Bone deformities in children and infants causes types and methods of repair

Bone deformities in children and newborns are among the most concerning issues for parents, as they not only affect the child’s appearance but also impact their movement and normal growth. In some cases, these deformities are congenital, present from birth, while in other cases they develop due to vitamin deficiencies or growth problems. This Dalily Medical article provides everything you need to know about the types of deformities, their causes, warning signs that parents should watch for, and treatment options, including medication, physical therapy, or surgery. You’ll also learn how to detect the problem early and protect your child from potential future complications.

What Are Bone Deformities in Children?
Bone deformities in children are any abnormalities or irregularities in the shape or growth of the bones. These deformities can be:

Congenital: Present at birth.
Acquired: Develop during growth due to vitamin deficiencies, certain diseases, or injuries.

Do All Cases Require Surgery?
Not all cases need surgery. Most children improve with vitamins, nutritional supplements, braces, or physical therapy. Surgery is usually reserved for severe cases or those that do not respond to conservative treatment.

Most Common Bone Deformities in Children
Some of the most common deformities include:

Bowlegs: Legs curve outward at the knees.
Knock knees: Knees are close together while the lower legs angle outward.
Scoliosis: Sideways curvature of the spine.
Clubfoot: Foot twists downward or inward.
Leg length discrepancy: One leg is longer than the other, affecting walking.

Is Some Bowing Normal in Children?
During the first two years of life, mild bowing can be normal due to the position in the womb. However, consult a pediatric orthopedic doctor immediately if:

The bowing is severe.
The curvature worsens over time.

Can Vitamin D Deficiency Cause Deformities?
Yes ✅. Vitamin D and calcium deficiencies are among the main causes of rickets and leg bowing in children. Therefore, it’s important for children to receive preventive vitamin D, especially during the first year.

When Should You See a Doctor Early?
Seek immediate medical advice if you notice:

Significant difference in leg lengths.
Uneven shoulders or a curved back.
Difficulty walking or delayed walking milestones.
Abnormal head shape or extra/merged fingers or toes.

Do All Cases Need Surgery?
No, most mild deformities improve with vitamins, braces, or physical therapy. Surgery is only for severe cases or those unresponsive to conservative treatment.

Do Deformities Affect the Child’s Life Later?

Early treatment: Children often live a normal life.
Delayed treatment: May lead to walking difficulties, chronic pain, physical deformities, or psychological issues related to appearance.

Are Bone Deformities Hereditary?
Some types are hereditary, such as osteogenesis imperfecta or skeletal dysplasia, but most deformities are acquired due to:

Nutritional deficiencies.
Growth problems.

When Do Bone Deformities Appear?
Bone deformities in children can appear at different stages and are not always visible at birth. The type and cause determine when the signs appear:

1️⃣ At Birth

Clubfoot.
Extra or missing fingers or toes.
Skull deformities like premature fusion of skull bones.
Certain forms of dwarfism or skeletal dysplasia.

2️⃣ During the First Two Years

Bowing of the legs due to vitamin D deficiency (rickets).
Minor spinal issues like mild scoliosis.
Unequal leg lengths.

3️⃣ When Walking and Growing

Knock knees.
Increased or decreased spinal curvature.
Delayed bone growth or weak bones.

4️⃣ School Age and Adolescence

Some deformities, like scoliosis, may appear or worsen during rapid growth periods.
Leg length discrepancies may become more noticeable.

Types of Bone Deformities in Children
Bone deformities can be congenital (present at birth) or develop later due to illness or injury. The main types include:

1️⃣ Spinal Deformities

Scoliosis: Sideways curvature of the spine.
Kyphosis: Excessive backward curvature of the upper back.
Lordosis: Excessive inward curvature of the lower back.

2️⃣ Lower Limb Deformities (Legs)

Bow legs: Legs curve outward at the knees.
Knock knees: Knees are close together while the lower legs angle outward.
Clubfoot: Foot twists inward or downward.
Leg length discrepancy: One leg is noticeably longer than the other.

3️⃣ Upper Limb Deformities (Arms and Hands)

Polydactyly / Syndactyly: Extra or fused fingers.
Congenital shoulder or elbow deformities.

4️⃣ Skull and Facial Deformities

Craniosynostosis: Premature fusion of skull bones, leading to an abnormal head shape.
Facial and jaw deformities: Such as a small lower jaw or asymmetrical facial bones.

5️⃣ Deformities Related to Bone Disorders

Rickets: Weak and deformed bones due to vitamin D deficiency.
Osteogenesis imperfecta: Severe bone fragility causing repeated fractures and deformities.
Skeletal dysplasia: Includes conditions like dwarfism.

Causes of Bone Deformities in Children
The causes vary depending on the type of deformity and when it appears:

1️⃣ Congenital Causes (During Pregnancy)

Genetic factors: Certain syndromes and inherited disorders.
Problems during pregnancy: Maternal infections or exposure to medications or radiation.
Fetal positioning: Pressure in the womb may lead to limb or foot deformities.

