Umbilical hernia of the linea alba in a child. Symptoms of a hernia of the white line of the abdomen in a child, treatment without surgery and surgery

Hernia of the white line of the abdomen is one of the rare pathologies in children.

The risk of developing the disease increases after five years, but in most cases the disease occurs in adult patients.

The pathology causes suffering to the child and cannot develop asymptomatically.

general information

Hernia of the white line of the abdomen in children - photo:

The linea alba represents vertical muscle strip starting at xiphoid process sternum and passing through the umbilical region. It ends at the pubic symphysis (pelvic part).

The width of the tendon layer is on average 2-3 mm, and its widest part reaches 20 mm. A hernia of the linea alba develops when the tendon bundles diverge at the level of the navel.

In the area of ​​such formations occurs protrusion of the omentum and intestinal loops. The width of the lumen can reach several centimeters.

Stages development of hernia of the white line of the abdomen:

• formation of preperitoneal lipoma;
• transformation of lipoma into a hernial sac;
• formation of a hernia of the white line of the abdomen.

Reasons for appearance

The development of a hernia of the linea alba in infants and older children can be provoked by congenital characteristics or the influence of certain external factors.

U newborns In children, the pathology is caused by constant and severe crying, overeating or constant stress on the abdominal area (for example, when coughing as a result of chronic bronchitis).

With age, the number of provoking factors increases.

Factors related to reasons for the development of pathology:

• genetic weakness of fibrous fibers;
• congenital defects of the abdominal wall;
• underdevelopment of the broad tendon plate;
• accumulation of fluid in the abdominal cavity;
• regular overeating;
• abdominal injuries;
• development of obesity;
• consequences surgical intervention;
• regular accumulation of gases and constipation;
• constant increase in intra-abdominal pressure.

Symptoms, clinical picture

The symptoms of hernia of the white line of the abdomen in children depend on the stage of development of the pathology. At the first stage, the disease occurs in the form protrusion of muscles in umbilical region .

When the baby relaxes his stomach or is in horizontal position, then the signs of a hernia become invisible.

In the presence of complications, the protrusion remains in permanent form And accompanied by pain. Symptoms of the pathology manifest themselves in the following conditions:

Possible complications and consequences

An advanced form of hernia of the white line of the abdomen can cause severe incarceration or necrosis certain internal organs.

Compression of the intestine or omentum impairs blood circulation, resulting in a risk of developing peritonitis.

If this pathology is detected in a child, it is necessary V as soon as possible carry out therapy disease or undergo surgery.

A hernia of the white line of the abdomen can provoke the following complications:

• rupture of an internal organ damaged by a hernia;
• development of peritonitis;
• intestinal obstruction;
• development of an inflammatory process or suppuration.

Why is a hematoma on the head of a newborn after childbirth dangerous? find out right now.

Diagnostics

Install preliminary diagnosis hernia of the white line of the abdomen, the doctor can, based on visual examination of the child and palpation certain areas of the abdominal cavity.

To confirm the pathology, additional examinations and consultations with specialized specialists are prescribed.

Based on the collected data, a course of treatment is drawn up or a referral for surgery is given.

Methods for diagnosing the disease are the following procedures:

• palpation of the area of ​​the white line of the abdomen;
• general blood and urine analysis;
• EGDS;
• Ultrasound of the abdominal organs;
• MRI of the abdominal organs;
• X-ray of the stomach and duodenum;
• computed tomography of the abdominal organs;
• herniorrhaphy;
• gastroscopy.

Prevention

The main measure to prevent hernia of the white line of the abdomen in children is to follow a diet and avoid exposure to negative factors. In a newborn or infant, the abdominal muscles characterized by weakness.

Persistent cough or crying have an extremely Negative influence on them.

Any sprain or injury can trigger the formation of a lipoma, which gradually turns into a hernia.

The following help prevent the development of pathology: recommendations:

• exclusion of excess weight in the child;
• preventing constipation;
• avoiding fasting and overeating;
• strengthening the abdominal muscles with a set of special physical exercises.

If there is a suspicion of the development of a hernia of the white line of the abdomen in a child, it is necessary consult a doctor as soon as possible. Alarm signal is the appearance of protrusion of muscles in the umbilical region. This symptom may be a sign not only of a hernia, but also of other serious pathologies.

