Funnel chest is a condition in which the breastbone is depressed or sunken in. The breastbone (sternum) connects the front end of the ribs. The diaphragm (a band of muscle separating the chest and abdominal cavities) attaches in front to the lower ribs and to the bottom of the breastbone. In children, the ribs are made of tough elastic tissue called cartilage; this cartilage gradually hardens into bone as the child grows. Since cartilage is not as strong as bone, the ribs of a baby are delicate, but the diaphragm is relatively strong. When some babies breathe in, the diaphragm pulls in the lower half of the breastbone, causing a hollow in the center of the chest. This hollow is exaggerated when the child makes a greater effort to breathe, as with bronchitis, pneumonia, and choking. This condition, called retracting, is a sign of breathing difficulty. If retracting occurs only when the child has difficulty breathing, it is not considered to be a true funnel chest.
A true funnel chest exists if the breastbone is depressed when the child breathes out, even while the child is at rest and is having no difficulty breathing. If mild or moderate, a funnel chest will cause no harm and will gradually correct itself over the years as the child’s ribs grow heavier and stronger. If funnel chest is severe, it may not correct itself and may interfere with breathing. Rarely is it severe enough to affect the position or functioning of the heart.
Signs and symptoms
A funnel chest can be seen by observing the chest of a well child. The breastbone appears to be sunken in, forming a hollow in the center of the chest. If this hollow appears whenever the child breathes out, this may be a sign of true funnel chest.
If a child has not previously shown signs of a funnel chest, retractions of the lower breastbone are an important sign of breathing difficulty.
A fixed deformity (true funnel chest) cannot be treated at home. Bring it to the attention of your doctor.
If retractions of the breastbone begin in a child with no earlier signs of funnel chest, look for other signs of breathing difficulty. Then treat the disease that is causing the breathing problems.
• Don’t be alarmed by persistent mild to moderate depression of the breastbone in an infant or young child.
• Do not restrict your child’s activities.
The doctor will determine if the child has a true funnel chest or if the child is having temporary difficulty breathing. In marked cases of funnel chest, the severity and effect on heart and lungs is judged by X ray and other test results.
If funnel chest is severe and persists without gradual improvement, the condition may require surgery. Surgery may be performed if there are signs of limited heart or lung function or for cosmetic reasons. Your doctor may order X rays, an electrocardiogram, and measurements of the lung capacity.