Scoliosis in children and adolescents

Short answer: The common form of scoliosis in childhood and adolescence is adolescent idiopathic scoliosis. In a study that screened 16,045 students across 40 provinces of Turkey, the prevalence between the ages of 10 and 15 was 2.3 per cent, and 90.5 per cent of the curves found were mild, meaning a Cobb angle (the degree of curvature measured on an X-ray) of 10 to 19 degrees. Scoliosis is less rare than families assume and less severe than they fear. The number of degrees on a report does not settle anything by itself, because how much growing a child has left weighs at least as heavily. That is why regular review through the adolescent years does more work than the diagnosis itself.

What adolescent idiopathic scoliosis is

Scoliosis does not mean only that the spine bends sideways. The spine also turns around its own axis, which is why the curve is described as a three-dimensional change in shape. The form seen in adolescence is called adolescent idiopathic scoliosis, and it typically appears once the growth spurt has begun.

A diagnosis rests on a Cobb angle of 10 degrees or more, measured on a standing X-ray of the whole spine, together with rotation around the axis of the spine that can be recognised. The 2016 SOSORT guideline draws a firm line here and states that a diagnosis of scoliosis should not be made below 10 degrees. A child whose film measures 6 or 8 degrees, given a brace on that basis, has not been managed in line with the guideline. That picture is called scoliotic posture, or postural asymmetry. It is a separate matter from structural scoliosis, and it largely disappears when the child lies on their back. The distinction, and what each of the words in a report means, is set out on the what is scoliosis page.

The word itself causes trouble. Idiopathic means that the cause is not known. It does not mean that the physician looked too briefly or that a test was skipped. On present knowledge a number of factors act together behind idiopathic scoliosis, and a genetic predisposition is the closest available explanation. No single gene and no single habit accounts for it. An unknown cause does not leave a family with nothing to do either, since watching for progression and stepping in when it happens are both possible without knowing the cause.

Why the growth period is decisive

What matters in scoliosis is that a curve can grow while the child is still growing. For the period when height velocity peaks, at around a bone age of 13 in girls, the 2016 SOSORT guideline gives the risk of progression according to the size of the curve: 10 per cent for a curve of 10 degrees, 30 per cent for one of 20 degrees, and 60 per cent for one of 30 degrees. Bone age is read from an X-ray and does not necessarily match a child's age in years. In the same child, once the last stage of puberty is reached, that risk falls markedly.

Those figures change the arithmetic a parent is doing. The distance between 12 degrees in one child and 28 degrees in another cannot be read as a gap of sixteen points on a scale, because the probability of progression is of a different order in the two cases. It is also why a physician who measures the same angle in two children can give them different review dates.

The second issue runs over a much longer horizon. The guideline states that curves reaching skeletal maturity above 30 degrees carry an increased risk of progression in adulthood, and that above 50 degrees there is a consensus that progression in adulthood is almost certain. Monitoring and intervening through the growing years aims at one thing: reaching skeletal maturity at the lowest degree possible, because the number measured on that day shapes much of what follows over the next decades. Nobody is trying to restore a shape the child once had.

The heaviest question about adult life is usually left unasked in the consulting room. In the study that followed patients with untreated idiopathic scoliosis for fifty years, chronic back pain was reported by 61 per cent of the patients and 35 per cent of the comparison group, although most of that pain stayed mild to moderate. Survival in the same study was consistent with the expected level. Scoliosis did not shorten life, and that is worth saying whether or not anyone asks.

What Turkey's own data show

Turkey has its own epidemiological study, and it speaks directly to the situation of a family living here. Yılmaz and colleagues screened 16,045 students between the ages of 10 and 15, in 85 schools across 40 provinces. Children were examined with the Adams forward-bend test and with a scoliometer, a small instrument laid across the back to read the angle of trunk rotation. Children whose examination raised a suspicion were sent the same day to a mobile X-ray unit parked in the school yard, and the diagnosis was confirmed by measuring the Cobb angle. The referral threshold used in that study was a trunk rotation angle of 5 degrees or more.

The overall prevalence was 2.3 per cent: 3.1 per cent among the girls and 1.5 per cent among the boys. Of the 369 adolescents found to have scoliosis, 256 (69.3 per cent) had a single curve and 108 (29.3 per cent) had a double curve. The number a parent should keep hold of, though, is the distribution by severity: 90.5 per cent of the cases detected fell into the mild category, with a Cobb angle between 10 and 19 degrees.

