Advice

Notes from the OPD.

Straight answers to the questions parents ask most. Pick a topic, read the short answer, and open the full note if you want more.

Legs · growth1 min read

Bow legs, then knock knees

Both are usual stages of growing up.

Most babies are born with bow legs. Around 18 months the legs look straight; then knock knees appear, most marked around 3 to 4 years, and by about 7 the legs are close to their adult shape.

Get a check if only one leg is bent, the shape is getting worse, there is pain or a limp, your child is short for their age, or the shape is outside these ages. Watch the chart below.

Not sure? Try the leg shape check.

Salenius and Vankka, JBJS 1975 · AAP HealthyChildren.org

Hips · babies1 min read

Swaddle loosely below the waist

A baby’s hips need room to bend up and fall apart.

Wrapping a baby’s legs straight and tight can harm a developing hip joint. Wrap the arms and chest snugly if you like, but leave the legs loose, so they can bend up and fall apart naturally.

Carriers and slings that hold the knees up and apart, with the thighs supported, are kinder to the hips than ones where the legs hang straight down.

Clubfoot? Start casting in the first weeks

Early treatment works best.

The Ponseti method gently turns the foot a little further each week with a new plaster cast. It works best when it starts early, ideally in the first few weeks of life, while a baby’s foot is at its most flexible.

Most babies then need a tiny release of the heel cord and, after the last cast, boots on a bar to keep the foot straight.

Read the clubfoot guide.

AAOS OrthoInfo · NHS

Fractures · children1 min read

Children’s bones bend before they break

And growing bones can straighten a small bend.

A child’s bone can bend and crack on one side only (a greenstick fracture) or buckle, rather than snap. A thick covering helps it heal quickly, and while the child is growing a small bend can smooth out over months.

Breaks near a joint, through a growth plate, or with a twist still need careful setting, so every broken bone deserves a proper check.

See the children’s fractures guide.

AAOS OrthoInfo

Casts · at home1 min read

Looking after a plaster cast

Dry, clean, and the toes or fingers pink.

Keep the cast dry (sponge-bath instead of a tub bath), keep it clean, and look at the toes or fingers often: they should be pink, warm and moving.

Call the clinic the same day if they look pale, blue or swollen or feel cold, the cast slips, cracks, gets wet or smells, or your child is in pain or has a fever.

Any worry about a cast is worth a same-day call to the clinic.

AAOS OrthoInfo

Urgent · infection1 min read

A limp with a fever is urgent

Be seen the same day.

A child with a fever who limps, won’t use an arm or leg, or has a red, hot or swollen joint can have a bone or joint infection. It needs treatment fast to protect the bone, the joint and its growth plate.

Go to the nearest emergency department the same day.

Bow, straight, knock, straight.

Keep scrolling. Most children’s legs change shape like this as they grow: watch the bones follow the chart.

BirthBow legs are normal
About 18 monthsLegs look straight
3 to 4 yearsKnock knees at their most
By about 7Close to the adult shape
Get a check if…The signs that need a look

Usually normal.

Bow legs and knock knees are usual stages. Get a check if the shape is one-sided, getting worse, painful, or outside these ages.

Try the leg shape check

The curve shows average knee angles measured in a large group of children (Salenius and Vankka, 1975). Every child is a little different, and a few degrees either side of the line is usual.

Myth or fact

Things parents are often told.

Tap a box to see the fact.

Quick checks

Check it. Track it.

Guidance only, not a diagnosis. When in doubt, have your child seen.

Leg shape

Is my child’s leg shape normal for their age?

How old is your child?

What do the legs look like when standing?

Based on NHS and American Academy of Pediatrics guidance on bow legs and knock knees.

A limp

My child is limping. How soon should we be seen?

Fever, or seems unwell?
Won’t stand on the leg or use the arm?
A red, hot or swollen joint or bone?
A fall or injury before the limp?

Based on NHS guidance on limping in children and bone and joint infections.

See a paediatric orthopaedic doctor if…

A newborn’s foot is turned in and can’t be gently brought to a normal position
A baby’s hip clicks out at a check, or the skin creases or leg lengths look uneven
Bow legs after about 2, knock knees after about 7, or either on one side only
One leg looks shorter, or your child walks on tiptoe on one side
A limp, or not using an arm or leg, with no clear reason
A baby’s head keeps tilting to one side

Emergency: fever with a painful, swollen arm or leg, a child who suddenly won’t move a limb, a limb that looks bent after a fall, or a hand or foot that is cold, pale or numb. Go to the nearest hospital emergency department now.

Did you know

Growing bones, in numbers

1in 1000babies is born with clubfoot
½of children with clubfoot have it in both feet
3–4yrswhen knock knees are usually at their most
2×as many growth plate fractures in boys as in girls

Sources: AAOS OrthoInfo (clubfoot, growth plate fractures) and Salenius and Vankka (1975). These notes are general information, not a diagnosis.

Questions

Parents ask.

Short answers. For your own child, Dr. Kayal’s advice comes first.

Are bow legs in a toddler normal?

Usually, yes. Most babies are born with bow legs, which straighten by about 2. Have them checked if they are severe, one-sided, getting worse, or still there after about 2. See leg shape by age.

When are knock knees a worry?

Knock knees are most marked around 3 to 4 years and usually ease by about 7. Get a check if they are severe, one-sided, painful, getting worse, or still there after about 7. See the knock knees guide.

My child is limping. Is it urgent?

A limp with fever, a red, hot or swollen joint, or a child who won’t stand on a leg needs to be seen the same day: go to the nearest emergency department. A limp after a fall should be checked within a day. Try the limp check.

How do I look after a plaster cast at home?

Keep it dry and clean, look at the toes or fingers often (pink, warm and moving), and come to every appointment. Call the clinic the same day if the toes look pale, blue or swollen, the cast slips or cracks, or your child has pain or a fever.

Can tight swaddling harm a baby’s hips?

Yes. Wrapping the legs straight and tight can harm a developing hip. Swaddle loosely below the waist so the legs can bend up and fall apart. See hip-healthy swaddling.