Pectus excavatum in children and teenagers: a guide for parents

By Javier Santana, founder of Pectus Academy · Updated October 2026

Short answer: many children with pectus excavatum lead a normal life and need no treatment. What matters is keeping an eye on it during growth, because it usually gets more pronounced at puberty, and seeing a doctor if symptoms appear or if it affects them emotionally. It is also the age with the most options: almost all the vacuum bell evidence comes from children and teenagers.

When does it show, and how does it change?

• Most cases become visible in the first year of life. Others are noticed later, at grade school age, as a small dip in the chest.
• It usually gets more pronounced as puberty starts, around ages 12 to 14.
• 35% to 40% have a family history.

When should you see the pediatrician?

• If they get tired or short of breath with exercise more than other children their age.
• If they have chest pain, palpitations, dizziness or fainting.
• If the dip is getting deeper.
• If they stop doing things to avoid showing their chest: the pool, the beach, locker rooms.

Even with no symptoms, bring it up at a checkup: it gives you a baseline and tells you how often to have it rechecked.

Which tests might be done?

A physical exam is sometimes enough for the diagnosis. Depending on the case, doctors add a chest X-ray or a CT scan, which gives the Haller index, lung function tests and an echocardiogram.

What is considered at each age?

What is known about the vacuum bell in children?

• According to the 2025 Scottish assessment, the best results are seen in younger patients with a shallow dip, a flexible chest and the motivation to use it.
• In a study of 72 patients, starting at age 11 or younger and using it for more than 24 consecutive months were linked to better results.
• In the largest study we reviewed, with 259 patients, 86 of the 165 who completed treatment rated it a success (52.1%).
• Mayo Clinic describes it as an option for children and younger teens, worn one or more hours a day for about 12 to 15 months.
• In the Basel series, patients have an electrocardiogram and an echocardiogram before starting, and the first application is done in the clinic.

The details are in vacuum bell: how it works, how many hours and for how long and side effects and contraindications.

What about surgery?

The main reason to operate is that the dip affects the heart or lungs. In the Nuss procedure, the most common one, the bar stays in for two to three years. As a rough guide, one parents' guide mentions about three weeks off school and six months or more to get back to all activities; sports with a risk of a blow to the chest wait until the surgeon gives the go-ahead.

In a study at 11 hospitals with 264 patients aged 8 to 21, one year after surgery body image and perceived physical difficulties had improved, and 97% felt the operation had improved how their chest looked. More in pectus excavatum surgery.

Can they play sports?

In general, yes. Many children with pectus have a normal, active childhood, and in the Basel series all patients are advised to keep up their sports. If they tire more than others or have symptoms, get them assessed first. We go deeper in pectus excavatum and sports.

How do you talk about it with your child?

Distress about how the chest looks has been described in the teenage years and measured in studies. Mayo Clinic notes that counseling may help some kids and teens feel better about themselves. A few common-sense pointers, which do not come from studies:

• Ask how they feel about it without assuming. Some barely care and others care a lot.
• If it matters to them, don't play it down.
• Don't turn posture into something you nag them about.
• Include them in decisions about treatment.

More in body image and confidence.

What we know and what we don't

What we know

• It usually gets more pronounced at puberty.
• Many children need no treatment.
• The vacuum bell evidence is stronger in children and teenagers than in adults.

What we don't know

• Which cases will get deeper and which won't.
• Whether vacuum bell results last in the long term: published follow-up after stopping covers only a few years.

Before starting exercises

If you are thinking about exercises for a minor, check first with their pediatrician or a physical therapist. To understand what the exercises work on and why, read which exercises help and which don't and posture and rib flare.

This content is educational and does not replace the advice of a healthcare professional. We do not promise a specific result.

Sources

1. Sharma G, Carter YM. Pectus Excavatum. StatPearls, updated February 15, 2026. ncbi.nlm.nih.gov/books/NBK430918
2. Mayo Clinic. Pectus excavatum: symptoms and causes, updated March 14, 2025. mayoclinic.org
3. Mayo Clinic. Pectus excavatum: diagnosis and treatment, updated March 14, 2025. mayoclinic.org
4. Seattle Children's Hospital. Pectus Excavatum. seattlechildrens.org
5. Nemours KidsHealth. The Nuss Procedure, reviewed May 2023. kidshealth.org
6. Haecker FM, Sesia S. Vacuum bell therapy. Annals of Cardiothoracic Surgery, 2016. annalscts.com
7. Lei W, Shao M, Hu Y, et al. Vacuum bell therapy for pectus excavatum: a retrospective study. BMC Pediatrics, 2024;24. doi.org/10.1186/s12887-024-04615-3
8. van Braak H, de Beer SA, al Ghouch Y, et al. 15 Years of Vacuum Bell Therapy for Pectus Excavatum: Long-term Outcomes and Influencing Factors. Journal of Pediatric Surgery, 2025;60(2):161891.
9. Scottish Health Technologies Group. Vacuum bell device for the correction of pectus excavatum, June 2, 2025. shtg.scot
10. Kelly RE Jr, Cash TF, Shamberger RC, et al. Surgical repair of pectus excavatum markedly improves body image and perceived ability for physical activity: multicenter study. Pediatrics, 2008;122(6):1218-1222. doi.org/10.1542/peds.2007-2723