What clinical signs should I look for when assessing a child for scoliosis?

When assessing a child for scoliosis, look for an abnormal lateral curvature of the spine visible when viewing the child from the front or back, which may present as asymmetry in the shoulders, scapulae, or waistline. This deformity can be detected by observing the child standing and bending forward (Adam's forward bend test), where a rib hump or prominence on one side may become apparent due to vertebral rotation. Additionally, check for any vertebral or localized spinal tenderness or deformity during physical examination, as these may be associated with scoliosis or underlying pathology. It is important to assess for any functional impairment such as changes in gait or mobility, and to be alert for red flag features including pain that is constant, worsening, or occurs at night, neurological symptoms (e.g., limb weakness, sensory loss), or systemic signs like fever or weight loss, which warrant urgent referral. Also consider the child's history for risk factors such as previous scoliosis, inflammatory or neurological conditions, or trauma. In children with cerebral palsy, scoliosis may be a secondary musculoskeletal complication and should be assessed as part of their musculoskeletal examination. Overall, the key clinical signs include visible spinal curvature, asymmetry on forward bending, spinal tenderness or deformity, and any associated neurological or systemic symptoms ¹ (Launay et al., 2006).