These figures matter more than an international average because they were collected here, in this age group, and with a referral threshold that is in use in Turkey. A scoliometer reading of 5 degrees is one of the thresholds screening programmes work with, and it is the one the Turkish study set for sending a child on to an X-ray.

The two halves of the result only make sense together. A prevalence of 2.3 per cent means that one or two children in an average class can be expected to have a curve, which disposes of the assumption that it will not happen in this family. The 90.5 per cent figure sits on the other side of the scale: a diagnosis of scoliosis does not mean that a child is heading for an operation. A parent can only find the balance between panic and neglect if both are said at once.

There is no national screening programme in Turkey

The national screening programmes published by the General Directorate of Public Health, part of the Ministry of Health, cover newborn screening, hearing screening, vision screening, developmental hip dysplasia, premarital carrier screening for spinal muscular atrophy and a haemoglobinopathy control programme. Scoliosis screening is not on that list.

Where scoliosis screening happens in Turkey, it happens through protocols signed at province level between the provincial health directorate and the provincial directorate of national education, rather than as a national programme. The programme run by the Samsun provincial health directorate for grades five to eight is a concrete example: the examinations were carried out by physiotherapists, and children in whom scoliosis was suspected were referred to a physical medicine and rehabilitation hospital. In a province with no such protocol, a school-age child is not looked at systematically for scoliosis at all.

For an international family this has a consequence worth spelling out, because school health here does not work the way it may in the country you moved from. Whether anything reaches you from the school depends entirely on whether your province has a protocol in place that year. Where there is none, no one will tell you that your child's back was never looked at, and nothing will arrive to say so. The expectation that a school would have caught it is not a reliable basis, and between the ages of roughly 10 and 14 a family's own observation is the only early warning for most children.

There is a contested side to this as well. In 2018 the US Preventive Services Task Force concluded that the current evidence is insufficient to weigh the benefits and harms of screening adolescents aged 10 to 18 for scoliosis. That statement does not mean that screening is harmful or that scoliosis is unimportant. It says that the studies which would compare screened and unscreened groups over the long term have not been done. Evidence in that state is part of why so much falls to a family's own observation.

What determines the risk of progression

Whether a child's curve will progress cannot be guessed from a single measurement. A physician reaches a judgement by setting several pieces of information side by side, and none of them decides the matter alone.

• How much growth is left. This sits at the centre of the assessment. The X-ray also shows the Risser sign: how far the growth cartilage at the upper rim of the pelvis has turned to bone. Risser 0 means ossification has not yet begun and growth potential is high; Risser 5 means growth is complete. Roughly speaking, Risser 0 to 2 is the period in which growth continues and the risk of progression is high. The sign has a known weakness: Risser 0 covers a very wide span of time, and because the North American and French systems use different definitions, the same child can be given a different stage under each.
• Bone age at the wrist, or Sanders staging. This is an eight-stage measure of maturity calculated from an X-ray of the hand and wrist. Stage 3 coincides with the peak of the pubertal growth spurt, the moment of highest risk, and stage 8 indicates full skeletal maturity. Because Sanders staging needs an additional X-ray, it is not used routinely in every centre, and whether to use it is the physician's decision.
• The date of the first period in girls. Menarche is a clinical marker that the peak of the growth spurt has passed, and the height gain remaining after it falls markedly. It is always asked about in the history and interpreted together with the Risser sign and, where it has been done, Sanders staging. Putting a figure in centimetres on what remains after menarche would be wrong, because it varies from child to child.
• The Cobb angle at diagnosis. The 10, 30 and 60 per cent figures given above are about this: at the same stage of growth, a larger curve carries a higher probability of progression.
• Sex. In the Turkish data the prevalence was 3.1 per cent in girls and 1.5 per cent in boys. In girls, physicians watch a little more closely before and during the growth spurt.
• The site and pattern of the curve. Whether there is one curve or two, where the apex sits and how much trunk rotation there is all enter the assessment. The SOSORT guideline counts a trunk rotation angle above 10 degrees among the prognostic indicators.

Risk is reassessed as a child grows. Every one of these variables shifts with time, and the physician rebuilds the picture at each review.

