Bowlegs In Children: The Symptoms And The Causes


It is common for a toddler to already start showing signs of legs that are bowed when the child is still very young. A child that has bowed legs usually has a gap that is distinctive between their lower legs and knees when they are standing with the feet together. Bowed legs will either effect one of or both the legs and a pediatrician or the parents will probably see that the legs of the child are starting to curve outwards in the initial years of the child’s life. 

The Causes Of Bowed Legs In A Child 

Many young children that start to exhibit bowed-legs when they are babies have what is known as physiological genu-varum. In many cases, this problem will correct itself eventually, and usually does not affect the mobility of the child or result in complications that are long-term.

A child that displays significant bowing might be examined for Blount’s disease, which is the condition which results in abnormalities in the tibia growth plate, or in the upper shinbone. For children that are under the age of 2, physicians might at this stage fail to distinguish physiologic genu-varum from bowing. Yet if by the age of three the bowing is not resolved, most doctors will conduct X-rays to find out if the patient has Blount’s disease. 

Rickets may also be the cause for bow-legs in a child. This is a type of bone disease that can cause other types of deformities in the bones. This condition is uncommon when it comes to developed countries as this condition is the direct result of a lack in calcium, phosphorous and vitamin D in the diet of the child. A child with bowed legs is likely deficient in vitamin D and supplements and lifestyle change can help solve this.

Symptoms Linked With Bowed Legs In Children 

Symptoms linked to bowed legs will be at its most obvious when a child stands or walks. A common symptom for this condition is an uncoordinated and awkward walking pattern. Another common symptom in toddlers that have bowed legs is known as turning in or in-toeing in the feet. Children that have bowed feet will usually not be delayed when it comes to meeting up to developmental milestones, yet the bowing may appear to be somewhat alarming. 

While bowed legs will not usually result in pain, bowing that is prolonged into the adolescent years can result in discomfort in the hips or ankle or knee pain caused from consistent stress to these joints. A child that has bowed legs might lose balance or trip more frequently. 

Treatment Options

There are a number of treatment options currently available for a child with bowing that includes both non-surgical and surgical options. The toddlers that have physiological genu-varum will not need active treatment, yet a pediatrician will monitor the child until such stage that the condition resolves. In rare cases, bowing may not resolve completely and the parents might have an aesthetic concern. When it comes to these cases, a doctor may recommend surgery to correct the bowed legs which were unable to resolve in the earlier years of childhood.

Immunization coverage

Immunization coverage

Stark inequalities in access to vaccination exist within and between countries, with children living in disadvantaged circumstances having considerably lower uptake. The reasons for these inequalities are complex but ultimately they reduce population immunization coverage, prevent achievement of herd immunity, and increase the chance of continuing or re-emerging epidemics of infectious disease. Another major threat to immunization coverage is an unfounded lack of professional and parental confidence in the safety and effectiveness of immunization.

In industrialized countriesthis usually reflects exaggerated or erroneous fears of adverse reactions, often following media scares. In developing countries this can reflect false beliefs about infectious disease and immunization. Problems in maintaining an adequate supply of vaccine and new developments leading to frequent changes to immunization schedules also impede high coverage.
Developing and delivering an effective vaccination policy is challenging for any country. Issues to consider include having comprehensive documented policies/guidelines, clear lines of responsibility, ensuring an adequate and safe vaccine supply chain, ensuring professionals.

delivering vaccination are adequately trained and supported, and fostering confidence in and engagement with the immunization program.

Immunization coverage

Many of these issues have been clearly set out by the World Health organization in Immunization in Practice: A Practical Resource Guide for Health Workers.
Interventions to increase vaccination coverage can be patient,
provider, or system orientated. Examples of interventions of proven effectiveness include:
* robust patient call–recall and reminder systems;
* provider prompt systems (for example computer ‘pop-ups’ that flag when a child attending any health care setting is overdue vaccinations);
* multifaceted education programs for professionals and parents;
* generally increasing the accessibility of immunization (including providing accessible immunization clinics and making immunization available in other settings such as hospital outpatients and Accident and Emergency departments);
* ensuring vaccination providers receive regular assessment of and feedback on their performance relative to vaccination targets;
* integrating immunization into general mother and child health programs;
* ensuring parents and providers do not incur costs associated with vaccination.

