From the Guidelines
For a 6-month-old with genu varum (bowleggedness), the best course of action is typically observation and reassurance, as this condition is considered normal developmental physiology at this age. No treatment is necessary for most infants, as bowleggedness naturally resolves on its own in the vast majority of cases by age 2-3 years. Parents should continue with normal developmental activities and regular well-child visits with their pediatrician to monitor the child's growth and development. During these visits, the physician can track the natural progression and resolution of the bowing.
Key Considerations
- If the condition appears severe, asymmetric, or is accompanied by short stature, pain, or other concerning symptoms, referral to a pediatric orthopedist may be warranted to rule out pathologic causes like rickets, Blount's disease, or skeletal dysplasias 1.
- The physiological basis for this recommendation is that infant bowleggedness is typically caused by normal in-utero positioning and will correct spontaneously as the child grows, develops stronger muscles, and begins weight-bearing activities like standing and walking.
Follow-Up
- Regular follow-up with a pediatrician is essential to monitor the child's growth and development, including measurements of height, weight, and intercondylar and intermalleolar distances 1.
- The physician should also assess the child's musculoskeletal system for any signs of lower limb deformity or other abnormalities.
Treatment
- Surgical treatment is not typically recommended for infants with genu varum, unless there are underlying pathologic conditions that require intervention. Guided growth techniques or osteotomies may be considered in older children with persistent deformities, but these decisions should be made on a case-by-case basis and in consultation with a pediatric orthopedist 1.
From the Research
Genu Varum in 6-Month-Old Infants
- Genu varum, also known as bowleggedness, is a relatively common finding in children, with physiologic bowing being the most common type 2.
- At 6 months old, most cases of genu varum are likely due to physiologic bowing, which has a favorable natural history and often resolves on its own 3.
- However, it is essential to monitor the progression of the condition to rule out pathologic bowing, which may require orthopedic referral and treatment 3.
Monitoring and Treatment
- Primary care physicians can manage most children presenting with bow legs, focusing on following the progression or resolution of varus with regular follow-up 3.
- A follow-up protocol using well-child checkups and a simple clinical assessment can be used to monitor varus progression and screen for pathologic bowing 3.
- In some cases, genu varum may be associated with systemic conditions, such as vitamin D-deficient rickets, which requires treatment with vitamin D supplements 4, 5, 6.
Vitamin D Deficiency and Rickets
- Vitamin D deficiency is a common cause of rickets, which can lead to bone deformities, including genu varum 4, 5.
- Serum alkaline phosphatase (ALP) level can be used as a marker for the presence of rickets, but its role in diagnosing genu varum is still unknown 6.
- Treatment of rickets with vitamin D supplements can help prevent and treat genu varum caused by vitamin D deficiency 4, 5.