What to look for at home

The main reason scoliosis is noticed late is that it does not hurt. In a study of 2,442 children with idiopathic scoliosis, 23 per cent had back pain at their first presentation and a further 9 per cent developed pain during follow-up. In the great majority of children, then, a curve progresses quietly. Because there is no pain, families tend to notice in a moment when they happen to see the child's bare back: in the bathroom, at the sea, or while a t-shirt is being changed. Knowing what a short look from behind consists of is useful for exactly that reason.

With the child standing comfortably, upper body uncovered and feet together, these are the things looked at from behind: whether the two shoulders sit level, whether one shoulder blade stands out more than the other, whether the space between the waist and the arm is the same on both sides when the arms hang loose, whether one hip sits higher, and whether the waistband of trousers or a skirt twists towards one side. The child then bends forward without bending the knees, arms hanging free, and one side of the back looking raised compared with the other may be a sign of rotation.

This look does not make a diagnosis and is not expected to. Its purpose is to let you notice when it is time to see a physician. Causes other than scoliosis, such as a difference in leg length or a standing habit, can produce a similar appearance, and the person who tells them apart is the physician. The spotting the signs at home page goes through the check step by step and lists the non-scoliotic causes that imitate it.

If a child does have marked back pain, that pain should not be waved away as the pain of the scoliosis. In the same study, 48 of the 560 patients with pain (9 per cent) were found to have another condition underneath it. Pain that wakes a child at night, numbness or weakness in the legs, a change in the way the child walks, and fever are all reasons to see a physician without waiting.

When to go, and to whom

The route through the health system here varies between provinces and between institutions, and a reader who did not grow up with it has no reason to know how it runs. Families usually start at a family health centre (aile sağlığı merkezi) with the family physician they are registered with, or with a paediatrician. From there, depending on how the hospital is organised, a referral may be made to physical medicine and rehabilitation (fiziksel tıp ve rehabilitasyon), to orthopaedics and traumatology (ortopedi ve travmatoloji) or to paediatric orthopaedics. In the screening protocols run at province level, in the Samsun programme for instance, children in whom scoliosis was suspected were referred to a physical medicine and rehabilitation hospital. Imaging follows only if the physician asks for it, and the diagnosis is made by measuring the Cobb angle on a standing front-to-back X-ray of the whole spine. State and university hospitals are booked through the national appointment system and private clinics directly with the clinic. The two routes differ in how long you wait, and which one suits a family is not something this page can decide for you. For a family living in or around Bornova, the choice usually comes down to what appointments are available and where the family physician points.

During the examination the angle of trunk rotation is measured with the scoliometer, that simple instrument again. There is a detail here worth knowing in advance: small asymmetry is normal. In Bunnell's screening study of 1,000 high school students, 80 per cent of the students had a trunk rotation angle of 3 degrees or more. The same study proposed 7 degrees as a referral criterion and reported that this threshold produced a referral rate of 3 per cent, against 12 per cent at a threshold of 5 degrees. Lowering the threshold catches more cases but sends more healthy children for an unnecessary X-ray, so the two effects pull against each other. Turkey's own screening study used 5 degrees.

The literature reports the reliability of the Adams test and the scoliometer across a very wide range, and the values shift with the threshold chosen, the age of the group screened and the training of the person taking the measurement. No screening method stands in for an X-ray. What it does is record a suspicion and carry it to a physician.

The follow-up calendar and repeat X-rays

Once a diagnosis is made, the process is tied to a calendar. The 2016 SOSORT guideline does not reduce the review interval to a single number. Instead it uses a decision table that weighs the stage of growth together with the severity of the curve, and in that table the intervals run from 3 months to 36 months. A child who is growing fast and has a larger curve is seen more often than one whose growth is nearly finished and whose curve is small.

Unease about repeated X-rays is not unreasonable. The decision to image belongs to the physician, and an X-ray is not needed at every review. Interim reviews can be done without one, using the scoliometer, an assessment of trunk symmetry and a record of height. The relationship between the trunk rotation angle the scoliometer reads and the Cobb angle is approximate. The scoliometer follows change, while the degree of a curve comes from the X-ray, and so does the evidence that a curve has genuinely progressed.

Parents often ask when a difference between two films counts as real. In this field 5 degrees is the threshold widely used both for measurement variability and for clinical significance. Small differences between two X-rays can sit inside the margin of the measurement itself, and whether a curve has actually progressed is judged by a physician weighing the size of the difference against the child's stage of growth. The wording of a report, the Risser stage written on it and the intervals between reviews are set out in more detail on the diagnosis and follow-up page.