Interview with the professor, head of the department of pediatric surgery, in this video:

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Hernia along the white line of the abdomen in a child - painful condition. It is characterized by the formation of gaps in the tendons between the muscles of the anterior straight line of the abdomen. The muscles form this area and have several tendon bridges.

It is in them that cracks sometimes appear, into which peritoneal fat is released first, and then the internal organs partially emerge. A painful protrusion forms anywhere in the middle part of the abdomen - a preperitoneal lipoma, in common parlance - a hernia of the white line of the abdomen.

Unfortunately, such hernias do not close spontaneously, so you should consult a doctor immediately when you notice the first signs of a hernia.

What is a hernia of the white line of the abdomen, symptoms

Unlike other types of hernias (umbilical, inguinal, etc.), hernias of the white line of the abdomen are quite rare in children, in only 0.8% of cases. They most often occur after 5 years of age due to underdevelopment of the aponeurosis. As a result, gaps may appear in the tendon bridges.

Hernias of the white line of the abdomen are divided into supra-umbilical, periumbilical, and sub-umbilical.
It is not at all difficult to recognize the appearance of a hernia in a child: a small rounded protrusion appears on the line between the navel and the xiphoid process of the sternum. If you gently press it, it will briefly move into the abdominal cavity. After which you can easily feel a small gap.

As the disease progresses, the child may experience abdominal pain. Moreover painful sensations may be strong or weak. Vomiting may occur, the general condition worsens - the baby becomes lethargic, eats poorly, is anxious, and constipation may appear.

The hernia is difficult to reduce inside, touching it is painful for the child.
Sometimes, a hernia does not cause any concern; the disease is asymptomatic and is detected during examination by a pediatrician.

How to treat a hernia of the linea alba?

The issue of removing a hernia should be decided immediately after diagnosis. If surgical treatment is not carried out on time, there is a high risk of hernia complications (strangulation) and further development of the disease. Massage for a hernia of the linea alba in a child and other means cannot cure it.

After surgical treatment under general anesthesia, complete recovery occurs, there are practically no relapses.

After surgery, when a hernia of the linea alba in a child was removed, the doctors’ recommendations are as follows. After surgical treatment During the rehabilitation period, it is useful to give him vitamins, especially vitamin C and special preparations. They will help you recover easily and return to your normal lifestyle.

Prevention of hernia of the white line of the abdomen in a child

To avoid the appearance of a hernia, it is necessary to engage in vigorous physical exercise with your child from the very beginning. early age. Pass mandatory preventive examinations, harden the baby.

During pregnancy and after childbirth, it is useful for the expectant mother to wear a special bandage, go for checkups on time, and follow correct mode day, lead a healthy lifestyle.

Be careful! There are certain folk remedies for treating hernia in children. They are most often useful in the early stages umbilical hernia. A hernia of the linea alba in a child can only be treated surgically!

In newborn children, hernias located in the area of ​​the white line of the abdomen are often diagnosed. If they are not treated properly, children may experience serious problems in the future.

At the beginning, children develop a small tubercle in the area of ​​the white line of the abdomen, which after some time can significantly increase in size (there are situations in which such a hernia reaches a diameter of 5 - 10 cm).

If the hernia does not bother the baby, his parents still should not be careless and contact a specialist. Delay can lead to strangulation of the hernia and emergency surgery.

Causes

After conducting numerous studies, experts determined main reason the appearance of a hernia of the white line of the abdomen in infants.

This disease develops against the background of poor development of connective tissues located in the area of ​​the white line of the abdomen. In patients, this tissue becomes thinner very quickly, resulting in holes in the aponeurosis.

The reasons for the development of a hernia include congenital anomaly development of the linea alba (some newborns have too wide gaps between the fibers of the line).

The disease can also progress in that category of young patients who have physiological underdevelopment of the aponeurosis.

Weakening of the connective tissue in the area of ​​the linea alba can occur in the following cases:

• for any injury to the abdominal cavity;
• with the growth of adipose tissue;
• with bad heredity;
• at sharp increase intra-abdominal pressure;
• for problems with bowel movements
• with prolonged crying;
• during infant cry, etc.

