Common Orthopedic Questions About Infants and Children

By Howard J. Bennett, MD

My newborn has overlapping toes. Should we do anything to straighten them?

It’s pretty snug inside the uterus, and babies have a number of anatomical variations because they are constrained in a small space. Shins are often bowed because the legs were crossed before birth. Feet are sometimes angled toward the shins because they are pushed in that position by the uterus. Lastly, toes frequently overlap one another.

If your newborn has overlapping toes because of intrauterine forces, they will straighten out in the next few months. If they overlap due to a family trait, they may stay in that position. Fortunately, this is unlikely to cause any problems.

My husband and I are nervous about holding our newborn. What should we do to protect his neck?

It’s common for first-time parents to be nervous holding their baby. The most important thing to do is to make sure you support the baby’s head when you’re holding him. The best way to do this is to place one of your hands on his bottom and the other where the neck meets the back of his head. Always keep in mind that a baby can surprise you by lifting his head or moving it back suddenly. As long as his head doesn’t “snap back,” it won’t hurt him to be moved around.

My 3-week-old’s big toenails look like they’re ingrown. Is this normal?

Because of intrauterine positioning, the nail of the big toe may grow into the fleshy part of the toe. This usually isn’t a problem because newborn toenails have the consistency of parchment and tend to break off when the baby moves around. (Most of the time, a newborn’s big toenails do not even need to be cut.) By the time your baby is six to nine months of age, his big toenails should look more “normal” to you.

If your baby’s big toenail looks ingrown and the flesh is red or swollen, you should see your doctor to check for infection.

My sister’s baby had dislocated hips. My baby is due in two months. Is this something to worry about?

Babies can be born with dislocated hips or they can develop them anytime in the first year of life. (The current term for this condition is developmental dysplasia of the hip.) This is a rare, but serious problem that doctors check for at every physical until a baby has his first birthday.

In the newborn period, doctors check to see if the baby has loose hips that “clunk” when examined. Later in infancy, a baby with hip dysplasia may only show limitations in movement when the hips are examined.

The main risk factors for hip dysplasia include a family history of the problem, firstborn babies, female infants, reduced amniotic fluid, and breech position. If you have one or more of these risk factors, the doctor may order an ultrasound of your baby’s hips.

Is it okay to swaddle my newborn?

Swaddling is a time-honored technique to help calm newborns. Because babies have a tendency to get out of their swaddle, products like the Miracle Blanket have been invented to make it easier for parents to swaddle their infants.

There are two things to keep in mind when swaddling your baby. First, swaddling can lead to overheating; so don’t overdress the baby before you wrap him in the blanket. (In most situations, a “onesie” and a diaper are all that’s needed when you swaddle your baby.) Second, in the last few years, doctors have become concerned that wrapping a baby’s entire body may increase the risk for hip problems. Therefore, the current recommendation is to focus on swaddling the baby’s upper body, leaving the legs free to move around.

My 2-month-old frequently falls asleep when I carry him in a Snugli. Will this hurt his back?

Infants are very flexible and carrying them in infant carriers will not cause back or neck pain. However, you don’t want the baby to throw up when he is in a carrier because it’s more difficult to protect his airway in this position. This is especially true if the baby has stomach reflux.

My 1-month-old’s feet turn in. Is this something I should be worried about?

As long as a baby’s foot is flexible, it’s not usually a problem if the feet turn in. In the old days (when babies slept on their bellies) turned-in feet sometimes got worse and ended up requiring special shoes or casting. But now that babies sleep on their backs, this condition (metatarsus adductus) is rare.

My 4-month-old loves to stand and bounce when I hold him upright. Will this cause his legs to bow?

The rate determining factor in holding babies upright is head control not leg control. At four months, most babies can hold their head pretty well. So as long as your baby can keep his head steady without it falling forward, you can hold him in this position. Bones grow in relation to the forces they encounter so bearing weight actually helps a infant’s bones straighten rather than become more bowed.

My one-month-old hates tummy time. Is there a way to encourage her to stay in this position?

Now that babies sleep on their backs to reduce the incidence of SIDS (sudden infant death syndrome), doctors recommend that they get tummy-time during the day to help strengthen their arms and upper body. Unfortunately, some babies do not like being placed in this position. One reason this occurs is because they are accustomed to sleeping on their backs. Another reason is because babies may get frustrated if they cannot see much while in the tummy-down position. There are a few techniques you can do to make tummy-time easier for your baby.

• Bend your baby’s arms at the elbow and pull them in towards her body. This stabilizes her shoulder area and makes it easier for her to lift her head and chest.

• Put something interesting in front of your baby to encourage her to look up. This could be a pet, a toy or your smiling face.

• Put your baby on a firm surface that is raised 20 to 30 degrees. This will make it easier to lift her head.

• Place the baby tummy-down on your chest. That way, she will feel close to you and has the added incentive of seeing your face when she looks up.

You should never leave your baby unattended during tummy-time for two reasons. First, you do not want her to fall asleep in this position because of the increased SIDS risk. Second, if you walk away even for a second, she could roll over and fall on the floor.

My 15-month-old has flat feet and a shoe salesman told me I need a firm shoe with an arch support to help develop her arches. Is this true?

All children have flat feet in the first few years of life. This is because they have a fat pad along their instep. Most develop an arch by the time they are five years of age.

Doctors often recommend getting shoes for babies when they turn one. However, shoes do not teach a baby to walk. Instead, they merely provide traction, warmth, and protection. The best shoes to get are the ones with flexible soles because it makes it easier to babies to move around.

My 18-month-old toes in when he walks. Does this need to be treated?

Toeing-in is very common in toddlers. In most cases, it’s due to a slight inward rotation in the shins or because the forefoot (front of the foot) moves in as the baby flexes his foot for stability as he walks. Toeing-in usually resolves without treatment by the time children are three or four years of age. If it continues beyond that time, it’s usually due to a type of rotation at the hip called femoral anteversion. This too, rarely requires any treatment.

Is toe-walking normal?

It is very common for infants to toe-walk. Most stop this behavior when they reach 18- to 24-months. If your baby continues to walk on his toes after two, his doctor should evaluate him.

My daughter is 16-months-old, and her legs are more bowed than when she was a baby. Is this normal?

Infants and toddlers go through some amazing changes when it comes to bone development. Their tibias (shins) are bowed at birth and usually straighten by age two. In some babies, however, the lower leg stays bowed until the child is three or fours years of age. At that time, many children become knock-kneed, and that pattern can last for another three or four years. If a child’s legs are very bowed, the doctor may get an X-ray to eliminate the possibility of two rare conditions: rickets and Blount’s Disease.

What is a nursemaid’s elbow?

Most parents enjoy being physical with their kids. Whether it’s rolling around on the floor or being swung through in the air, kids respond to physical play. However, children less than five are more susceptible to dislocating their elbows than older kids. The injury typically occurs when an adult is holding a child’s hand as they walk. If the child stumbles, the adult will yank the child’s hand to keep him from falling. The forces generated by this action may dislocate the elbow by pulling the radius bone out of position. (There are two bones in your forearm; the radius is the one that attaches to the wrist behind the thumb.) The radius may also be dislocated if a child is lifted off the ground by one hand or is swung through the air with one arm. Therefore, be very careful if you lift your toddler off the floor or swing him through the air. The safest way to do this is to hold the child with both hands in his armpit area.

Is it bad to crack your knuckles?

I wrote a KidsPost column on this subject. Click here to read this article.

What causes growing pains?

I wrote a KidsPost column on this subject. Click here to read this article.

© 2012 Howard J. Bennett. All Rights Reserved.

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