Bow Legs by – Dr. Sameer DesaiDr. Sameer Desai
Bow Legs is a very common condition seen in toddlers. When the legs are brought together then there is a gap at the level of the knee. It happens because of inward bowing of thigh bone or tibia. The deformity may appear to increase on standing.
Daily requirement of calcium
The optimal primary nutritional source during the first year of life is human milk. Premature infants have higher calcium requirements than full-term infants while in the nursery. These may be met by using human milk fortified with additional minerals or with specially designed formulas for premature infants. Around 6 months of age when weaning foods are started, food items rich in calcium should be added. Readymade formulas are fortified with calcium but one must remember that the bioavailability of calcium from human milk is greater than that from infant formulas or cow’s milk. Hence breast feeding should be encouraged. In children age 2-8 years the daily requirement is around 800 mg/d. In children 9- to 18-year-olds the daily requirement is 1,200-1,500 mg/day.
Some of the common items that are rich in calcium are:
|Food item||Quantity||Amount of calcium in each serving|
|Milk||1 cup (240 mL)||300 mg|
|Cheddar cheese||1.5 oz(42 g)||300 mg
|Spinach cooked||½ cup (90 g)||120 mg
|Sardines or salmon with bones||20 sardines (240 g)||50 mg
|Sweet potatoes||½ cup mashed (160)||44mg|
Babies younger than 1 year old need 400 IU of vitamin D a day. Kids older than 1 year need 600 IU or more of vitamin D a day. Our bodies make vitamin D when our skin is exposed to the sun. The recommended exposure to sunlight is at least 30 min every day. There are various fortified food items that have vitamin D. Also medicines are available which can provide the daily requirement of Vitamin D
Physiological genu varus. In most of the toddlers, the legs are curved inwards. They should improve over a period of time. The legs should straighten by 2 yrs. The child should be investigated if the deformity is severe; the deformity is only in one leg, if the child complains of pain and if the child appears unusually short.
Figure 1a: Photograph of a child at year showing bow legs
Figure 1b: Photograph of the same child at 1.8 months showing partial correction
Figure 1c: Photograph of the same child at 2 years showing complete correction
Rickets. It is a condition in which the bones become weak because of deficiency of calcium, phosphorus or vitamin D. The commonest cause is nutritional deficiency. Children should drink minimum 2 cups of milk every day and should have adequate exposure of sunlight of about 30 min per day
Figure 2a: Radiograph of wrist joint showing features of rickets
Figure 2b: Radiograph of the child of lower limb showing bowing and features of rickets