Cobb angle thresholds and what each one opens up

The table below is for a parent holding an X-ray report and trying to attach a meaning to the number on it. A threshold only tells you which conversation you are about to have with the physician.

The SOSORT guideline also defines the goals of care according to the severity of the curve. In a low-magnitude curve the primary goal is to stay below 20 degrees and the secondary goal below 45. In a moderate curve the primary goal is to stay below 30 degrees, with the same secondary goal of 45. In a severe curve the primary goal is to stay below 45 degrees and the secondary goal is to delay surgery.

The numbers in the table produce no decision on their own. The guideline's own decision scheme uses the stage of growth and the severity of the curve together, and the same 28 degrees carries quite different meanings in a child at Risser 0 and a child at Risser 4. Whoever sees the film and the child in the same room is the one who can weigh those things against each other.

The steps: observation, exercise, bracing, surgery

The SOSORT guideline sets out the options as a sequence of steps: observation, scoliosis-specific physiotherapy exercises, a night-time brace, a part-time brace, a full-time brace, casting and surgery. Not every child starts at the beginning of that sequence, and not every child travels to the end of it. Which step is opened is determined by the stage of growth and the state of the curve.

When a brace comes up, the first question asked is how many hours a day it will be worn. The guideline separates braces by daily wearing time: a night-time brace is worn 8 to 12 hours a day, a part-time brace 12 to 20 hours, and a full-time brace 20 to 24 hours. In progressive idiopathic scoliosis during growth, a brace comes into the discussion above 25 degrees, and in that situation scoliosis-specific exercise on its own is not regarded as appropriate unless a physician experienced in scoliosis specifically recommends it.

The evidence behind the question of whether a brace does anything is the BrAIST trial. It enrolled patients aged 10 to 15 who had not reached skeletal maturity (Risser 0, 1 or 2) and whose largest curve measured between 20 and 40 degrees. Children in the brace arm were told to wear it for at least 18 hours a day, and failure was defined as progression of the curve to 50 degrees or more. When every child was counted in the group they had originally been assigned to, whether or not they kept to the plan (an intention-to-treat analysis), success was 75 per cent in the brace arm and 42 per cent in the observation arm. On average, three children needed to be braced to prevent one from going on to surgery. The data and safety monitoring board stopped the trial early because the benefit was clear.

The part of that trial most useful to a parent is its sub-analysis. Daily wearing time was measured objectively with a heat sensor. Among children who wore the brace for an average of 0 to 6 hours a day, the success rate was 41 per cent, which is close to the rate in the observation group, whose children wore no brace at all. Among those who wore it 12.9 hours a day or more, the success rate rose to between 90 and 93 per cent. What is decisive about a brace is the number of hours the child has it on. A brace worn for less than 6 hours a day produces the same result as not wearing one.

Stopping a brace is not tied to a single criterion either. In a consensus study among international experts, indicators of skeletal maturity, change in height, and the size and course of the curve are used together, and stopping is recommended gradually rather than all at once. How a brace is carried at school, in summer and during sleep is a subject of its own, and the bracing and exercise page takes it on.

A parent looking at the last step on that list usually wants to know something else entirely: how much of a curve an operation changes, whether the rods and screws stay in the back for life, what the risk of nerve injury or infection is, how long the scar is, whether a child can bend and play sport afterwards, and how long recovery takes. Those questions are named here rather than glossed over, because this page cannot answer them. What an operation changes, and at what cost, depends on the individual spine, the technique used and the surgeon's own results, and none of that can be settled in general terms on a physiotherapy page. They belong to the spine surgeon, and the surgery decision page gathers them into a list to take into that appointment.

Where physiotherapy fits and where it stops

Scoliosis-specific physiotherapy exercises, shortened to PSSE in the guideline, differ from general exercise and from sport. According to the SOSORT consensus they rest on four principles: active self-correction, in which the child works on straightening their own spine in three dimensions, training in activities of daily living, stabilisation of the corrected posture, and patient education. The Schroth method is the most widely known school of practice under that definition. Session frequency can vary from 2 to 7 days a week depending on the complexity of the technique and the child's motivation, and long-term programmes typically run 2 to 4 times a week.

