Is This Normal? A Guide to Your Child’s Hips, Knees, and Feet

Podcast Transcript

Dr. Richard So:

Welcome to Little Health, a Cleveland Clinic Children's podcast that helps navigate the complexities of child health one chapter at a time. In each session, we'll explore a specific area of pediatric care and feature a new host with specialized expertise. We'll address parental concerns, answer questions, and offer guidance on raising healthy, happy children. Now, here's today's host.

Dr. David Gurd:

When you notice your child isn't walking quite like other kids or you see a curve in their legs that doesn't look right, it brings up a lot of worries. I'm Dr. David Gurd, an orthopedic surgeon and the head of pediatric spinal deformity surgery at Cleveland Clinic Children's. Today, we're talking about developmental issues like hip dysplasia, clubfoot, and bow legs. We'll explain why these conditions happen, why early action is important, and the best ways to keep your child active. Joining me today is my friend and colleague, Dr. Ernest Young. He's a pediatric orthopedic surgeon at Cleveland Clinic Children's. Welcome to Little Health, Dr. Young.

Dr. Ernest Young:

Thanks for having me.

Dr. David Gurd:

Please tell us a little bit about yourself.

Dr. Ernest Young:

I'm a pediatric orthopedic surgeon here at the Cleveland Clinic. I'm originally from California where I spent most of my life. I came here for med school many years ago, and I'm still here. It's been great. Cleveland's great.

Dr. David Gurd:

We're glad to have you here. Thank you, and thank you for joining us today. So we'll start with identifying the issues. Could you explain the three areas where parents usually notice issues, the hips, the knees, and feet, and discuss what's happening?

Dr. Ernest Young:

We'll go in order. Probably the most common discussion that we have in our clinic isn't the hips or the knees. It's usually the feet, because that's the thing that most parents are looking at the first, especially as you've watched your child develop an age and you're looking for them to make that first step. How do they make that first step? What is the foot doing? You look at their feet, you look at your feet. You're thinking, is my child walking the same way as me? Is their foot pointing the same direction? So if we start at the feet, a lot of the issues that we discuss are, does my child have a flat feet? Is it the foot look normal? Does it hit the ground at the normal way? And then if you look at the way the foot is pointing, the number one complaint we also get is my child's foot is turning in.

If you look at, probably you're looking down at your own feet when you walk, you see that your feet point outwards. And when your child's feet point in, it always brings up concern that maybe there's something wrong with my child or there's something else going on. So we start with the feet at the bottom. And then if you go up to the knees, another thing is most people are able to look down and look at your knees. And you see that for most people, your legs are straight. Your knees are together, your ankles are together. But a lot of babies that are infants and toddlers, though knees aren't necessarily together, they'll have bow legged or knock knees, and that's normal for that age. And so the knees and the legs are going different directions, and that also brings up concern.

The hips aren't so much a concern. It's hard for parents to see. It's mainly a concern for pediatricians, but oftentimes you're looking at the hips, mainly for the concern of is my child's one leg longer than the other? Are there hips within the socket? And so you're looking at the thigh creases, you're looking at the anatomy, or just globally what the hips look like to your eyes. And those are the main things that we see. A lot of this stuff that we'll discuss in the future has to do with the fact that a lot of what you're seeing in your infant and toddler is a dynamic process. You as an adult are done growing, so there's nothing that's going to be changing with your legs, but in a lot of these infants and toddlers and even young kids, their legs are growing, they're rotating, they're changing as they get older. And so it's a dynamic process.

Dr. David Gurd:

So when a parent sees bow legs or pigeon toes, how do they know if it's normal development phase or if it's a red flag?

Dr. Ernest Young:

I think for pigeon toes, most parents are worried, "Is my child normal?" And what we tell most parents is that if the child is in towing, there are three main causes for an in towing in a toddler. And if you start at the bottom, you're looking at the feet, some babies have little curved bean-shaped feet. We call that metatarsus adductus. That can resolve on its own up to age four or five, does not need any intervention, but that can make your child look like they're in towing. The next thing is a lot of kids, a lot of babies will have tibial torsion, which is our term for when your actual tibia or your shin-bone is twisted inwards. And that actually brings the feet in towards the middle, makes them look like they're pigeon-toed. That can resolve up to age three.

