Growth & Developmental Concerns

Parents watch their children grow more closely than anyone. That attention is exactly why so many growth and developmental concerns are first raised at home: a baby who always turns her head to one side, a toddler who is still cruising furniture at 16 months, a 7-year-old who wakes up crying about aching legs, or a teen whose shoulders seem to be rounding forward. These moments raise a fair question. Is this simply how my child is growing, or is something wrong?

Our pediatric orthopedic team in Gilbert helps families answer that question with a careful exam and clear explanations. This page covers the newborn and infant conditions we see, differences in the hands and feet that children are born with, growing pains and early motor milestones, posture and flexibility concerns, bone health, and the orthopedic care we provide for children with neuromuscular and genetic conditions. If you are concerned about the shape of your child’s legs or how their feet point when they walk, our bone and joint disorders hub covers those topics in depth.

Growth Shapes Every Part of Pediatric Orthopedics

Growth is not a steady climb. Children grow quickly in infancy, settle into a slower and fairly even pace through the elementary years, and then accelerate again during puberty. The timing of that teenage spurt differs by gender and from child to child, as the chart below shows.

Several of the concerns on this page cluster around these phases. Growing pains are most common during the slower, steady years of early and middle childhood. A rounded upper back from Scheuermann’s disease often becomes noticeable during the teen growth spurt. Conditions that affect bone strength or muscle balance can become more obvious as a child grows bigger and heavier. Knowing where a child sits on this curve helps us predict how a condition is likely to change and when treatment, if any, will work best.

Newborn and Infant Concerns

Torticollis

Congenital muscular torticollis is a tightening of one neck muscle, called the sternocleidomastoid, that causes a baby to tilt the head to one side and turn the chin toward the other. It is often linked to the baby’s position in the womb or a difficult delivery, and some infants have a small, soft lump in the neck muscle in the first weeks. Parents may notice that their baby always looks in one direction, has trouble feeding on one side, or develops a flat spot on the back of the head. Most babies improve with a home stretching routine and physical therapy, particularly when it starts in the first few months. Because torticollis is also associated with hip dysplasia, we check the hips at the same visit. Our torticollis page explains the stretching program and what to expect.

Brachial Plexus Birth Injury and Erb’s Palsy

The brachial plexus is the network of nerves that runs from the neck to the arm. During birth, especially a difficult delivery, these nerves can be stretched, which weakens the arm. The most common pattern, Erb’s palsy, affects the shoulder and elbow, so the arm hangs by the side with the hand turned inward. These injuries affect about one or two babies per thousand births. Many babies recover substantial function in the first few months as the nerves heal. Gentle range-of-motion exercises help keep the joints flexible during recovery, and we refer infants who are not improving as expected for specialized nerve evaluation. Our brachial plexus birth injury page covers the recovery timeline.

Hand and Foot Differences Present at Birth or Early Childhood

Some children are born with differences in how the fingers or toes are formed. Others develop them in the first few years. Most of these differences do not cause pain, and families often want to understand whether treatment will help function, appearance, or both.

Extra Fingers or Toes (Polydactyly)

Polydactyly means an extra finger or toe. Pediatric hand and foot specialists see it more often than almost any other digit difference in newborns. The extra digit is most often on the pinky side and may be a small nub of soft tissue or a fully formed finger or toe with bone and a joint. Treatment depends on how the extra digit is attached. Small, soft-tissue digits are sometimes removed in infancy, while those with bone are usually removed with a short surgery when the child is older, often before walking for toes or before school age for fingers, so that shoes fit and hands work normally. Our polydactyly page explains the options.

Webbed Fingers or Toes (Syndactyly)

Syndactyly is when two or more fingers or toes are joined. The connection may involve only skin or may include bone. Webbed toes rarely cause problems and often need no treatment. Webbed fingers are more likely to affect hand function and growth, especially when fingers of different lengths are joined, and are usually separated surgically in early childhood. Our syndactyly page covers timing and recovery.

Trigger Thumb

Pediatric trigger thumb occurs when the tendon that bends the thumb cannot glide smoothly through its tunnel, so the thumb tip stays bent. It is usually noticed between ages 1 and 3, and there is often a small, firm bump at the base of the thumb. Some cases loosen with time or splinting, while persistent ones are corrected with a short outpatient procedure. Our trigger thumb page explains how we decide.