Symptoms

In most cases, a hernia of the linea alba in newborns is accompanied by the following symptoms:

• swelling appears at the site of the hernia;
• swelling with any tension in the abdominal cavity can change size;
• after eating, the baby begins to behave restlessly;
• pain appears (the baby may experience pain in lumbar region, in the area of ​​the shoulder blades, in the hypochondrium);
• nausea and vomiting;
• belching, especially after eating;
• heartburn;
• stool retention;
• the appearance of blood clots in the stool, etc.

Signs

When a hernia of the white line of the abdomen protrudes, in newborns the bulges can be located in different places. They are classified as follows:

• infraumbilical hernia (located under the umbilical ring);
• supra-umbilical hernia (the location of this bulge is above the child’s navel);
• peri-umbilical hernia (located in the umbilical region).

At the initial stage of development this type Hernias are quite problematic to diagnose, since parents of newborn children pay attention to the disease only when a protrusion appears.

As the disease progresses, elements of nearby organs may penetrate into the area of ​​the hernia sac: omentum, small intestine. In some young patients, doctors detect several hernias in the area of ​​the white line of the abdomen. With multiple localization, hernias can be located one on top of the other.

A hernia of the white line of the abdomen has several stages of development:

Today medicine knows a large number of cases when a hernia of the white line of the abdomen stopped its further development at the first stage.

Diagnostics

Parents of newborn children who independently identify a hernia of the linea alba in their babies should urgently consult a doctor. The specialist will prescribe a number of measures that will confirm the preliminary diagnosis and prescribe the correct treatment.

Doctors (depending on the situation) may prescribe:

• abdominal radiography;
• ultrasonography;
• multislice computed tomography of the abdominal organs;
• herniography;
• esophagogastroduodenoscopy.

Treatment

In the case when a small hernia of the linea alba is detected in newborns, the surgeon straightens it with his hands, after which he firmly fixes it in this position with a plaster. Massage and physiotherapy also prescribed to newborns as treatment for small hernias.

If the hernia does not disappear during long-term therapy, doctors perform surgical treatment of this disease. During surgery, the surgeon cuts out part of the omentum.

To do this, you need to carefully open the contents of the hernia. In most cases, surgeons during surgery remove diastasis of the rectus muscles, which are located in the abdominal cavity (near the hernia).

When performing emergency surgical treatment, doctors can use various methods:

• tension hernioplasty. This technique uses local tissues of the abdominal cavity;
• non-tension hernioplasty. Wherein surgical method mesh prostheses are used.

If carried out in a timely manner surgical treatment Patients almost never experience relapses.

In order to avoid any complications after surgery, parents of newborn children need to monitor their nutrition and prevent constipation, in which the abdominal muscles will become very tense.

Complications

At high voltage muscles (for example, with constipation) of the abdominal cavity in patients diagnosed with a hernia of the white line of the abdomen, various complications may occur:

• strangulation of the contents of the hernia;
• intestinal obstruction accompanied by severe pain
• the appearance of blood clots during bowel movements;
• development inflammatory processes in the hernia and nearby organs;
• as a result strong pressure on nearby organs, they may be injured, etc.

Cost of surgical treatment

In every medical center, which specializes in the surgical treatment of hernias of the white line of the abdomen in infants, sets its own prices for these operations. The pricing policy for surgical treatment of hernias directly depends on the size of the bulge, its location and stage of development.

Prevention

To prevent a hernia of the linea alba in small child his parents need to spend preventive actions. The child must be taught to physical activity from a very early age, but this should be done gradually.

It is important not to miss preventive examinations with local pediatricians, during which the doctor, upon palpation, will immediately identify any deviations from the norm. Many experts recommend hardening children, and this should be done almost from the first days of their life.

In order to prevent hernia of the white line of the abdomen in newborns, pregnant women are recommended to wear special bandages. Regime compliance, management healthy image life and long walks fresh air will have a positive impact on the health of the developing fetus.

To prevent the development of a hernia in an infant, his parents should ensure that he long time didn’t cry, because when he screams he will be very tense abdominal cavity.

Also for mothers, especially those breastfeeding breast milk, it is important to carefully monitor your diet. Many foods that enter a baby's body through breast milk can cause constipation, which can lead to the appearance of hernias of the white line of the abdomen.

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There are purely childhood diseases, and there are ailments that are most often found in adults. These include a hernia of the white line of the abdomen, but nevertheless, although rare, it still happens in children.