And then the last thing to change is the actual femur bone. So your thigh-bones. If you're looking down at your femur, looking down at your knee, just imagine the whole bone, your whole thigh twisted inwards, and that causes your feet to point in. And that can un-rotate in a child even up to age 10. So there's all these things, like I said, the feet up to age five, the tibia's up to age three, the femur's up to age 10. All these things are changing slowly as the child ages. And I think the key thing when you're thinking about this is this abnormal or is this normal? Usually if it's one-sided in towing and that one other side is not in towing, as in if you have one side as normal, one side is not, then that's usually bad. You want to have symmetrical or you want them to point the same way, if that makes sense.

And also if it's cause of tripping or cause of pain, that's a whole other issue. That, of course, parents are welcome to bring the child in for evaluation to see whether it really is a problem. And then if we're talking about bow legged, so there's a difference between, we say bow leg and knock knees. Bow leg is colloquial term for when the... If you're looking at the actual legs of your baby and it makes like a O shape, and as the knees go outwards and the feet goes in and there's space between the knees, that is very normal up to age... We say it's usually normal up to age two. So what actually happens is that a lot of babies are born with their legs rounded out or the knees going out and as they get older up to age two, it's usually the legs start to straighten. And then we say it rebounds.

And then what happens is that you get knock knees, which is the knees go inwards, the legs go outwards. There's essentially at that point, most of the kids have their knees touching, but their ankles are far apart. And that can usually happen. The maximum we usually say that happens is at age three. And then as the child gets older, this can self-resolve up into age seven or eight. So those are the main things we were talking about where bow legs and into in which we say is normal of the infant. And we predict that most of these children will eventually develop out of them.

Dr. David Gurd:

Why is screening for hip dysplasia so critical and how could it be missed during a standard exam?

Dr. Ernest Young:

The reason why it's so critical is just the fact that the earlier you treat it, the earlier you catch it, the more effective you are at treating it and the less invasive the treatment is. So we know just from studies that if you're able to catch a baby, especially a baby younger than six months with hip dysplasia, that we can treat it non-operatively usually in what we call Pavlik harness, which is this parachute harness the baby wears all the time until their hips normalize. And then if that works, 95% of the time is effective and your child will be normal and it doesn't require any future surgery. But if you catch it later after six months or even beyond that, then what happens is that you have the hip not really in the socket or partially in the socket. And at that point, usually the harness is non-effective.

Also, the child's baby is usually too big to put in a harness and will overpower the harness. And so usually at that point you're talking about more invasive and higher level of intervention, which is less predictable than the Pavlik harness. So it's really helpful to find the baby very young that still has a problem. That's why screening is very critical. The American Academy of Pediatrics has guidelines on what kids should be screened. And when I say screen, that means ultrasound screening.

Most infants, regardless if you have any sort of risk factors, most infants will be evaluated when they're firstborn by the neonatologist in the nursery, will be seen by their pediatrician, usually multiple times before they're even one month old. And both of those doctors are checking to see whether or not your child has hip dysplasia with certain physical exams. But then if there are any concerns on the physical exam or your baby has risk factors, then your baby gets referred for ultrasound.

And the risk factors that I think the American Academy of Pediatrics recommends are if there's a family history of hip dysplasia, if your baby was breeched inside you at any single time, not just third trimester, if your baby was breeched at any time, or if there's any issues with the fluid that the baby was inside you, so we call oligohydramnios, which is when there's not enough fluid for your baby to be inside the womb, and therefore the baby's more cramped inside the womb, which is a risk factor hip dysplasia. If your baby has any of those risk fractures, your pediatrician should and probably will refer you for an ultrasound. And again, the whole point is that we want to catch it as soon as possible to treat it as soon as possible because the earlier we treat it, the more effective the treatment is.

Dr. David Gurd:

When discussing hip dysplasia, we use terms like click and clunk, a noise that can occur in a child's hip. What exactly does that mean?

Dr. Ernest Young:

So I think it more like if a click, I think most people can conceptualize and think of a click. It happens all the time. Most of us can crack our knuckles. I tell the patients that it's this click that happens. Usually what happens is that the tendon is pushing, either a joint is moving really fast in its range of motion and the fluid inside a joint makes a sound, or a tendon is going over a piece of bone and it makes that click. It's sudden, sometimes it's not reproducible. And you're thinking, did that really just happen? Did something happen? Did you feel that? Did you hear that?