Curly Toes

Curly toes are toes that curl under the neighboring toe, most often the third and fourth toes on both feet. The condition tends to run in families and is caused by a tight tendon. It is usually painless, and many cases improve as children grow. Taping has not been shown to correct it. If a curled toe causes pain, blisters, or nail problems once a child is older, a simple tendon release can straighten it. Our curly toes page describes what to watch for.

Accessory Navicular

An accessory navicular is an extra small bone or piece of cartilage on the inner side of the foot, just above the arch. Many people have one without ever knowing it. In some children, it becomes painful during the preteen or teen years, often with a tender bump that rubs inside shoes or during activity. Most cases settle with supportive shoes, rest, or a walking boot, and surgery is reserved for pain that persists despite those measures. Our accessory navicular page covers treatment.

Growing Pains

Growing pains are one of the most common reasons parents call us, and one of the most reassuring diagnoses we give. The name is a little misleading, since no evidence shows the pain comes from bones growing. The aches are thought to relate to muscle fatigue after an active day, and they are most common in children between about 3 and 12 years old.

Classic growing pains have a recognizable pattern:

• Aching or throbbing in both legs, most often the front of the thighs, the calves, or behind the knees
• Pain in the late afternoon, evening, or at night, sometimes waking a child from sleep
• Complete relief by morning, with a child who runs and plays normally the next day
• No limp, swelling, redness, or tenderness in a joint
• Comfort from massage, a warm compress, or a dose of children’s pain reliever

Pain that does not fit this pattern deserves an evaluation. Call us if the pain is in only one leg, is felt in a joint, is present in the morning or during the day, causes a limp, or comes with swelling, fever, weight loss, a rash, or unusual tiredness. These features suggest a different cause that should be identified. Our growing pains page explains what parents can do at home to ease nighttime aches.

Walking, Motor Milestones, and Coordination

Every child reaches motor milestones on a personal timeline, and the normal range is much wider than many parents expect. The World Health Organization tracked healthy children across several countries and found that independent walking began anywhere from about 8 to almost 18 months of age.

Children who crawl late, scoot on their bottoms instead of crawling, or skip crawling entirely often walk on schedule. Late walking is generally worth discussing with your pediatrician if a child is not walking independently by about 18 months, or sooner if a child has lost skills, seems unusually stiff or floppy, or uses one side of the body much more than the other. A pediatric orthopedic exam can rule out hip, foot, and muscle tightness problems, and we coordinate with pediatricians and therapists when a broader developmental evaluation is needed.

Clumsiness and Frequent Falling

Toddlers and young children fall often, and some are simply less coordinated than their peers. Frequent falling becomes more concerning when it is getting worse rather than better, when a child has trouble running, climbing stairs, or getting up from the floor, or when it comes with muscle weakness, pain, or a change in walking. These signs can occasionally reflect a muscle or nerve condition and should be evaluated.

W-Sitting

W-sitting means sitting on the floor with the knees bent and the feet out to each side, so the legs form a W shape. Many children find this position comfortable because of normal inward rotation at the hips. For most typically developing children, W-sitting is harmless and does not cause hip problems. It is worth mentioning at a visit if a child sits only this way and cannot sit cross-legged, or if it comes with frequent tripping or other motor concerns. Our W-sitting page explains when to simply encourage variety.

Posture and the Growing Back

A rounded upper back is common in teenagers, and most of the time it is a posture habit, made worse by long hours looking down at phones, tablets, and schoolwork. This postural roundback straightens when a teen stands tall or lies flat, and it improves with core and upper back strengthening.

Scheuermann’s disease is different. In Scheuermann’s kyphosis, several vertebrae in the upper or middle back grow into a wedge shape instead of a rectangle, creating a stiff, sharper curve that does not fully correct when the teen tries to stand straight. It usually becomes noticeable during the growth spurt, is more common in boys, and may cause aching after long periods of sitting or activity. Diagnosis is confirmed with X-rays. Many teens are treated with exercise and physical therapy; some benefit from a brace while they are still growing, and surgery is rarely needed. Our Scheuermann’s disease page covers each option. Side-to-side curves of the spine are covered on our scoliosis page, which sits in our bone and joint disorders section.

Flexible Joints and Hypermobility

Children are naturally more flexible than adults, and some have especially loose joints. They may bend their thumbs back to their wrists, hyperextend their elbows and knees, or slip easily into splits. Joint hypermobility is common in young children and usually decreases with age. For most kids, it causes no problems and can even be an advantage in activities like dance and gymnastics.