Definition and pathogenesis

In adults, the disease manifests itself between the ages of 20 and 30 years. On average, for every 10 hernias, one is formed at the level of the white line of the abdomen. Unlike inguinal and umbilical hernias, such a hernia in children occurs in less than 1% of cases.

The linea alba is a vertical muscle strip that begins at the xiphoid process of the sternum and ends at the symphysis pubis. The middle of this tendon layer passes through the navel and at its level has a width of 10–25 mm, and a little lower it narrows to 2–3 mm.

A hernia of the linea alba in a child occurs when the bundles of the tendon plate diverge at the level of the navel, and loops of intestine and omentum protrude through them. The wider the divergence of the fibers (up to 10–12 cm), the lower the risk of strangulation of the hernia. But generally the hernial orifice diverges to 5-6 cm.

A hernia of the white line of the abdomen in a child can occur due to genetic or acquired anatomical weakness of fibrous fibers . As a result, thinning, expansion, formation of slit-like openings and divergence of the rectus abdominis muscles occur. Also, the occurrence of a hernia may be due to underdevelopment of the wide tendon plate, consisting of collagen and elastic fibers.

provoke white hernia belly can obesity, abdominal trauma, postoperative scars . As well as an increase in intra-abdominal pressure that occurs with constipation, prolonged screaming, chronic bronchitis, whooping cough, etc.

Stages of hernia development

A hernia of the white line of the abdomen has three stages of development. IN first phase formation of a preperitoneal lipoma occurs. Sometimes the disease progresses into the so-called initial phase, and sometimes it reaches the final stage of formation.

The first phase is characterized by the protrusion of preperitoneal cells through the slit-like divergence of tendon fibers. This is exactly the picture that characterizes the formation of preperitoneal lipomas. Very often the disease stops at this stage and does not develop further.

But sometimes a lipoma can transform into a hernial sac, filled with part of the omentum and a small area small intestine. And the finally formed hernia has a hernial orifice and a hernial sac with contents. Inside the hernial sac you can often find the transverse colon, loops of the small intestine and even the walls of the stomach.

Last stage The development of a hernia of the white line of the abdomen is clearly visible to the naked eye. In addition, it is very easy to identify by palpation.

Basically, hernias of the white line are formed locally. But sometimes several hernias form, located one above the other. Hernias are supra-umbilical, peri-umbilical and sub-umbilical.

Signs of a white hernia

A hernia of the linea alba in a child is not a disease that can lurk for years. Its symptoms are usually visible to the naked eye. And the first sign of a hernia is painful protrusion along the linea alba .

If a child complains of increasing pain after eating, when playing sports, after defecation, etc., it makes sense to show him to a doctor. If the child constantly feels pain, most likely he has a temporary strangulated hernia.

Also, increased pain in the hernia may be due to the tension of the omentum connected to the hernial sac, or increased pressure on nerve endings parietal peritoneum. In most cases, a hernia of the linea alba in a child is accompanied by pain in the hypochondrium, scapula, and lower back.

If the pinching is severe, the child may feel nauseated, sharp pain in the peritoneum. Also, his condition may worsen due to retention of feces and gases.

How to confirm the diagnosis and begin treatment for a hernia

Any mother should be wary if her child often has a stomach ache. If the pain intensifies, you should immediately consult a surgeon. First of all he will examine little patient, and then refer him for additional examination.

In addition to palpation, a hernia of the white line of the abdomen is diagnosed using Ultrasound and computed tomography abdominal organs. In addition, the doctor may prescribe x-rays of the stomach and duodenum, gastroscopy or herniorrhaphy. Last method examination consists of insertion into the peritoneum contrast agent for the purpose of investigating a hernia.

Once the diagnosis is confirmed, the child should be immediately scheduled for surgery. There is no other way to cure a hernia of the linea alba. When preparing for surgery, you need to exclude certain foods from your diet.

First of all, these are sharp and fatty dishes, including spices. A mother should make sure that a child who has been diagnosed with a hernia of the white line does not have butter, semi-finished products, various snacks (for example, chips, crackers), tomatoes, lemons, chocolate. In addition, it is recommended to exclude vegetables and legumes from the diet, which cause bloating, colic and constipation. And in order to further reduce the load on the peritoneum, the child needs to be fed often, but in small portions.