Clunk to me is more like a tectonic shift. Something is moved inside the body. You will see something change with your eyes and your body. And in this situation, in babies, we're talking about hips. And so what that click or clunk, which gets confused with each other, what they're both referring to is that in the situation where the hip is coming in and out of the socket, when it's out of the socket and you push it into the socket, like I described, it's a clunk because it's like a global tectonic action.

The hip all of a sudden shifts into place and you feel this sudden movement and it stays still. It's a sudden movement, may or may not have a sound. The click is something that you may feel or hear, and it happens really quickly, but usually is not hip dysplasia. But oftentimes these terms get mixed up with each other because not everybody has experience to feel that feeling of putting a hip back in place or dislocating a hip. I think in the end of the day, regardless if it's a hip click or clunk, it's probably beneficial to get an ultrasound to make sure that your baby's hip is normal.

Dr. David Gurd:

Can certain baby wearers, jumpers, or walkers cause hip dysplasia?

Dr. Ernest Young:

We're traditionally taught that none of those things necessarily cause hip dysplasia, but you have to think about how would you cause hip dysplasia in a baby. And we say that if you swaddle your baby, which is essentially you trap your baby's legs together so that they can't spread apart, and you make them straight, like in some Native American cultures where they swaddle your babies, that can cause hip dysplasia because you're forcing the hips in, and that causes the hip to want to come out of the socket.

So the natural position that you want your child in is that you want them to have their legs spread, their hips flex. So if we're talking about a baby carrier, most back facing, which is to say like in a baby be arm where the baby's faces towards the mother's stomach or the father's stomach and their legs are spread out across your stomach or your abdomen, that's actually the position that we want the baby in with their hips spread apart. It's no different in the position if you, like I've done multiple times with my children, you pick up your baby, you put your baby on your hip and your baby's hugging you, side-saddle on you. That position with the legs apart is where you want them to be. There are some carriers that may not hold at that position, but as long as their legs aren't trapped, I don't believe it's dangerous to your baby.

Dr. David Gurd:

What about W sitting? Kids sit in a W shape all the time with the feet to the side of their bottom. Is this damaging their hips?

Dr. Ernest Young:

I think in the past we were taught, and we thought that it was damaging. If you look at the W-sitter, the main reason why some children can W-sit is that they're, like we discussed before, their femurs are still twisted in. Usually, it's a child underneath the age of nine. It may or may not a boy or a girl. I feel like it's more prominent in girls. And what happens is that when they sit down, their legs naturally want to go in that position. It is more comfortable for that position. And in the past, we thought it was wrong. We thought that if we stopped our children from doing that, that it would somehow prevent future problems that would inhibit your child's ability to remodel or develop normally.

And we know now that it doesn't matter per se, that it doesn't matter if your child sits in a W position. I personally have three daughters. I think two of them still W-sit. I have never told them not to W-sit. A lot of times, especially if grandma comes, they'll say something about the W-sitting, but there is no scientific data to say that it's wrong.

Dr. David Gurd:

Let's do a deep dive into clubfoot. What's the structural difference between a positional foot and true structural clubfoot?

Dr. Ernest Young:

I think this is, if you were just looking at it, basically if you were to go to Google image both of these, it's really hard for a normal layperson to see the difference. And I think the key difference really is that a clubfoot can't just be corrected if you just pushed on the foot. If it's a positional foot deformity is when, say, for example, the baby is inside his or her mom's stomach and the foot is trapped in a position and the foot's trapped for several months and they come out and the foot, like for example, the foot may be completely up and stuck on the tibia. What happens is that those are positional foot deformities that it got stiff in there, they were stuck in that position. And usually what happens is that you see the baby and you take your hand and gently without any force is you maybe use one finger and you can push the foot into a normal position that usually is not a club foot.

Clubfoot characteristically is stiff, not just foot going foot up and down, but also inwards. And you can't just take one finger, let alone two fingers and just correct it on its own. And that's the key difference and that's easy for most people to evaluate. If you're able to make the foot normal with your hands without any force, then it's not a clubfoot.

Dr. David Gurd:

So for the real clubfoot, what is the Ponseti method for treatment and how does that process work?

