Bow legs in children

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Bowing of legs in children can cause a lot of anxiety for new parents. However, it is not always as bad as it appears. Here is why.

My daughter is five-and-a-half months old. Ever since her birth, she was an eager beaver. She always kicked much more vigorously than I had ever seen in any baby. She could turn over quite early, and at the age of five months, she wanted to stand all the time. This was of course with support. And this being our first baby, we were quite amused by her efforts, and let her do what she wanted. But, we noticed that her legs started bowing. I had seen bow legs in children before, and we were quite worried.

During the next visit to the paediatrician, we brought it up. The doctor was quite understanding and reassured us that this condition is quite common in babies. In fact, the most common cause of bow legs in children is the tight, limited space in the uterus where they develop. 

What Causes Bow Legs in Children?

Does this mum’s story seem familiar to you? Perhaps you too are worried about bow legs in children. That’s why we want to help ease your worries and tell you exactly what causes it, and what can be done about it. 

As babies develop in the womb, their legs are folded – or bowed – in the foetal position. When they are born, they still prefer to stay in the foetal position. And that is why they love swaddling (well, at least most of them do!).

In the initial few months of development, the bowing is not that noticeable as there is no weight bearing. The bones are developing, but they are quite different than the adult bones.

The adult bones get deposited with calcium – doctors call this process “ossification”. The bones of a growing child are not completely ossified. As a result, they are not that rigid as the adult bones.

Consequently, they can bend due to a constant pressure. The good news is, they can bend right back into shape!

So, as the baby starts standing, walking, and consequently running, they get bow legs. This is a physiological (read normal) phenomenon called genu varum. 

For the normal variant:

  • The bend is bilateral – equal in both knees.
  • One limb does not appear shorter than other.
  • It disappears after the age of three.

What Might Follow…

bow legs in children

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After the age of three, the bones of the legs start correcting, and the bowing, if any, disappears. However, it is often followed by knocking of knees, where the legs bend the other way round at the knees. 

It is commonly seen between the ages of three and five years. This is again physiological (read normal) and is attributed to growing up. Knock knees are called genu valgum in medical talk. This condition disappears by the age of eight. 

When Is Bowing of Legs Not Normal?

While in most cases, bowing of knees in children is physiological, there are instances where it is due to some underlying condition. The most common pathological conditions causing bow legs in children are Rickets and Blount’s disease. 

Blount’s Disease

This is caused due to an abnormality in the growth plate in the bone of the shin (tibia). The cause is not known, but there might be some genetic causes to it. It is linked to childhood obesity and early walking. It can occur in one or both legs, and it might even be hereditary. 

Before the age of three, it is not possible to distinguish between the normal genu varum (bow legs in children) and Blount’s disease. So if the bowing is persistent after the age of three or four years, you should definitely be concerned. 

Rickets

Rickets is caused due to a deficiency of Vitamin D. We get our daily dose of vitamin D through sufficient exposure to sunlight. Vitamin D is essential in the calcium metabolism, and it helps the deposition of calcium in the bones and teeth. So you can imagine that the bones would bend under pressure if the calcium deposition is not optimal. 

There are various causes of rickets, and it is more common in exclusively breastfed babies. It is seen more commonly in children who are:

  • dark-skinned
  • have significantly less exposure to sunlight
  • may have a genetic condition affecting Vitamin D production
  • have coeliac disease that interferes with the vitamin D metabolism

There are other symptoms associated with Rickets as well, so if the bowing is due to it, it is most likely diagnosed well in time. 

When to Be Concerned

It is quite scary as a new parent to notice anything irregular with your baby. And bowing of legs can be quite alarming. To make sure that your baby does not have bow legs when he grows up, you should ensure that you don’t rush your child into early walking! In addition, ensure that:

  • He has an adequate intake of Vitamin D. So ensure outdoor time and a good diet.
  • Introduce nutritional supplements especially if you have an urban lifestyle.
  • Overweight children may continue to have problems with knees, so ensure he gets plenty of exercise.
  • Look out for the red flags (see below).

Your child does not need special footwear, braces, or correction if it is physiological bowing. 

The Red Flags

  • The bowing is quite severe and interferes with walking.
  • It persists after the age of three.
  • The child is limping or in pain.
  • Only one leg is affected.
  • The child appears very small for his age.

If you do not observe these red flags, your child is just growing up and the bowing is something he might just go through. If you are concerned though, don’t hesitate to visit your doctor. 

 

Reference: Children’s National Health System

Also read: From first steps to a budding athlete