Antidepressants Blog

KNOCK KNEES

Knock knees is a common condition in toddlers and becomes most obvious at around 3 years of age, disappearing by the time the child starts school. When the child stands, the knees touch but the ankles are separated by a gap of 5 cm or more. The condition is very rarely due to an underlying medical or orthopaedic cause but it can run in families. In the vast majority of cases, knock knees are considered to be normal and of no consequence. Some children may appear clumsy when they run, but most have no problems at all. Treatment is rarely required for children with knock knees. If your child is overweight, losing weight can help to resolve the problem. In more severe cases, night splinting or special shoes may be prescribed.

‘PIGEON TOES’ (IN-TOEING)

Babies and toddlers have a normal tendency towards having feet that point inward. This may also be accompanied by bowing of the legs. Pigeon toes are usually due to a particular alignment of the thigh and hip bones, which are turned inward.

This condition usually corrects itself naturally as the child grows. Very occasionally pigeon toes are seen as part of an underlying neurological condition, such as cerebral palsy.

Some toddlers and young children with pigeon toes may appear clumsy, but usually most parents come to the doctor because of concerns about the way the child’s feet look, or about marked wearing on one side of the shoes. Treatment is rarely necessary, although in severe or persistent cases, night splints or special shoes are sometimes used. Surgery is rarely necessary.

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When a child limps he carries his weight more on one leg than on the other, usually because of pain although a limp can also be painless.

Cause

There are numerous possible causes for a limp, ranging from a bruised leg or foot, a tight shoe, or a wart on the sole of the foot, to a broken bone (fracture), or cerebral palsy. A bone tumour can cause a limp, but these tumours are rare.

Clinical features

The child’s limp favours the good leg, and puts as little weight as possible on the leg that is causing pain. Sometimes the child will be able to point to the area of pain, but more often it is generalised and the muscles themselves are sore from straining due to the limp.

When to see your doctor

Any child who has a limp that persists for more than a day, which does not have an obvious cause such as a tight shoe, should be seen by a doctor without delay.

You should also see your doctor:

• your child has an unexplained fever;

• your child refuses to walk at all;

• there is obvious swelling of part of the hip or leg, especially around a joint.

Treatment

Treatment depends on establishing the particular cause of the limp. In minor injuries, rest may be all that is required. Problems of a more serious nature should be referred to a specialist for further assessment.

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This is the commonest disease of the hip joint in childhood. Cause

The cause of irritable hip is uncertain, but the condition has been attributed to viruses and trauma.

Clinical features

A child with an irritable hip is usually between 2 and 5 years of age. He is generally well, and may have only the slightest fever. He has a noticeable, but painless limp, and when examined has difficulty in moving his leg to the side.

Investigations

X-rays of the hip as well as blood tests are usually normal. Follow-up X-rays are usually performed a month later to monitor progress.

• if your child suddenly develops an unexplained limp;

• if he is also unwell or has a fever;

• if he complains of pain in the hip joint or knee.

Treatment

The preferred treatment once the diagnosis of irritable hip has been made is bed rest for a week. Your doctor will generally refer your child to a paediatric orthopaedic surgeon, who may advise the short-term use of traction.

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If CDH is detected during infancy, treatment is usually simple and straightforward, resulting in total correction. The later it is diagnosed, with subsequent delay in the commencement of treatment, the more difficult it is to correct, and the more uncertain the final result.

All newborn babies suspected of having a dislocated hip are placed immediately in a special harness or splint, which holds the hip in the socket of the hip joint by keeping the thighs apart. This is worn for around 3 months and can be removed at bath time. Although it may look awkward, the splint causes the baby no discomfort.

If treatment is started after the child is 1 year old, then traction and often surgery are needed, followed by 6 to 9 months in a plaster cast (which is changed every few weeks to allow for growth).

When to see your doctor

If you notice any of the features described above, see the doctor. If there is any doubt, an X-ray or ultrasound can confirm the diagnosis. Referral to a paediatric orthopaedic surgeon for a specialist opinion may be advisable.

Prevention

Every baby should be examined fully straight after birth, and again at 6 weeks, including a check for CDH. If there is a family history of CDH or your baby was born by a breech birth, special care needs to be taken with t the examination. While CDH cannot be prevented, early detection and immediate institution of treatment are very important.

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