Dr. Ernest Young:

So Dr. Ponseti was a very famous surgeon out the University of Iowa. He was actually from Spain. He came here during the Spanish Revolution and he did a lot of work, seminal work, not just in clubfoot, but in pediatric orthopedics in general. But one of his lasting legacies is his Ponseti or Clubfoot casting treatment, which actually did not become fully embraced and popular until the late '90s, early 2000s. And you have to think about prior to the Ponseti casting, most of the treatment for club feet was just surgery, surgery, surgery. And that usually results in stiff and sometimes painful foot. And so with Ponseti casting, what happens is that you put a child in a cast over space of weeks. You come in every single week, you get a new plaster cast, the cast goes from the foot all the way up to the thigh, and you're just gently stretching the foot.

Every single time they come in, you're stretching the foot to kind of rotate outwards. So the normal clubfoot is sort of curled in like a bean, and then you're slowly rotating the foot out over the space of weeks and months with the cast. Usually takes about somewhere between six to eight casts. And then once the casting is over, then we usually have to, and this is true in Ponseti's work, usually about 80 to 90% of these kids end up needing some small procedure. What we do is we release the Achilles tendon in the back of the heel that makes the foot being able to come up, and that will allow the baby to get into the Ponseti shoes and bar, which we'll talk about next.

But the whole process of casting, it's not painful. Most babies cry, and that's not because it's painful. I found in my experience that babies hate two things, they hate being cold and they hate being held still. And so as you can see, when we're holding the foot in one position, they're going to cry because you're holding their foot and they want to move it, but the whole process is not painful.

Dr. David Gurd:

So after casting, you're going to use certain types of braces after. The question is, how do parents survive the bracing stage? How long does a bracing stage last? And what are the biggest hurdles for sleep and mobility?

Dr. Ernest Young:

If you've looked this up, you could look up a Ponseti shoes and bar and all it really is two shoes connected with one bar. And what it's doing really is that the foot, I tell parents the clubfoot, if left alone, after the cast, say after the casting, after the Achilles tenotomy, the foot will almost look normal. But if you leave it alone, the foot remembers and wants to go back to where it was when the baby was firstborn. And so what the shoe does, the shoe not only keeps the ankle up, but usually uses the other foot to sort of push the baby's foot back towards the position that we had them in the casting. And so it's mainly a maintenance thing. And what we say is that after the Achilles tenotomy, the baby is usually in the shoes and bar full time for three months and after that nighttime only.

And yes, it's a real burden to parents because I found that kids really, they don't necessarily hate the shoes, but they really hate the bar. And it's really about whether or not you're willing to go through that process of letting your baby be uncomfortable for a little bit because the shoes and bar don't harm them. Whether or not you can as a parent withstand their discomfort until they get used to it, because you have to think about what happens if you don't use it. And that is that we know that if the kids use the shoes and bar and they're supposed to use it up to age five, that the recurrence rate of clubfoot is less than 15%. It's from 10%. But if you don't use the shoe and bar, the recurrence rate is somewhere in that 75 plus percent. So it's directly related. The recurrence of clubfoot is directly related to whether or not the child is still wearing the brace.

And I understand it's very difficult, especially when the baby learns how to take off the shoes and bar, you might not be able to get it back on, especially when they're that old and that smart and that dexterous. But if you're able to get your child to wear it for as long as humanly possible, the chances of him or her needing any intervention are lower.

Dr. David Gurd:

Let's move on to growth and leg alignment. At what age should bow legs and knock knees straighten out and when does it become a medical concern?

Dr. Ernest Young:

So for bow legs, as we discussed, bow legs are very common in infants and toddlers younger than age two. And we say that usually the kids will start outgrowing it between one and two. And by age two, they might at that point be straight, if not much better than they were at age one. And that progression I think is really hard for parents to see because you're seeing your child every single day. It's hard to see whether or not it's improving, especially if you're trying to think, "Oh, what did my baby look like two months ago?" And what I tell parents is that if you're worried about it or you're concerned, especially because sometimes I see them age one, I tell them to wait until age two, I tell them to take a photo maybe every single month, and that way they can see the progression over the space of months as opposed to trying to see a difference every single day.

That's one thing. And I think another thing to be worried about is like, when is it wrong? When is it bad? And that's usually if the baby's bow leg is not getting straight by age two or in fact getting worse, that's bad. If it's one-sided only, it's usually always bad or it's causing some sort of disability with their walking. That's also bad. And it's easy for you to go see a pediatric provider, a pediatric orthopedic provider to be evaluated. But as we say, bow legs normal up until around age two. Then what happens, and we call it's like a pendulum, you start with bow leg and you go to straight at age two, and then it goes the opposite direction. And now instead of bow legging, you have what we call knock knees, which is when your knees are together and your ankles are spread out, you have the gap between your ankles.

