Treating very young children with spinal deformities is challenging and complex, and it entails risks. The consequences of surgical treatment can be profound, with lifelong implications. The recent focus on "fusionless" surgery and spinal column lengthening strategies, such as growing rod instrumentation and the use of a Vertical Expandable Prosthetic Titanium Rib, illustrate the current understanding of the importance of spinal growth and lung development in infants and young children.