Making complete vaccination a requirement for children to enter childcare or school is effective in increasing coverage and is used in some countries. This approach has not been adopted in the UK due to the potentially damaging consequences of overriding parental choice. Ensuring the availability of high-quality information on the target population population that would benefit from vaccination is also important in developing effective recall systems and monitoring performance. Achieving and maintaining high vaccination coverage is an important effective measure to reduce health inequalities.

Source: Forfar and Arneil’s Textbook of Pediatrics, 7E

Prevention in neonatal period

Prevention in neonatal period

Good intrapartum obstetric care and subsequent effective monitoring, investigation and treatment of the many disorders from which the newborn infant may suffer are important preventive measures. Such disorders include asphyxia, birth injury, low birth weight and hyperbilirubinemia. Neonatal screening procedures are discussed in the section
on Child health surveillance and screening.

The promotion of breast-feeding is a crucial preventive measure. Breast-feeding reduces the risk of necrotizing enterocolitis, diarrheal disease, lower respiratory infections, otitis media, and other serious neonatal infections. It also appears to reduce the risk of childhood obesity, probably through better development of appetite control. Recent evidence has further linked lack of breast-feeding with poorer intellectual development, possibly due to the lack of certain long chain fatty acids, essential for normal brain development, in most breast milk substitutes, although it is difficult to totally exclude the possibility of confounding from these studies.

Frequent breast-feeds given over a prolonged period also significantly reduce fertility and increase the birth interval, with indirect benefits to both mother and infant. WHO and UNICEF are coordinating a global initiative (the Baby Friendly Hospital Initiative) to promote breast-feeding and to improve health service support for breast-feeding mothers. Hospital routines and practices can discourage women from breast-feeding or make it difficult for them to do so successfully hence good practice guidelines have been developed for maternity hospitals. Key features of good practice include ‘rooming in’, i.e. allowing mother and babies to remain together, supporting skin-to-skin contact and the first breast-feed soon after birth, encouraging subsequent feeding on demand, and education of staff and mothers to promote good positioning and attachment of the baby.

Improving hospital practices and staff skills in line with these guidelines has been shown to improve breast-feeding rates across all ethnic and socio-economic groups. Policy statements on breast-feeding by pediatric associations have been used to raise awareness amongst pediatric staff of the need to promote breast-feeding, to promote good practice and to advocate for inclusion of breast-feeding topics in the undergraduate medical and nursing curricula and in postgraduate courses for pediatricians, obstetricians, general practitioners, midwives and maternal and child health nurses.

Prevention in neonatal period

Vitamin K should be given to all babies at birth to prevent the rare but serious disorder hemorrhagic disease of the newborn (HDN). Vitamin K administered either as one intramuscular injection shortly after birth or as multiple oral doses (with more doses required for breast-fed babies) over the first few weeks of life is effective at preventing early, classic, and late HDN. As compliance is higher and costs are lower with the IM route, that is the regimen that is usually preferred. This was questioned following the publication of one case–control study in 1992 that reported an association between administration of vitamin K via the intramuscular route to neonates and the subsequent development of childhood leukemia. Later studies and systematic reviews have failed to replicate this finding however, and the consensus view is now that IM vitamin K does not increase the risk of cancer. Current advice from the Department of Health for England states that all babies should be offered vitamin K but does not state which regimen should be followed.
The risks of HIV transmission are now better understood, leading to guidelines for the management of HIV-positive mothers to reduce vertical transmission of infection. Key interventions include universal antenatal screening of mothers for HIV infection, antiretroviral therapy for those found to be infected along with elective Cesarian section delivery and avoidance of breast-feeding in areas where it is safe to do so.

Source: Forfar and Arneil’s Textbook of Pediatrics, 7E

Chorionic Villus Sampling

Chorionic Villus Sampling

What is chorionic villus sampling?