2️⃣ Acquired Causes (After Birth)

Vitamin D and calcium deficiency: The most common cause of rickets and bow legs.
Poorly healed fractures: Improperly treated fractures may lead to deformities.
Bone and joint infections: Such as osteomyelitis.
Bone tumors or masses: May cause abnormal bone growth.

3️⃣ Growth-Related Causes

Uneven bone growth: For example, differences in leg length.
Hormonal disorders: Thyroid problems or growth hormone deficiency.
Excess weight: Puts pressure on bones and joints, causing deformities over time.

4️⃣ Rare Causes

Rare inherited bone disorders: Such as osteogenesis imperfecta.
Skeletal dysplasia: Includes dwarfism and complex deformities.

Signs of Bone Deformities in Children
These are the signs that may alert parents to possible bone deformities in infants or older children:

Early months and infancy:

Abnormal head shape (flat on one side or unusually long).
Extra or fused fingers or toes.
Foot twisted downward or inward (clubfoot).
Difficulty moving joints or arms.

Beginning of walking (1–2 years):

Noticeable bowing of the legs or knees close together.
Frequent tripping or inability to walk straight.
Leg length discrepancy affecting walking.
Delayed walking compared to peers.

Signs in Childhood and School Age

Noticeable spinal curvature (side tilt or humpback).
Frequent unexplained bone or joint pain.
Difficulty standing or running like peers.
One shoulder higher than the other or protruding shoulder blade.

General Signs Parents May Notice

Visible deformity in bones or joints.
Abnormal limb growth (one arm longer than the other).
Frequent bruises or fractures even with minor falls (possible bone fragility).
Short stature or delayed growth compared to other children.

Diagnosis of Bone Deformities in Children
Diagnosis relies on careful medical examination and various tests to determine the cause and type of deformity:

1️⃣ Medical History and Physical Examination
The doctor asks about:

Family history: Any inherited bone disorders?
Pregnancy and birth: Any complications or abnormal fetal positioning?
Onset of symptoms: Present from birth or appeared later?

Then examines the child:

Shape of bones and spine.
Movement and walking.
Measurement of limb length differences.

2️⃣ Imaging Tests

X-ray: Shows bone shape and curvatures.
CT scan: For complex spine or skull cases.
MRI: Evaluates nerves, joints, and scoliosis.
Ultrasound: Useful for infants to detect congenital hip dislocation.

3️⃣ Laboratory Tests

Blood tests for vitamin D, calcium, and phosphate levels.
Thyroid or growth hormone tests if hormonal disorders are suspected.

4️⃣ Special Tests for Certain Cases

Genetic testing: For inherited conditions like osteogenesis imperfecta.
Growth measurements: Monitoring height, weight, and head circumference using growth charts.

Risks of Bone Deformities in Children
Bone deformities can cause serious issues if not treated early:

1️⃣ Movement and Growth Problems

Delayed walking or running.
Difficulty participating in games and activities.
Leg length differences affecting walking.

2️⃣ Chronic Pain

Persistent joint or back pain due to abnormal bone pressure.
Pain may increase with activity or age.

3️⃣ Physical Appearance Deformities

Visible spine or leg curvature.
Abnormal skull or facial shape.
Can cause psychological embarrassment or reduced self-esteem.

4️⃣ Internal Organ Problems

Severe scoliosis may compress:
- Lungs: Difficulty breathing.
- Heart: Reduced efficiency over time.

5️⃣ Long-Term Complications

Bone fragility or early joint inflammation.
Persistent muscle spasms due to poor posture.
Academic or social performance affected by fatigue or appearance.

Treatment of Bone Deformities in Children
Not all deformities require surgery; many improve with medications and physical therapy, especially if caused by nutritional deficiencies or hormonal problems.

1️⃣ Medication-Based Treatment

Vitamin D: Key for rickets and weak bones; can be given as drops, tablets, or injections depending on deficiency. Helps the body absorb calcium and strengthen bones.
Calcium: Supplemented with vitamin D to support proper bone growth and prevent bowing.
Phosphate: Used in certain hereditary rickets with phosphate deficiency.
Hormonal medications: For deformities caused by thyroid issues or growth hormone deficiency; may include synthetic growth hormone or thyroid treatments.
Medications for rare bone disorders: Such as bisphosphonates for osteogenesis imperfecta.
Pain relief and supportive supplements: Safe analgesics for children and nutritional supplements (iron, zinc) if growth is slow.

2️⃣ Surgical Treatment
Cases requiring surgery:

Clubfoot: If casts or braces fail.
Scoliosis: If spinal curvature is severe.
Leg length discrepancy: If it significantly affects walking.
Severe bow legs or knock knees.
Craniosynostosis: If early skull closure pressures the brain.
Congenital hand or finger deformities (e.g., fused or extra fingers).

Types of Surgeries:

Osteotomy: Cutting and realigning bones, fixed with screws or plates.
Spinal fusion: For severe scoliosis or kyphosis using rods and screws.
Limb lengthening: Gradual bone lengthening with internal or external devices.
Skull and jaw surgeries: Correct head or facial deformities affecting brain or breathing.
Hand and finger surgeries: Separating fused fingers or removing extra digits.