Reading the evidence on exercise means separating individual trials from the sum of them. In a randomised controlled trial with the assessor and the statistician blinded, 50 adolescents were followed for six months. The largest curve decreased by 1.2 degrees in the Schroth group and increased by 2.3 degrees in the control group, giving a between-group difference of 3.5 degrees in favour of Schroth. Using a threshold of 5 degrees of change, 88 per cent of the children in the Schroth group improved or stayed stable, against 60 per cent in the control group. A later analysis by the same team calculated that around four children would need to be treated with a six-month Schroth programme added to standard care for one of them to gain an additional benefit. The confidence interval around that estimate is very wide, meaning the uncertainty about where the true value lies is high, and the authors wrote so themselves.

The finding of a randomised trial from Turkey speaks directly to a parent's situation. Forty-five adolescents were divided into three groups: the first did Schroth exercises in a clinic under the supervision of a physiotherapist, the second did the same exercises as a home programme, and the third was followed without any intervention. A significant improvement in the Cobb angle appeared only in the supervised clinic group, at 2.53 degrees. Changes in waist asymmetry and in the rib hump also appeared only in that group. In the control group the scoliosis progressed. No significant difference was found between the groups in quality of life. The scale of the trial was small: about fifteen children per group, a single centre and twenty-four weeks of follow-up, with limited blinding. The finding has to be read with those limits attached.

Another randomised trial, in mild curves, sets the comparison up differently. The question there is whether a scoliosis-specific programme gives a different result from conventional spinal exercise. Active self-correction and task-oriented exercises came out ahead of conventional exercise in that comparison. Knowing that the control group was not a group doing nothing makes it possible to separate how much of the finding belongs to exercise and how much to the specific form the exercise took.

Put all of these trials together and the picture becomes more cautious. The 2024 Cochrane review examined 13 randomised trials and 583 participants and concluded that the benefits of therapeutic exercise in idiopathic scoliosis are uncertain. The authors described the evidence consistently as very uncertain and of low certainty, and they emphasised that every one of the trials included small numbers of participants. The same review stated that adding exercise to a brace may reduce progression in children who are wearing one.

A 2025 meta-analysis focused on Schroth exercises pooled 11 randomised trials and 446 participants, and across those trials the Cobb angle fell on average by about 3.2 degrees. The authors wrote plainly that this change does not reach the 5-degree threshold accepted as clinically meaningful. In the same analysis the change in trunk rotation angle was not statistically significant, while the improvement in quality of life was. Another meta-analysis marks the boundary more sharply still: the effect of PSSE on the Cobb angle was not significant compared with controls in patients whose curve measured 30 degrees or more.

Taken as a whole, the evidence says this. Scoliosis-specific exercises may contribute to slowing the progression of a curve, to trunk symmetry and to quality of life. There is no evidence that they remove a structural scoliosis. In a child for whom a brace is indicated, exercise does not take the brace's place. Exercise does most where curves are mild, and its effect diminishes as a curve grows.

The boundary of physiotherapy is clear as well. Diagnosis belongs to the physician. A physiotherapist does not diagnose, does not request X-rays, does not prescribe a brace and does not alter the decision a physician has made. Within the frame the physician has set, the physiotherapist introduces the child to their own curve, teaches the correction work, supports adherence where a brace is in use, and renews the programme as growth continues. Once a curve has reached the surgical threshold, the person to see is a spine surgeon. The detail of the method is on the Schroth method page, and what actually happens in a session is described on what happens in a session.

The family told to keep an eye on it

The angle measured is well below the surgical threshold, the physician says, “Let us keep an eye on it and see you in six months,” and the family goes home with nothing in their hands to do. The evening of searching online usually starts right at that point. Yet the period of observation is not an empty stretch of time, and there are concrete things a family can do in it.

• Put the review date in a calendar and set a reminder. Do not wait to be telephoned about the appointment. When a review interval is missed, what is lost is time.
• Keep the X-rays and reports together in one folder. Each report should carry the date, the Cobb angle measured, the site of the curve and the Risser stage. How those same numbers move over time tells you more than any single film.
• Measure and record the child's height every three months, at the same time of day and in the same way: shoes off, heels against the wall, first thing in the morning. A period of rapid growth is a window of risk, and the family is the first to see it at home.
• In girls, note the date of the first period and tell the physician at the review. It is one of the pieces of information used in estimating remaining growth.
• Repeat the forward-bend look every three months. Its purpose is to notice a marked change.
• Talk to the physician about having the siblings assessed once.
• Ask the physician who is following your child, in as many words, whether scoliosis-specific exercise is appropriate. The answer may be that it is not needed, and that is an answer too.
• Do not let your child give up sport. That is precisely the subject of the section below, where the evidence for it is set out.