And that is the maximum we say around age three. And now that should resolve by age seven, just like with the bow leg, it's bad if it's one-sided, bad if it's causing pain or bad. If it's not better by age seven, there are definitely some procedures that we can do as they get older to correct it, but there isn't really anything that the parents need to do. There's no braces, et cetera. There's no exercises. It's really just watching.

Dr. David Gurd:

Why are injuries or alignment issues near a growth plate treated differently than adult bone issues?

Dr. Ernest Young:

This relates to whether or not your child is really just a mini adult. And the answer is no. Growth plates are there for a reason. What happens is that the child grows, these growth plates, which are actually just thin layers of cartilage, they grow and your child's bone grows. And so in an adult, if we have some sort of injury or fracture or some sort of deformity in the bone, it's that way forever. And we can't rely on your bone to "grow straight" like we would in a child.

And so a lot of this growing straight or this potential of your child to get a broken bone, have a twisted bone, and eventually be normal has to do with the body's ability to remodel, which therefore has to relate to the growth plate's ability to grow. And when there's a fracture or injury near the growth plate, whether it's a fracture or an infection, the capability of the growth plate to continue to grow is that question is under jeopardy.

I find that it varies dramatically based on the type of injury and the age of the patient, but usually it requires some sort of long-term follow-up to make sure your child's growth plate continues to grow like it's supposed to or grows in a predictable way so that it needs to be monitored. Like for example, if there's a growth plate injury, it may not be that the whole growth plate closes, but part of it closes and may need to be managed and monitored for over the space of years. And that's one of the main difference between kids and adults other than the obvious differences. But just that growth plate injuries usually require some sort of long-term monitoring and usually requires a pediatric orthopedic specialist to monitor them because this is the thing that we're trained to do to watch the child see whether or not they need an intervention or nothing at all.

Dr. David Gurd:

Do all kids with flat feet need expensive orthotics or is barefoot is best a better approach?

Dr. Ernest Young:

I think this discussion, I always have my parents, always there's a conflict of interest in my part because I have flat feet. I think that we are trained to say that most children, especially toddlers, half flat feet because they're ligamentously lax or not strong enough, and essentially 100% of the little kids have flat feet. The question is it really flat? Is it actually just a flexible flat foot because they have loose ligaments? And I think the key thing is to see, can your child go on tiptoe? Do they have an arch? Do they have an arch at any point? Is the foot stiff? Is it flat and staying flat like it doesn't move at all? Is it causing pain? In those situations, painful flat foot or a stiff flat foot. Those usually require some sort of intervention, whether it's orthotics or exercises or braces.

But most of the time, 99% of the time, most children just have flexible flat feet and they don't have any symptoms and there really doesn't need to be anything done. And we've tried in the past, it's not that braces, orthotics will permanently change your child's foot. If your child's going to have flat feet, it was their fate to have flat feet. There's nothing that you necessarily need to do. And then if it's causing them problems, usually the first step is either a running shoe or a shoe of arch support or orthotic. And again, that has to rely on whether or not your child wants to use that shoe or orthotic. I think the key thing here is that if your child has a flexible, non-painful flat foot, you are not doing your child harm by not doing anything about it. A.

Nd barefoot, going around barefoot, I think doesn't just strengthen the foot muscles, but also like the leg muscles. I wouldn't say barefoot is best based on the household and whether or not you wear shoes in the house and whether or not your spouse wants your child's feet to be dirty, but it's entirely up to the parents. And I think the key thing here is that you're not doing your child harm by leaving their flat feet alone.

Dr. David Gurd:

Can Tech Neck or heavy backpacks be issues to children's developing spines?

Dr. Ernest Young:

I don't think there's any studies that show that it actually causes permanent damage. Can it cause pain and discomfort? Yes, it can. I've had my own issues with my neck. My son has had his own issues with his back from his backpack and leaning over the computer to get as close to the screen as possible. So I think there are guidelines on how heavy the child's backpack should be. I think it's on the American Academy of Pediatrics. They have guidelines on it, but rest assured that none of the things that, if your child is looking down at their screen all the time, that's a whole other issue. But if your child is looking down at the screen all the time or wearing a heavy backpack or hunched over the computer like my child, it doesn't cause any permanent damage. It does cause pain. It should be corrected in the same way your ergonomics at work should be corrected so that you can avoid long-term discomfort, but it doesn't, like I said, doesn't cause any long-term problems.

