As children grow, it is normal to have anatomical changes occurring in the bones, muscles and tissues of the body. This is called “normal postural variance”. As you can imagine, the anatomical variances occur as the baby is still developing. Most of the time, these changes go unnoticed because it is simply “part of growth”. However, in some cases, these variations can seem exceptional or exceed the “norm”. There are a few causes and reasons that these variances may continue on into adulthood and therefore influence functional and motor skills. Assessment and review of these concerns by a physiotherapist can help identify whether these are expected changes. A few examples of these instances are highlighted below:
This refers to the angle of the knees and are deformities considered from assessment in the frontal plane. You may be more familiar with the terms “knock-knees” (genu valgum) and “bow-legs” (genu varum). It is normal for the angle to change as the child grows. You may notice your child with bow-legs when they first start to stand and walk, and then notice that the angle changes later in the toddler age. When this angle falls outside the normal range, and outside of the normal age range, the child should be assessed for correct management. Assessments and diagnosis is usually made through physical examination. After examination, physiotherapy can help determine the best line of management and education around the child’s growth.
This refers to the position of the forefoot, where there is a sharp, inward angle of the forefoot. This is a normal variation in a child’s growth, with the angle of the foot seen to “in-toe” more noticeably as the child starts to stand independently. In most cases, metatarsus adductus is positional, and will resolve spontaneously. Physiotherapy assessment will identify this “flexibility” of the foot, which will guide a thorough treatment plan.
Plagiocephaly refers to the shape of the head, where there is mechanical and positional deformation of the growing skull. Plagiocephaly can develop at any stage, up to 6 months of age. It is common, and can be seen across a large range of incidence of 5-48% of healthy newborns. There may be a number of causes or reasons for flattening of the bone, which can be identified and assessed through cranial measures. Often, cases of positional plagiocephaly can be managed conservatively through guidance and positional therapy provided by physiotherapists. In some, more moderate to severe cases, referral for orthoses may be necessary.
Plagiocephaly may be caused by tightening or contracture of one side of the neck, which is seen in babies with a condition called torticollis. In the adult world, this is commonly seen as acute wry neck, where the common complaint is ‘waking up with neck pain after sleeping funny’. Similarly to this, babies will present with a tilt or rotation of their head to one side. Torticollis should be identified early by a childs physiotherapist, to reduce the risk of developing positional plagiocephaly. Assessments and management for torticollis will usually include a thorough musculoskeletal examination for identification of soft tissue, bony, and neurological issues.
Asymmetry (one side looks different to the other)
Pain, limping, or reduced activity
Alignment that seems worsening, not gradually improving
Bow legs not improving past ~3 years, or knock knees that are still pronounced beyond ~7–8 years
A head turning preference/torticollis that is persistent or linked with head shape flattening
