Normal Leg Alignment throughout Development
Is my baby bow-legged? Is my preschooler knock-kneed?
If you are one of the many parents who’ve asked yourself this question
when your little bundle-of-joy started the transition from tiny infant
to toddling human, the answer is: yes. It is very normal for a baby to
be born with bowed legs which they will outgrow as a part of normal development.
In fact, your child’s body will go through an incredible amount
of change in the first five to seven years of life, and periods of bowed
legs and knocked-knees can be normal expressions of those changes.
Babies are born bowlegged because of the time spent cramped in the womb.
Infants enter the world in a curled position called “physiological
flexion,” in which the spine, arms, and legs are flexed. Since the
infant is unaccustomed to standing, bowing of the legs is very common
and even expected.
In the exciting first year of development, your baby’s body will
change a great deal as their body prepares for moving upright. Your child
will begin moving freely and accomplishing new skills, including tummy
play, rolling, sitting, crawling, and eventually standing. As your baby
becomes more experienced with these new movements, muscles will get stronger
and their posture will become more erect.
In the spectrum of normal development, bowing of the legs will typically
diminish over the first 18 months as your child starts to pull themselves
up to stand, cruise furniture, and walk. By 18 months of age, or six months
after the onset of walking, this bowing will generally become less apparent,
and the toddler’s legs will briefly straighten out completely. At
this phase of development, the overall posture and alignment-not just
of the legs-will become more similar to that of an adult.
Around three years of age you will see your child’s alignment change
yet again, this time becoming more knock-kneed in appearance. Simply put:
you will see that when your child’s knees are touching, the ankles
are not. Your child’s feet may turn slightly outward. This alignment
may continue through five years of age.
This stage is often a cause for concern or questioning by parents. However,
like the early bowleggedness, the knock-kneed toes-out alignment should
also resolve on its own with natural growth. By seven years of age, your
child’s legs should straighten out again, the feet should face mostly
forward. By this point, your child’s alignment and walking-pattern
will, for the most part, look like that of an adult.
Nevertheless, while these are all normal stages of development, there are
signs that can be monitored to determine when your child’s alignment
or walking-pattern may benefit from talking with a health care provider.
Prominent bowlegged alignment over two years of age, or prominent knock-kneed
alignment, with toes pointing way in or way out over seven years of age,
may be something you want to discuss with your child’s pediatrician.
If you have questions about your child’s leg alignment or walking
pattern, a pediatric physical therapist can perform a full assessment
to determine if your child’s alignment is normal or if treatment-which
could including strengthening, or in some occasions, orthotic use-is needed
to assure your little one remains on-track and thriving.
Sarah Riley DPT, C/NDT, is a pediatric physical therapist at Bozeman Health