What a family does not do matters just as much. Exercise carried out without measurement, and without a programme built for the individual, cannot be assumed to give the same result as supervised work. In the trial from Turkey described above, even a programme taught by a physiotherapist and taken home did not reach the result of the supervised clinic sessions. There is no basis for expecting a general video found online to do better than that. Brace hours are not reduced by family decision, because the dose-response data from BrAIST show that this particular decision changes the outcome directly.

School, sport and how the adolescent feels

The belief that a child diagnosed with scoliosis has to give up sport is widespread, and the evidence says the opposite. In a study following 785 patients with juvenile and adolescent idiopathic scoliosis who were wearing a full-time brace, those doing sport twice a week or more were found to have higher odds of improvement over 18 months than those doing it once a week or less. This was a cohort study rather than a randomised trial, and the possibility that children who play sport differ in other ways cannot be set aside. Even so, the direction of the finding makes the advice that a braced child cannot play sport indefensible.

Swimming produces the opposite of what most people expect. In a study comparing competitive young swimmers with students of the same age, swimming was found to raise the risk of trunk asymmetry. This is not a reason to keep your child out of the water. The study looked at high-volume competitive swimmers, and a child who swims twice a week for pleasure is not in that group. Swimming is good exercise for general health; presenting it as a treatment for scoliosis, or putting it in the place of scoliosis-specific exercise, has no support behind it. The advice that a child with a curve should take up swimming has no scientific basis.

Heavy school bags and poor sitting are asked about constantly. The cause of idiopathic scoliosis is not a bag, and lightening one will not change a curve. A heavy, badly worn bag can still add to the discomfort of a child who already has a curve, so lightening it is a reasonable thing to do. Nor is there evidence that posture causes scoliosis. Those two facts lift a guilt that parents carry often: this picture is not the result of anyone's neglect.

Exemption from physical education is not the rule, and whether it is needed is decided by a physician. Separating a child from their peers in an effort to protect them usually costs more than the protection is worth.

What the adolescent is living through belongs in this picture too. For a child between twelve and sixteen, body image is a tender subject, and adherence to exercise depends directly on motivation. When the situation is explained to a child, it helps not to build an identity around illness, to bring the child into the decisions, and to keep goals short-term. The basic thing a child needs to hear is this: it is not their fault, it did not happen because they sat badly, and they do not have to give up sport. School life and the daily routine are covered on the school, sport and daily life page, and the other headings families ask about are gathered on parents' questions.

Questions to take to the physician

Going to a review prepared changes what you come away with. The questions below are kept short and can all be asked in a single appointment.

1. How many degrees is the Cobb angle, and in which region of the spine? Can that be written into the report?
2. What is the Risser stage? How much growth do you think is left?
3. With this angle and at this stage of growth, how is the risk of progression being assessed?
4. When is the next review, and will an X-ray be taken at it?
5. On what basis do you decide to repeat an X-ray, and can interim reviews be done without one?
6. Are scoliosis-specific physiotherapy exercises appropriate for this child, and if so, how often?
7. Is a brace on the agenda now? If not, which finding would put it there?
8. Is there any reason not to continue with sport, and is there a movement you need to restrict?
9. Would you recommend that the siblings be assessed as well?
10. Which signs mean we should come to you without waiting for the review date?

At the practice in Bornova, Evka 3, in Erzene Mahallesi, a scoliosis assessment for a child or adolescent is carried out in a one-to-one appointment of 60 minutes. A short introductory call can be held beforehand, in which the reports the family already has are looked over and the way the process will run is explained. Consultations can be held in English. The assessment itself takes in postural analysis, a scoliometer measurement, breathing and movement patterns and the X-ray reports the family brings, and the programme is planned in step with the physician's follow-up. The practice is in the same neighbourhood as the Evka 3 metro station, which is the eastern terminus of the M1 line. How the area works and the local questions families ask are covered on the Bornova and Evka 3 page, and the diagnostic process step by step is on diagnosis and follow-up.