Dr. David Gurd:

Let's finish up with treatment and long-term outlook. Parents are often terrified of the concept of breaking and resetting bones. When is surgery necessary?

Dr. Ernest Young:

I think this is a loaded question because this covers lots of different things. And I think that the number one, if we're talking about breaking a bone to make it straight, which is what we term an osteotomy, usually we're doing this because a bone needs to be in a different position entirely, or it's say your child broke and it broke crooked and that crookedness, we don't think that the child will grow out of it. And therefore it needs to be broken, essentially broken or cut and put back in place. And the rationale to do it is usually, like I said, it's because we don't think your child will overcome it. And not only that, but that if they don't overcome it, that the deformity, the crooked bone or whatever will cause some sort of long-term problem. And that's why we're doing the procedure.

I like to think of it, these cutting surgeries almost like it was just another fracture and that we're just putting the bones, making it heal in a certain position. It does seem like a lot, especially if you start saying stuff like cutting and sawing and that type of stuff. But if you conceptualize it as a fracture that we're trying to make the bone heal in a certain position, I think it's easier for most people to contemplate and comprehend that.

Dr. David Gurd:

For kids with hip or foot issues, are there specific sports they should avoid?

Dr. Ernest Young:

So for the vast majority of foot issues, there aren't any specific activities they should avoid. And the real question I think is, this is a philosophical question is, can you actually get your child not to do the activities you don't want them to do? But that's besides the point. For hip issues, for hip dysplasia, as long as the hip is in the socket, there are no restrictions to your child can do what they want. I think the only concern is that some patients that have what we call leg cath Perthes disease or Perthes disease, usually those children are under surveillance by us because they have a hip disorder that causes the hip to change shape based on how old they are and what they're doing. And those kids in particular, we limited their athletic activity and their weightbearing activity for a short period of time, but that's the only pathology that I can think where we're actually making children stop what they're doing. But for the vast majority of hip and foot issues, usually there are no restrictions.

Dr. David Gurd:

What are things a parent should watch for in their child's gait that warrant an immediate specialist visit?

Dr. Ernest Young:

I think that some of this is based on our earlier discussion, which is deformity. And like I said previously, if your child has a deformity or say something wrong with one leg and not the other leg, the one leg looks different than the other leg, that's usually always bad. That's the setting of deformity. And then if we talk about trauma, they just fall. They injure themselves, something happens, they're hurting, they're limping, when do I need to bring my child in?

I think that varies for most people. Most parents, if your child has a broken bone and it's obvious, you can see that the limb is twisted or in the wrong position or you're feeling their arm and you feel the bone separated, then yes, that child should go to the emergency room ASAP. But if you're in a position like most parents where your child may have fallen down and they're limping and you can't find any particular where they hurt, I think a lot of times most parents will give their child some ibuprofen, rest for a little bit, and sometimes they'll put their child to sleep and see what happens in the morning. And then if they're still hurting, bring them in. But if it's a major concern, and if your child is in a lot of pain, it's probably best to bring them in as soon as possible.

Dr. David Gurd:

Well, Dr. Young, that was wonderful. Anything that we failed to ask, anything that you would like to exit with?

Dr. Ernest Young:

I know that parenting is hard and that we're all learning to be parents, and all this is confusing. You hear us talk on this show, you hear your parents talk, you hear random internet specialists talk about the same topic, and you're confused, like, what is right? What is wrong? And you're trying to go through life, trying to be the best parent that you can, and sometimes no one's going to tell you. Sometimes you just have to find out. And I think that's a philosophical answer, but there's nothing from a pediatric orthopedic standpoint that we haven't covered on this discussion, but know that sometimes there isn't a right answer for everything.

Dr. David Gurd:

Well, thank you, Dr. Young, for joining us today. That was wonderful and very informative. If you've noticed anything unusual about the way your child walks or stands, please discuss it with your pediatrician. To schedule an appointment with Dr. Young or another pediatric orthopedic specialist at Cleveland Clinic Children's, please call 216.444.2606. That's 216.444.2606.

Dr. Richard So:

Thanks for listening to Little Health. We hope you enjoyed this episode. To keep the Little Health tips coming, subscribe wherever you get your podcasts or visit clevelandclinicchildrens.org/littlehealth.