Age, body mass index, and modern technological influences predisposed to high prevalence of postural deviations such as forward head posture and thoracic hyperkyphosis, and rounded shoulders among school-aged children. The comprehensive integration of developmental and biomechanical perspectives on these adaptations is limited Upper-body postural adaptations reflect a complex interplay between developmental growth and biomechanical loading. Regular posture assessment in schools and clinical settings is crucial for early detection and culturally tailored prevention. Future longitudinal and cross-cultural studies are essential to establish normative postural values and clarify causal pathways across populations

This review aims to synthesize existing literature addressing age- and BMI-related upper-body postural adaptations and biomechanical loading interact to impact spinal and shoulder alignment, muscular strength, and postural control efficiency in school-aged children.

Methods: A structured narrative synthesis was conducted utilizing literature from PubMed, Scopus, and Google Scholar databases. Inclusion criteria focused on studies involving school-aged children (6-18 years) that investigated head, thoracic, and shoulder posture, as well as muscle strength in relation to age, BMI, and lifestyle factors.

Age-related maturation influences spinal curvature, cervical alignment, and scapular positioning through evolving neuromuscular control. Elevated BMI alters load mechanics and mass distribution, increasing thoracic kyphosis, forward head posture, and shoulder protraction while reducing relative neck and shoulder strength. Obesity-related intramuscular fat infiltration and sedentary life style further impair postural stability and muscle performance

Inclusion Criteria:

• school-aged children (6-18 years) has forward head posture, kyphosis and rounded shoulder

Exclusion Criteria:

• systemic disese scoliosis

School-aged children (6-18 years) has forward head posture, kyphosis and rounded shoulder