Question

Case Study #18

You are an LPN/LVN working in a pediatrician's office. Mrs. Pfeiffer has brought her son Robbie in for his 1 year "well-baby" examination. She reports that Robbie has been taking steps and "cruising" along furniture for the past two months, and he took his first steps just a couple of weeks ago. She is concerned because Robbie "looks bow-legged and pigeon-toed. His feet are just so flat." She says, "All my brothers have flat feet, and I'm concerned. I also have a first cousin with muscular dystrophy. I worry about that for Robbie."

What information about normal development of the human musculoskeletal system does Glenda need?

You explain to the mother that it may be too early to know whether Robbie has muscular dystrophy. Glenda is interested in learning more about the disorder. What points will you include in your teaching?

Answer 1

1. The child begins exploring his environment by using his motor abilities of crawling and walking

Most one-year olds can stand alone can take their first steps without holding on

Many on-year olds can walking in some forms of standing , cruising along furniture and taking independent steps

Objects held in each hand are banged together and purposefully release the objects from grasp

Walking is awkward with arms held high

Concerns regarding muscular development in toddlers

• As the legs grow and develop from birth, they normally go through a period of being bowlegged. If the baby stands or lies with their feet together; it is present in both legs
• This bowing is due to forming of legs while the baby is still in the womb when the bones are soft and flexible. The bend in the legs often causes child to walk like pigeon-toed (with feet pointing inwards). A family history of bowing is common
• This period is usually from birth to 18 months, but can sometimes be present until 4 years of age
• The bowlegs usually straighten out with no treatment

Criteria for treatment

For most of the children, the bowing corrects itself with normal growth and development

If you are concerned about the whether or not bowing is getting better, you can take photographs of your child's leg every 6 months to keep a record of the change

Orhtopedic evaluation is recommended if

• the bow legs are severe
• getting worse
• develop after age 5
• involve only one leg and are in combination with severe in-toeing or child is too short