Month: January 2020

Baby walkers or infant walkers consist of a wheeled base supporting a rigid frame that holds a fabric seat with legs opening and usually a plastic tray. These devices are designed to assist the babies, with feet on the floor and to allow mobility while they are learning to walk. Baby walkers are commonly used between 5 and 15 months of age.

Various reasons for using baby walkers are – to keep the infant quiet and happy, to encourage mobility and promote walking, to provide exercise, to hold the infant during feeding and walkers would keep their infant safe.

Common types of baby walker related injuries – 

• Trip and fall over

• Roll down stairs

• Get into dangerous places, which are otherwise difficult to reach

• Child in a baby walker can move more than 3 feet in 1 second, so walkers are never safe, even with an adult close by.

Baby walker may cause delay in motor development –

Baby walkers are not only unsafe but may also slow the motor development. This is because walkers give an infant the sensation of walking on their own. And thereby, baby walkers eliminate the desire to crawl or to walk. So baby walkers are not a boon to the child’s development.

Recommendations –

American Academy of Paediatric recommends a ban on the manufacture and sale of mobile baby walkers.

Don’t use a baby walker for your baby and don’t allow other care givers to use baby walkers.

Efforts should be made, through media campaigns, warning labels to educate parent about the hazards and lack of benefits of baby walkers.

Safest walker is one without wheels, stationary activity centers should be promoted as a safer alternative to mobile baby walkers.

Conclusion –

Baby walkers are not safe and not a boon to the development of child. One way to keep baby safe and help in baby’s development is to throw away your baby walker.

References –

https://pediatrics.aappublications.org/content/108/3/790

https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/expert-answers/baby-walkers/faq-20058263

https://www.healthychildren.org/English/safety-prevention/at-home/Pages/Baby-Walkers-A-Dangerous-Choice.aspx

In bowed legs, the knee appears to bow out from the body and does not touch, however, the feet do. All babies are born with bowed legs. However, parents notice bowed legs when children begin to walk at around 12 months. The bowed legs tend to straighten with age between 18 and 24 months.  So it is normal for infants to be born with bowed legs.  The bowed leg in children which gets corrected with age is called physiological bow legs.

Cause of physiological bowed legs –

Bowed legs in the newborn are because of the folded position of the foetus in the uterus. This actually increases until the age of 18 months, and then the legs straighten as the child grows.

Treatment of physiological bowed legs –

Physiological bow legs corrects naturally so special shoes, braces or exercises are not recommended. If parents are concerned about the shape of the child’s leg, then it may be helpful to take photographs every six months. Photographs should be taken with the child standing with knees facing forwards.

When to visit Paediatric Orthopaedic Surgeon (Red flag signs) –

• Your child’s bowed legs are severe

• Bowed legs persist after age three

• Only one leg is affected

• Your child has pain or a limp

• Your child is unusually short for their age

Paediatric Orthopaedic Surgeon examination –

The examination begins with a brief history of the child’s development, nutrition habits and any family history of skeletal dysplasia. The doctor will observe the child’s walking pattern, look for any lateral thrust at the knee. Then will evaluate the ligamentous laxity and torsional profile of the limb. Many times, especially in younger toddlers, a thorough physical exam is all that is needed. In some cases, with red flag signs, a radiograph and blood test are recommended.

Conclusion –

Bowed legs in a child less than 18 months is normal and usually straighten by 24 months. Any bowed legs after three years are pathological, which needs evaluation and treatment.

Know more –

http://orthokids.org/Condition/Bowed-Legs-Knock-Knees

https://www.rch.org.au/uploadedFiles/Main/Content/ortho/factsheets/BOWLEGS.pdf

https://kidshealth.org/en/parents/bow-legs.html

https://www.ucsfbenioffchildrens.org/conditions/bow_legs_and_knock_knees/

https://www.columbiadoctors.org/condition/bowlegs-knock-knees-pediatric

Backpacks are a practical and popular way for children and adolescents to carry school books and supplies.  If backpacks are used correctly, can be a good way to carry the necessities of the school days. And backpacks are designed to distribute the weight of the load among some of the body’s strongest muscles. However, when backpacks are too heavy or worn incorrectly can cause problems for children and teenagers.

