospital's pediatric department has a reputation for providing quality care to children. Their team has experience in diagnosing and treating funnel chest. They offer a combination of non - surgical and surgical treatments, depending on the severity of the condition. The hospital focuses on providing holistic care, addressing not only the physical but also the emotional and social needs of the child.

Factors to Consider When Choosing a Treatment Center

Expertise of the Medical Team

It is crucial to choose a treatment center with a team of experienced and qualified medical professionals. Look for centers where the surgeons have a high volume of experience in performing surgeries for funnel chest, such as the Nuss and Ravitch procedures. The team should also include pediatric cardiologists, pulmonologists, and other specialists who can provide comprehensive care. For example, at CHOC, their pectus treatment team includes pediatric pulmonologists, cardiologists, pediatric anesthesiologists, pediatric thoracic surgeons, and patient mentors. This multidisciplinary approach ensures that all aspects of the child's health are considered during treatment.

Treatment Options Available

A good treatment center should offer a variety of treatment options, both non - surgical and surgical. This allows the doctors to choose the most appropriate treatment for each child based on the severity of the condition, the child's age, and other individual factors. For instance, some children may benefit from non - surgical treatments such as bracing or vacuum bell therapy, while others may require surgery. Centers that offer a full range of options can provide more personalized care.

Success Rates

Research the success rates of the treatment center in treating funnel chest. High success rates indicate that the center has a proven track record of achieving good outcomes. You can ask the hospital for data on the success of their surgeries, the rate of complication, and the long - term results. For example, at Cleveland Clinic Children's, over 98% of their pectus excavatum patients have been successfully treated with the minimally invasive Nuss procedure.

Patient and Family Support

Going through treatment for funnel chest can be a stressful experience for both the child and their family. A treatment center that provides good patient and family support can make a significant difference. This may include support groups, counseling services, and educational resources. Some centers, like CHOC, offer a pectus family mentorship program that connects past pectus patients with new patients to assist families through the process.

Location and Accessibility

Consider the location of the treatment center and how accessible it is for you and your family. If the child requires multiple visits for treatment, follow - up appointments, or surgery, a center that is close to home can reduce the burden of travel. However, in some cases, it may be worth traveling to a more specialized center that offers better treatment options and expertise.

Recovery and Aftercare

Post - Surgical Recovery

After surgical treatment for funnel chest, the child will need a period of recovery. The length of the recovery period can vary depending on the type of surgery performed. In general, the Nuss procedure has a shorter recovery time compared to the Ravitch procedure. Most children will experience some pain after surgery, but hospitals use various pain management techniques, such as cryoablation, to reduce pain and discomfort. For example, in the Nuss procedure, the child may be in the hospital for a few days or may even be discharged on the same day, as in the case of some patients at CHOC. After discharge, the child will need to follow a recovery plan that may include rest, avoiding strenuous activities, and taking medications as prescribed. Physical therapy may also be recommended to help the child regain strength and mobility.

Follow - up Care

Follow - up care is an essential part of the treatment process. The child will need to have regular check - ups with their doctor to monitor the healing process, the position of the bar (if used in surgery), and the overall improvement of the condition. X - rays or other imaging tests may be performed during these follow - up visits. The doctor will also assess the child's physical and psychological well - being. In cases where a bar was inserted during surgery, the doctor will determine the appropriate time for its removal. After the bar is removed, the child may still need some additional follow - up to ensure that the chest remains in the correct shape.

Psychological Support

Funnel chest can have a significant psychological impact on children, especially as they become more self - conscious during adolescence. Therefore, psychological support is an important aspect of aftercare. Parents, teachers, and healthcare providers should be aware of the child's emotional state and provide support. Some children may benefit from counseling or support groups where they can interact with other children who have had similar experiences. This can help boost their self - esteem and confidence.

Conclusion

Treating funnel chest in children requires a comprehensive approach that takes into account the child's age, the severity of the condition, and individual needs. There are various treatment options available, including non - surgical and surgical methods. When choosing a treatment center in New York City or elsewhere, it is important to consider factors such as the expertise of the medical team, the available treatment options, success rates, patient and family support, and location. Recovery and aftercare are also crucial for a successful outcome, and this includes post - surgical recovery, follow - up care, and psychological support.