It is common for children to come to the hospital with congenital scoliosis or kyphosis, which often seriously affects the normal development of the spine, and in the late stages of the disease, it can also have a serious impact on the heart, lungs, spinal cord function, and the psychology of the child. In advanced stages, paraplegia and cardiopulmonary failure may result in death. Therefore, early detection and early treatment can effectively control the development of deformity and prevent the occurrence of late complications. Examination of the child should be after birth by the doctor or parents carefully touch the spine, often can be found spinal abnormalities, a few months after birth spinal deformity will be more obvious. There may be unequal shoulders, chest asymmetry, scoliosis, and pelvic tilt. The skin on the back of children with congenital spinal deformity may have tufts of hair, shallow concavities, shallow sinuses, and café-au-lait spots, as well as varying thicknesses of the calves, different sizes of the feet, and impaired movement of the toes. All these signs suggest the possibility of spinal or spinal cord developmental malformation, and need to go to a specialized hospital to confirm the diagnosis. There are many causes of pediatric spinal deformities. These malformations are caused by abnormalities in the development of the fetal spine during the embryonic period. They can be divided into two types: segmental defects and formation defects of the spine. Segmental defects are characterized by bony connections between vertebrae (congenital bone bridges). Unsegmented bone bridges result in scoliotic growth of the spine; bone bridges occurring in the vertebral bodies result in a kyphosis of the spine. The formation defect is an undeveloped portion of the vertebrae, with one side of the spine missing and the other side becoming half a vertebra. Congenital kyphosis is caused by asymmetrical growth of the vertebrae, meaning that the convex side grows faster than the concave side. There are many other causes of pediatric spinal deformities, such as idiopathic (or unexplained) scoliosis, neurofibromatosis, bone metabolism disorders, spinal cord cavernous disease, spastic and paralytic scoliosis, spinal cord tumors, and mesenchymal disorders, among others, which can result in the formation of scoliosis or kyphosis in the pediatric spine. The physician’s clinical examination should describe in the history: 1) when the deformity was first detected; 2) the progression of the deformity; and 3) the presence or absence of other comorbidities, such as hip, cardiopulmonary development, and so on. Physical examination should include: dorsal view of the pediatric spine for scoliosis or kyphosis, symmetry of both shoulders, level pelvis, symmetry of both lower extremities, etc. X-ray examination: take a front and side view film of the entire spine. Generally, a scoliosis of more than 10° is the diagnostic criterion. Further detailed examination includes CT, 3D imaging or MRI, except for the presence of longitudinal tears of the spinal cord, spinal cord malformations, spinal cord embolism, etc. Most congenital lateral kyphosis requires surgery, and only a small percentage can be treated conservatively with bracing. The method and timing of surgery are very important. Before surgery, the deformity needs to be categorized and diagnosed, and its development and prognosis need to be assessed. Over-treatment may affect or destroy the growth potential of the child’s spine and aggravate the spinal deformity of medical origin. If the treatment is too late, the deformity worsens, making surgical orthopedics difficult, with many surgical complications and often unsatisfactory outcomes. Therefore, it is important to choose the appropriate time for surgery in order to maintain the potential axial growth of the spine and to prevent the development of deformity. At the same time, if other deformities are found to be combined in the process of diagnosis and treatment, they should also be treated.