Problems backpacks can pose –

When a heavy backpack is placed on the shoulder, the weight forces can pull a child backward. To compensate, that child will bend forward at the hips or arches the back. This compresses the spine unnaturally, leading pain at the shoulder, neck, and back.

Pack with narrow tight straps digs into the shoulder and can interfere with circulation and compress the nerve. These can lead to tingling, numbness, weakness in the arms and hands.

And also, the bulky or heavy backpack can hit others while turning around; children can trip over, pack falls on them and increases the risk of falling due to off-balance.

Finding a safe backpack –

• The most important thing to consider is an appropriate size backpack. An ideal backpack should not be wider than the child’s torso and should not hang more than 2 inches below the waist.
• Lightweight backpack – Pack should not add much weight to the load so avoid leather pack.
• Use pack with two wide, padded shoulder straps, which help to distribute the weight on children back without digging into shoulder.
• Use a backpack with padded back. It provides increased comfort and also protects kids from being poked by a sharp object or edges {pencils, rulers, notebooks, etc.} inside the pack.
• Use backpacks with multiple compartment and compressive straps, which help to distribute the weight throughout the pack.
• Use backpacks with waist straps, which help distribute the weight of the pack more evenly across the children’s back and also holds the pack close to the body.

Safe and sensible usage of the backpack –

• Pack light – Backpack should not weigh more than 10 to 15 percent of the child’s body weight.
• Make sure children use both shoulder straps when carrying the pack and use the waist strap. Adjust straps to fit snugly.
• Encourage children to bring only necessary books and material.
• Organize the pack, put the heaviest items low and near the center of the back.
• Do not bend over at the waist when wearing or lifting a heavy pack, instead bend using both knees.
• At last and most important, learn back strengthening exercises to build up the muscles used to carry a pack.

References

https://www.nsc.org/home-safety/safety-topics/child-safety/backpacks https://orthoinfo.aaos.org/en/staying-healthy/backpack-safety/ https://www.safety.com/backpack-safety https://kidshealth.org/en/parents/backpack.html?WT.ac=ctg

Introduction –

Wrapping or swaddling a newborn can help the baby to feel more secure and comfortable. This may assist the baby to settle and establish regular sleep patterns. However, improper wrapping or swaddling baby tightly with legs straight can hinder the normal growth and development of the child’s hips.  So improper wrapping or swaddling can result in DDH.

Van Sleuwen BE, et al, in a systematic review of swaddling noted that developmental dysplasia of the hip is more prevalent when the legs are bound so they are not free to move. Similarly, Yamamuro et al noted a decrease in the incidence of DDH from 1.5-3.5% to 0.2%, following the implementation of the national programs to eliminate swaddling with hips and knees in an extended position.

In contrast, cultures that carry their children in the straddle or jokey position, have very low rates of hip dislocation compared to cultures that wrap their children tightly with the legs together and extended.

In the mother’s womb, babies generally lie with their hips in an outward position. This position helps the hip joint to develop normally. In some babies, the ligaments around the hip joint are loose, which in most gets corrected during the first few months of life. So, incorrect swaddling or wrapping can have an effect on the growing hip joint and cause the hip to become unstable and dislocate.

That’s why all parents and caregivers need to know how to wrap a baby correctly to minimize the chance of hip dysplasia. So, safe wrapping or swaddling is most important during the first three months of life.

Safe wrapping or swaddling –

Any safe wrapping or swaddling methods like diamond method, square method or using a pouch can be followed. But it is recommended to leave enough rooms for legs to move freely.

International Hip Dysplasia Institute and POSNA, has issued the following statement. “It is the recommendation that the infant hips should be positioned in slight flexion and abduction during swaddling. The knees should also be maintained in slight flexion. Additional free movement in the direction of hip flexion and abduction may have some benefit. Avoidance of forced or sustained passive hip extension and adduction in the first few months of life is essential for proper hip development.”

To conclude, when wrapping or swaddling, “Always remember to leave the baby’s legs free to move”.

Know more –

http://bengalurukidsortho.in/health-info/developmental-dysplasia-of-hip/

https://www.rch.org.au/uploadedFiles/Main/Content/kidsinfo/safe-wrapping-for-hip-dysplasia.pdf

https://www.aaos.org/uploadedFiles/PreProduction/About/Opinion_Statements/position/1186%20Swaddling%20and%20Developmental%20Hip%20Dysplasia(1).pdf