Reference — Pediatrics
Scoliosis Screening Reference
A thirty-second exam that catches a curve while it’s still small enough to brace. The Adams forward bend turns spinal rotation into a visible rib hump — here it is step by step, with what to look for and when to refer.
Educational use only. Screening protocols and referral thresholds vary by program; the Cobb angle from a standing radiograph (read by the provider) drives management. This reference supports screening and teaching. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
The Adams Forward-Bend Test
- 1Privacy and exposure: back uncovered (gown open at back); have the child stand straight, feet together, arms at sides
- 2Inspect standing: shoulder height, scapular prominence, waist crease symmetry, hip/pelvis level, and trunk shift
- 3Adams forward bend: child bends forward at the waist, knees straight, arms hanging together toward the floor
- 4Sight along the back from behind (and from the side): look for a unilateral rib hump (thoracic) or lumbar prominence
- 5Scoliometer (if used): place across the back at the apex of any hump; note the angle of trunk rotation
- 6Document findings and refer for standing X-ray (Cobb angle) per threshold
What’s Positive & When to Refer
Positive forward bend: a unilateral rib hump or lumbar prominence (asymmetry between the two sides of the back). Standing asymmetries — uneven shoulders, a winged scapula, unequal waist creases, uneven hips — support it.
Scoliometer: an angle of trunk rotation of roughly 5–7 degrees or more is a common referral cutoff for a standing X-ray.
Cobb angle: measured on the radiograph; ≥10° defines scoliosis, and the magnitude (with remaining growth) drives observe vs brace vs surgery.
Atypical Red Flags (Look Deeper)
- !Significant pain (idiopathic scoliosis is usually painless)
- !Left thoracic curve (right thoracic is the common idiopathic pattern)
- !Rapid progression or onset outside the typical adolescent window
- !Neurologic signs (weakness, numbness, bowel/bladder changes), foot deformity, or skin markings over the spine
NCLEX Pearls
- ✦Adams forward bend is the screening test — a unilateral rib hump is the positive finding.
- ✦Standing asymmetries: uneven shoulders, prominent scapula, unequal waist creases, uneven hips.
- ✦Cobb angle ≥10° defines scoliosis; the angle plus remaining growth drives management.
- ✦Idiopathic scoliosis is painless and usually a right thoracic curve — pain or a left curve is a red flag.
- ✦Screen around the adolescent growth spurt; progression risk is tied to remaining growth.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Academy of Pediatrics (AAP) · CDC / ACIP (immunization schedule). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →