FAQ Category: Child

Bowlegs are common in toddlers and young children. A bowlegged condition is also known as tibia varum (singular) or tibia vara (plural).

The condition is considered physiologic when it’s a normal variation. In those cases, the child will grow out of it. Most toddlers have bowlegs from their position while in the uterus. This curvature stays until the muscles of the lower back and legs are strong enough to support them while standing up.

In some cases, abnormal growth of the bone causes the bowing to get worse instead of better over time. This condition is called Blount disease or pathologic tibia varum.

Blount disease becomes obvious between the ages of two and four as the bowing gets worse. Being overweight for height and body type is a major factor in Blount disease. An accurate measure of obesity is the body mass index (BMI). If your child has a BMI of 22 or higher, nutritional counseling is advised.

A second measure used to predict Blount disease is the tibial metaphyseal-diaphyseal angle (TMDA). This angle is viewed on X-rays of the lower leg. A TMDA of 10 degrees or more requires a second look.

Combining BMI with TMDA can help predict which children will need early treatment. Your doctor may have already taken these factors into consideration when advising you to take a wait-and-see approach. You may want to make a follow-up appointment to discuss your concerns.

Blount disease is a condition of bowlegs that’s more-than-normal. Obesity has been linked with this condition. It is thought that the extra load on growing bones makes the normal curvature of the lower legs even worse.

It does make sense to think that if obesity is the problem, it should cause similar changes on both sides. But scientists have discovered that the mechanical load contributing to these changes may not be the same from side to side.

The angle of the bones and degree of curvature already present are extra factors. Many children are not the same from side to side. A few develop greater bowing on one side compared to the other. With the added factor of obesity, the bone deformity increases.

Too much pressure on the inside edge of the tibia (lower leg) can cause the bone to stop growing. When only one side of the tibia stops growing, there are abnormal changes in bone alignment. The result can be this curvature or bowing of the bone on one side.

Ingrown toenails in infants don’t occur very often, but it is possible. Most of the time it is either present at birth or appears soon after. The affected toe(s) become red, swollen, and painful. Inflammation may be accompanied by infection causing pus and drainage.

Not much is really known about this problem in children. There are many theories about the cause(s). A sharply curved or short nailbed may cause inflammation and then pain in the nailfold. The nailfold is the corner of the nail where the skin and soft tissue meet the nailbed.

Malalignment of the nail may also be an anatomic variation leading to ingrown nails. Shape, size, and alignment of the nailbed may be inherited. A family history of ingrown toenails suggests a hereditary factor.

Toe sucking and lying on the stomach may be contributing factors. Position in the uterus (mother’s womb) (especially with twins) could be a possible cause. And it’s likely that more than one factor present leads to eventual symptoms requiring treatment.

Ingrown toenails is a rare, but possible, problem in infants. When present at birth, the condition is considered to be congenital. Usually, but not always, there is a hereditary link.

A recent report from Children’s Hospital and Regional Medical Center in Seattle, Washington described four cases of ingrown toenail in infants. In all children, the condition affected the big toe on both sides.

Conservative care was applied for months without success. Three of the four cases required surgery to take care of the problem. One child was treated successfully with warm soaks and antibiotics. Thin pieces of cotton packing were also put between the inflamed soft tissue and the nail plate.

For those children whose ingrown nails did not recover with this type of care, surgery was successful. The overgrowth of soft tissue, skin, and fat was removed with good results. No one had a recurrence of the problem.

There is still quite a bit of debate about the best way to treat and rehab tendon injuries of this type. Some experts recommend casting to immobilize the joint. Others suggest splinting works better.

The success of immobilization post-operatively may depend on the child’s temperament and level of cooperation. Some nurses and doctors say there’s no point in an early rehab program. There’s little cooperation and kids heal quickly anyway.

The main problem is scarring along the length of the tendon. Tiny adhesions can keep the tendon from gliding and sliding as it should. This can affect motion. Sometimes the sudden loss of motion affects the joint, resulting in greater loss of motion from a joint contracture.

Teenagers can be treated like adults. Early immobilization followed by a period of mobilization is usually followed for the best results. Work closely with your surgeon and hand therapist. This may ensure the best results in a patient this young. Give nature time. Healing is remarkably fast in this young age group.

He may have what’s called an extensor tendon lag. Complete tears of the central extensor tendon cause a disruption of the tendon fibers. Even with surgery, healing may not restore normal function and motion of the tendon. The result can be the lag you’ve noticed.

Therapy with a certified hand therapist may be needed. This is either a physical or occupational therapists who has had specific training with problems like this.

For some people an extensor tendon lag is only a cosmetic problem. Grip strength may be less than normal. Function is often normal to nearly normal. Children under the age of five with complete lacerations have more problems with extensor lag than older children or children with a partial tendon tear.

Your surgeon may be able to give you a better prediction of long-term results. Age and location and extent of the injury are the main determining factors of final outcomes.

Osteomyelitis is a bone infection caused by bacteria. Bacteria often travel throughout the body via the blood stream. An infection in one area of the body can spread by this route to other parts of the body.

So for example, an abscess of the soft tissues can spread to the bone causing osteomyelitis. The abscess may be caused by some other initial infection such as a urinary tract infection.

In the pelvic or abdominal cavities, there is nothing separating the organs and soft tissues from each other. Any kind of infection or inflammation of the gastrointestinal (GI) tract or genitourinary (GU) tract can affect the soft tissues and bone in the area.

Lab tests of blood and urine combined with an MRI usually help narrow down the diagnosis. A history help identify the risk factors and/or cause of the problem. Treatment follows from there.

Symptoms such as pain and swelling can be difficult to assess in a young child. Sometimes a limp or change in gait (walking) pattern is all a parent has to go on.

X-rays are a good first look inside to see what’s going on. But unless there is a bone fracture, tumor, or hip dislocation, you’re not likely to see anything helpful.

When blood tests are negative, the next step may be additional imaging studies. The doctor has several to choose from. Ultrasound (US) is painless and noninvasive.

A special device called a sound head is moved over the skin. Sound waves pass through the soft tissues and bounce back. A picture of the soft tissues is formed and displayed up on a screen.

US can show areas or pockets of effusion (fluid collection). Abscess of the soft tissues may be evident. But this testing is not very precise. For example, it’s not always clear how much swelling is present.

If there is effusion, the physician may want to remove some of it and test it for infection caused by bacteria. This test can be painful and may be avoided in a young child. Instead, an MRI may be more useful.

Collections of fluid show up on MRI in great detail. MRI is very sensitive in picking up any problems in the bone marrow and nearby soft tissues. Such changes occur early in the course of some diseases and would not be seen otherwise.

Your pediatrician or family doctor will be able to advise you what’s the next best step. The history, physical exam, and test results so far will help point the way. An early diagnosis may be needed to prevent further problems. Don’t delay in going back to the physician for additional testing.

Osteochondral dissecans is another term for Little league elbow. Although it affects baseball pitchers most often, it can occur in other athletes who use (and over use) their elbow.

Forceful and repeated actions of the arm during some sports can strain the immature surface of the elbow joint. The outer part of the elbow is affected. The bone under the joint surface weakens and becomes injured.

Damage to the blood vessels to the bone can cause a small section of bone to die. The injured bone cracks. It may even break off. Pain, weakness, and loss of function develop. These symptoms don’t go away without treatment.

Cartilage transplantation is a fairly new procedure used for this condition. Plugs of cartilage and bone are removed from an area of healthy tissue and moved to the damaged area.

The knee is a good donor site because there are non-weightbearing surfaces that won’t be disturbed by the loss of some tissue. The patient is usually back to normal walking within a week. No specific rehab is required for the knee. This means the athlete can focus his or her attention on the elbow.

There are different types of scoliosis that can affect a child. One type, infant idiopathic scoliosis affects children under 3 years old and it is usually discovered when the child is between 6 and 12 months old. This type of scoliosis often corrects itself, although many children do need bracing or surgery.

The more common types of scoliosis with which the general public are familiar include juvenile and adolescent. There is an adult scoliosis, but this is rare.

Juvenile scoliosis is diagnosed with the child is between 3 and 10 years old. Adolescent scoliosis is diagnosed in children between 10 and 18 (adulthood).

It’s always best to speak with the doctor or surgeon about the reasons why treatment should be done. There are usually many details involved in making a decision for treating scoliosis.

In general, treating scoliosis is done to protect the lungs and heart (giving them room to grow properly) and comfort, to relieve (or prevent) pain. People with scoliosis tend have more back pain and as they get older, the curves can worsen. Treating scoliosis in adulthood is more difficult than treating in adolescence.

Tuberculosis (TB) of the knee is treated like TB of the lungs, with anti-TB medications. However, the area on the knee does need to be checked to be sure that it is a TB lesion and there is nothing else wrong.

For this reason, the knee area should have a biopsy. After this, the surgeon would likely clean out the area in the knee that was affected by the TB, as well as prescribing anti-TB medication.

Osteoporosis prevention does start early in life; it is good to be aware of it while your daughter is still building bone mass. However, it is important to remember that diet is only one part of osteoporosis prevention.

In terms of diet, your daughter should be consuming enough calcium for her age group. Children from 1 to 3 years old should have 500 mg of calcium per day (about equal to 2 glasses of milk); children between 4 and 8 years should get about 800 mg per day; and teens should get about 1300 mg per day.

Along with eating a diet with enough calcium, it’s very important that children and teens get enough weight-bearing exercise to help the bones build bone mass. If your daughter is in her late teens and has not yet begun menstruating, mention this to her doctor because estrogen plays a strong role in bone mass, as well. If a woman doesn’t menstruate or has very rare periods, this could cause problems with the bone density.

Calcium, although known to be in milk and dairy products (like cheese and yogurt) can be found in many other foods as well. You can find calcium in:

– Soy or Rice Milk

– White beans

– Instant Oatmeal

– Broccoli, cooked or raw

– Orange juice, calcium fortified

– Oranges and

– Sweet potatoes, among others

Most of the time, back pain in adolescents is idiopathic, meaning it is unknown exactly what causes it. It is hard to know exactly how common back pain in adolescents is as the research is varied. Back pain in adolescence tends to increase as children get older. In fact by age 18, it occurs at rates similar to adults.

Pain that is non-specific, meaning that it is most likely muscular can actually indicate a risk for back pain in adulthood. One review of the research found that four out of five studies show spinal pain in adolesence was a significant risk for back pain in adulthood. Also, the younger the child when the spinal pain began, the more likely the pain would be chronic.

Low back pain (LBP) is a common problem among all age groups, including adolescents. The likelihood of LBP in children increases with age. By ages 14 to 17, almost three-fourths of all teens have had at least one episode of LBP.

Back pain at night that keeps a person from sleeping may be caused by a sudden lack of distractions. The pain is present during the day but activities and events keep the focus away from the pain. Lying down at night in a quiet room without other things to focus the attention may make it seem like it’s much worse at night.

However, anytime back pain wakes a person from a sound sleep, it’s considered a red flag warning. This is especially true if there are other symptoms such as difficulty breathing, night sweats, or coughing. A medical exam is always needed to rule out a more serious cause of symptoms.

The first step is to see a medical doctor and get a diagnosis. The plan of care will be determined by the findings. If there is no other disease or illness causing back pain at night and disturbed sleep, other care may be needed. Many patients seek out a physical therapist, chiropractor, or other health care provider.

Studies show that the risk of back pain increases with age. Most children between the ages of 14 and 17 have reported LBP at least once. Psychosocial factors are often part of the picture with low back pain (LBP) in adolescents. Depression is one possible cause.

Other risk factors for LBP in this age group include family history, rapid growth, and smoking. Studies have not been able to link obesity, length of trunk, or spinal flexibility with back pain.

Researchers have also looked at the school furniture used by this age group. There have been some suggestions that poorly or improperly adjusted tables, chairs, and desks are part of the problem. But this has not been proven conclusively.

A bigger problem and more likely cause of back pain in this age group is the back pack. Children often carry up to 30 pounds in their back packs. Slinging it over one shoulder or carrying it in one hand can put an uneven load on the spine leading to LBP.

Insomnia strikes many people, particularly those who experience chronic pain. Studies have shown that there is also a component of worry, thinking that if they relax and try to sleep, the pain may get worse.

If your son does not want to take any medication to help him sleep, there are some tips he may try to help promote sleep.

– Meditation and relaxation: people who learn how to meditate and relax on demand may find it easier to fall asleep

– Sleep hygiene: the bedroom should only be for sleeping, not for watching tv, playing video games, or working on the computer. A calm, peaceful environment can promote sleep.

– Lighting and temperature: be sure the bedroom is dark enough to induce the feeling of wanting to sleep and the room is comfortable.

– Bed is for sleeping: don’t stay in bed if you’re not asleep.

– Food: don’t eat just before bed, stay away from caffeine (food or drinks) after late afternoon

– Routine: establish a calming routine just before bed so your body associates certain actions with the time to start winding down.

– Comfort: ensure the pillow and mattress are comfortable.

– Schedule: go to bed the same time every night, including weekends. Get up around the same time every morning, this can help put your body into the right routine.

It is always very important that you understand exactly what surgery your daughter will undergo and you should ask as many questions as you need to help you feel comfortable with the decision. A few suggestions of questions include:

Why is this surgery necessary?

What may happen if we don’t do the surgery?

What is the surgeon’s experience with this type of surgery?

How many times has he/she performed the surgery and what is the success rate?

What are the options if you decide not to go ahead with the surgery?

What is the expected outcome from the surgery?

What are the risks of this particular surgery?

How long will it take for recovery?

What is involved in recovery?

Where can you get a second opinion?