When preparing a child for surgery, you need to feed him dishes made from brown rice, cereals, and vegetables - in particular carrots, cucumbers, and asparagus. You can also give fruits, fish, low-fat cheese, egg white, cauliflower and lean veal. But we must remember that such a diet is not a treatment, but only relieves the stomach and intestines before surgery.

Surgery and recovery

Surgical intervention for a hernia of the white line of the abdomen in a child is called hernioplasty and is carried out under general anesthesia. Depending on the degree of the disease, hernioplasty is performed using local (native) or artificial material (synthetic prostheses).

During the operation, the doctor is faced with the task of not only opening the hernial sac and removing its contents, most often this is a small part of the omentum, but also eliminating the discrepancy of the rectus abdominis muscles - diastasis. Only prevention of further diastasis guarantees complete cure from a hernia of the white line of the abdomen.

When hernioplasty using local (own) tissues, the defect of the aponeurosis (wide tendon tissue) is eliminated using a synthetic non-absorbable thread. This type of surgical intervention often leads to recurrence of the hernia, since the load on the sutures is quite large and they can erupt.

Therefore, most often the operation is performed using synthetic mesh frame , which covers the aponeurosis and evenly distributes the load on the sutures. Since through allomaterial connective tissue germinates without difficulty, the likelihood of relapse is negligible.

The entire operation takes no more than an hour, and the next day, if there are no complications, the child can be discharged home. Although the doctor may leave him in the hospital for another two days. The stitches will be removed only after a week or a week and a half.

After surgery there occurs rehabilitation period , which is accompanied by a special diet and refusal of physical activity.

Both before and after surgery, you should not give your child spicy, fatty or fried foods. To make the digestion process easier for the stomach, you need to focus on liquid foods: porridge, purees, fermented milk products.

In order for the intestines to empty regularly, the child after surgery should eat liquid oatmeal, drink light vegetable and chicken bouillon, low-fat yogurt, kefir or yogurt. You can also give your child milk and fruit jelly.

To improve peristalsis, it is necessary to add fruit and vegetable purees and juices. But you should not overuse fiber, as its excess can lead to flatulence and colic.

In addition, for speedy recovery Children after surgery should be given vitamins C and B, as well as calcium.

How to prevent a hernia from appearing

Prevention of hernia of the white line of the abdomen in infants are regular bowel movements and lack of excess weight. Since constipation and obesity increase the load on the abdominal cavity, care must be taken to ensure that the baby does not overeat and that his intestines work properly. In addition, the baby should not be allowed to burst into tears from screaming.

Replies

Hernias often occur in newborn children, so many parents have already encountered this diagnosis. But not everyone knows what it is and how to get rid of this problem.

Sometimes it happens that internal organs suddenly find a loophole in the tissues surrounding them. This can be either a physiological hole or acquired as a result of some kind of disorder. Through it, the internal organ partially crawls into places that are not at all intended for this. This phenomenon is called a hernia. One of its most common locations is white line abdomen, which stretches from the xiphoid process of the sternum to the pubis.

In newborns, the main causes of this defect are: long loud cry, coughing and bad stool. When screaming and constipation, it becomes very tense abdominal wall, due to which the connective tissue inside it weakens and diverges. The cause of a hernia of the white line of the abdomen in an older child may be any trauma to the abdomen or a large excess weight. There is also genetic predisposition to this disease.

Symptoms

On initial stage development of the disease, it is quite difficult to notice a hernia, especially when it comes to a newborn child. After all, he cannot clearly say or show where it hurts. Therefore, it is worth taking extremely pay attention to the following symptoms:

A hernia of the linea alba in an older child may also manifest itself as heartburn, nausea, pain in the lower back, under the ribs or in the area of ​​the shoulder blades.

Symptoms that cause discomfort usually do not appear immediately, but as the hernia develops. Therefore, even in their absence, any unusual bulge on the linea alba should be examined by a doctor as quickly as possible.

Stages of disease development

Development of a hernia of the white line of the abdomen in a child goes through three stages:

• a small amount of fatty tissue passes through the gap between the tendons, thereby forming a benign tumor;
• then from this tumor is formed hernial sac, into which internal organs partially extend;
• the hernial sac falls out through the gaps between the tendons along with parts of the internal organs located in it.

Quite often, the development of a hernia stops at the first stage, but you shouldn’t count on such luck. If the third stage is reached, there is likelihood of serious complications.