Some hypermobile children have frequent aches after activity, tire easily, sprain joints often, or feel a joint partially slip. We assess flexibility with a standard scoring system, look for patterns that suggest an inherited connective tissue condition, and focus treatment on strengthening the muscles around loose joints. Our joint hypermobility page explains what helps.

Bone Health and Bone Strength

Strong bones are built during childhood and adolescence. Most children with a broken bone or two simply had an accident, but bones that break repeatedly or after very minor falls can signal a problem with bone strength.

Rickets and Vitamin D

Rickets softens the bones of growing children, most often caused by a lack of vitamin D or calcium. It can cause bowed legs that worsen rather than straighten, thick wrists and ankles, delayed walking, bone pain, and frequent fractures. Even in sunny Arizona, children can be low in vitamin D because of sunscreen use, time spent indoors, darker skin, or certain diets. The American Academy of Pediatrics recommends vitamin D supplements for breastfed infants. Doctors diagnose rickets with X-rays and blood tests and usually treat it with supplements, often in partnership with your pediatrician or a pediatric endocrinologist. Our rickets page explains the signs.

Osteogenesis Imperfecta

Osteogenesis imperfecta (OI), sometimes called brittle bone disease, is a genetic condition that affects collagen, the protein that gives bone its strength. Children with OI break bones easily, sometimes with little or no trauma. Other signs can include a blue or gray tint to the whites of the eyes, loose joints, short stature, and later-life hearing loss. OI ranges from mild to severe. Orthopedic care focuses on treating fractures, protecting bones, and, for some children, placing rods inside the long bones to strengthen them and reduce deformity. We work closely with genetics and bone health specialists. Our osteogenesis imperfecta page covers the types and treatment.

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Orthopedic Care for Neuromuscular and Genetic Conditions

Children with conditions that affect the nerves, muscles, or skeleton often need ongoing orthopedic care as part of a larger team. Our goal is to support comfort, mobility, and independence as they grow.

• Cerebral palsy.
  According to the CDC, cerebral palsy is the most common motor disability in childhood. Muscle tightness can pull on the hips, knees, and feet as a child grows. Regular hip X-rays, often called hip surveillance, help catch hip displacement early, and treatment may include bracing, therapy coordination, injections, or surgery.
• Spina bifida and muscular dystrophy.
  These conditions can affect the feet, hips, and spine over time. We monitor alignment and work with families and other specialists on bracing and positioning.
• Skeletal dysplasias, including achondroplasia.
  Achondroplasia is the most common form of skeletal dysplasia associated with short stature. Children may develop bowed legs, spinal narrowing, or other alignment concerns that need periodic orthopedic review.

Our neuromuscular and genetic conditions page explains how we coordinate with neurologists, physiatrists, geneticists, therapists, and orthotists.

Ages are typical. Sources: AAOS OrthoInfo, POSNA OrthoKids, WHO, CDC, and AAP.

Signs Worth Bringing to a Specialist

Use this list as a guide. If something on it matches what you see at home, it is reasonable to schedule a visit:

• A baby who always tilts or turns the head the same way, or has a lump in the neck
• An arm that seems weak or does not move normally after birth
• An extra, joined, or stiffly bent finger or toe
• Leg pain that is one-sided, present in the morning, or comes with a limp, swelling, or fever
• Not walking independently by about 18 months, or losing motor skills that were already learned
• Falling more over time instead of less, or difficulty getting up from the floor
• A stiff, rounded upper back that does not straighten when your teen stands tall
• Joints that slip, sprain often, or ache regularly after normal activity
• Bones that break after very minor bumps or falls, or more than one unexplained fracture

How We Evaluate Growth and Developmental Concerns

Developmental questions are best answered over time and in context. At the first visit, we review your child’s birth history, growth records, milestones, family history, and any changes you have noticed. We then examine posture, flexibility, strength, joint motion, and, for older babies and children, how your child sits, crawls, stands, and walks. For infants, we pay close attention to the neck, shoulders, and hips.

Imaging is used only when it might change the plan. We may recommend X-rays for a curved back, a suspected bone health problem, or a hand or foot difference that involves bone. Blood tests may be ordered for suspected rickets or other bone health concerns. Many visits end without any imaging.

For many children, the most valuable tool is a follow-up visit. Watching how a concern changes over three to six months often tells us more than any single test. When you need a broader picture, we work alongside pediatricians, physical and occupational therapists, geneticists, endocrinologists, and neurologists so your family isn’t left coordinating everything alone.

Frequently Asked Questions About Growth and Development