Chorionic villus sampling (CVS) is a prenatal test that diagnoses chromosomal abnormalities such as Down syndrome, as well as a host of other genetic disorders. The doctor takes cells from tiny fingerlike projections on your placenta called the chorionic villi and sends them to a lab for genetic analysis.

CVS and another test called amniocentesis produce a karyotype – a picture of your baby’s chromosomes – so that your caregiver can see for sure if there are any problems.

Women who choose to have CVS or amniocentesis are often those at increased risk for genetic and chromosomal problems, in part because these tests are invasive and carry a small risk of miscarriage.

The main advantage of CVS over amniocentesis is that you can have it done earlier — generally between 10 and 13 weeks of pregnancy. For an amnio, you’ll have to wait until you’re at least 16 weeks pregnant.

What kind of problems does CVS diagnose?

Like amniocentesis, CVS can identify:

  • Nearly all chromosomal abnormalities, including Down syndrome, trisomy 13, trisomy 18, and sex chromosome abnormalities (such as Turner syndrome). The test can diagnose these conditions, but it can’t measure their severity.
  • Several hundred genetic disorders, such as cystic fibrosis, sickle cell disease, and Tay-Sachs disease. The test is not used to look for all of them, but if your baby is at increased risk for one or more of these disorders, CVS can usually tell you whether he has the disease.

Chorionic Villus Sampling

Unlike amniocentesis, CVS cannot detect neural tube defects, such as spina bifida. If you opt for CVS, you’ll be offered a blood screening test in your second trimester to determine whether you’re at increased risk for neural tube defects. Most neural tube defects can be detected by a detailed second-trimester ultrasound done at a state-of-the-art academic center.

Be aware that if you have CVS, there’s a 1 to 2 percent chance of getting an unclear result. This is called a confined placental mosaicism, in which some of the cell lines cultured from the placenta contain abnormal chromosomes and some are normal. If your CVS detects a mosaicism, you’ll have to have amniocentesis and possibly other testing to determine whether your baby is affected.

Is there any way to reduce the risks of CVS?

Ask your practitioner or genetic counselor to refer you to an experienced doctor who does a lot of CVS procedures and who is expert at both the transabdominal and transcervical procedures, so your doctor can choose the procedure that’s safest for you. You may also want to ask about the estimated rate of procedure-related miscarriage for the doctor or the center where you’re considering having the procedure done.

You’ll also want to make sure that an experienced registered diagnostic medical sonographer provides continuous ultrasound guidance during the procedure. This greatly increases the chances that the doctor will be able to obtain enough tissue on the first try, so you won’t have to repeat the procedure.

Fetal Surgery

Fetal Surgery

Of the approximately 4 million babies born in the United States each year, about 120,000 (3 percent) have a complex birth defect. Maternal-fetal specialists have long known that some birth defects could be successfully treated after birth. But as technology, fetal imaging and prenatal testing have improved in the past few decades, so too has our knowledge of fetal development.

Expanded diagnostic tools have allowed us to identify more precisely when conditions worsen during fetal development. This knowledge has helped us develop new ways to help babies sooner while in utero. Today, fetal therapy is recognized as one of the most promising fields in pediatric medicine, and prenatal surgery is becoming an option for a growing number of babies with birth defects.

Fetal Surgery

Treating birth defects before birth

Fetal surgery allows us to intervene earlier. Using highly sophisticated surgical procedures, we are now able to treat certain disabling and life-threatening birth defects during fetal development instead of after birth, and to offer new hope to families.

Fetal surgery is a complex and challenging procedure, requiring the most expert, comprehensive care for both mother and unborn baby. Few medical teams have the skill and resources to perform such complex procedures, which can present significant risks for both mother and baby.

The Center for Fetal Diagnosis and Treatment at Children’s Hospital of Philadelphia has been providing this care to patients since 1995, experience that helps us to deliver the best outcomes while minimizing the risks to both you and your baby. Be sure to ask these questions before you allow a clinical program to perform fetal surgery.