All complications resulting from the lack of treatment for a hernia are fraught with very serious health problems. Therefore the best prophylactic V in this case is timely diagnosis diseases.

Diagnosis and treatment

As soon as the baby shows signs of hernia formation, he must be immediately shown to the surgeon. Primary diagnosis carried out using improvised means: visual inspection, palpation and listening to the abdomen. These steps are usually sufficient to make a diagnosis, but in some cases the doctor may use other methods. The child is given a referral for blood and urine tests, then ultrasound diagnostics, x-ray or MRI.

After making a diagnosis, the doctor takes decision on treatment. In some cases, a hernia is diagnosed very early stage, then it can be cured with a course of special massage, as well as wearing a bandage. But most often the only reliable way to get rid of a hernia is surgery.

There are only a few contraindications for this treatment:

• serious illnesses;
• infectious diseases;
• irreducible hernia.

If there are contraindications to surgery, it is prescribed wearing a bandage or a special patch. But these methods can usually only stop the growth of a hernia, and not cure it.

Surgical intervention

The word “operation” often terrifies young parents. But the procedure for removing a hernia is not complicated. Similar surgical intervention may pose a danger only if the hernia has reached the stage of complications, but even then it cannot be avoided. To reduce the possibility unpleasant consequences at a minimum, you need to carefully prepare the child for surgery in advance, by correctly adjusting his diet.

Carrying out the operation

There are several types of surgical intervention:

1. Open access. To do this, a vertical incision is made above the place where the hernia is located, and all parts of the organs located in the hernial sac are released. This method is usually used for strangulation and large hernias. Open access surgery allows you to almost completely avoid subsequent relapses. But it leaves a big scar, and rehabilitation is quite painful.
2. Laparoscopy. Three very small punctures are made on the stomach, after which there are no scars. Through these holes a laparoscope is inserted into the abdominal cavity - special tool with optics. This method is used mainly for small and medium-sized hernias. After surgery, rehabilitation is quick and easy, but relapses of the disease are possible.
3. Preperitoneal access. The operation is also performed through small punctures in the abdomen. The intervention occurs using a special balloon that peels off the peritoneum. Like laparoscopy, the preperitoneal approach is good because of the absence of scars and an easy rehabilitation period. But the operation itself is quite complex and lengthy, and there is a high risk of relapse.

The method of intervention is selected by the surgeon depending on the stage of the disease and general condition child. Any of these operations is performed under general anesthesia. The purpose of the surgical intervention is to open the hernial sac, remove the parts of the internal organs that are there, set them in place and suture the discrepancy of the abdominal muscles through which the hernia has formed.

Suturing is done in two ways.

Rehabilitation usually takes from two to six months. At this time, you need to carefully monitor the child's diet. It should be approximately the same as during preparation for surgery. But you need to give more liquid food: soups, purees, cereals, yoghurts and kefir. Purees can be both fruit and vegetable, and you can also give your child juices. But, still, you should not overuse fruits, as they can provoke flatulence.

Also, it is necessary to carefully monitor the regularity of the child's bowel movements. Constipation is unacceptable, as such tension can lead to relapse. To avoid them, you need to regularly give your child laxative foods.

During rehabilitation period prohibited physical exercise . Any stress on the press is unacceptable. If we are talking about infant, then severe prolonged crying or coughing is also dangerous. Older children should avoid constipation and exercise. But after the end of the rehabilitation period, on the contrary, it is recommended to engage in muscle development abdominals, since strengthening them will reduce the risk of hernia recurrence.

Alternative Treatments

Many parents, in the event of a hernia in their child, prefer to contact not a surgeon, but alternative medicine, healers, various folk remedies. Such a decision provokes the development of the disease. Absence proper treatment allows the hernia to grow, there is a risk various complications. You can get rid of it only with the help of a surgeon, otherwise no one will be able to guarantee the preservation of the child’s health.

Prevention of hernia

Preventing a hernia is much easier than treating it. If we are talking about an infant, then it is necessary to monitor the regularity of bowel movements. Also, do not let your child scream and cry for a long time. Cough should be treated with initial stages so as not to lead to long severe attacks. Simply put, if you exclude excessive stress on the abdominal muscles, then the risk of a hernia of the linea alba in an infant will be minimized.

For children aged five years and older the best prevention are regular classes sports. They will strengthen the muscles, thereby preventing possible discrepancy.