How to recognise joint hYpermobility in your child
It’s spotlight on joint hypermobility for this #titbittuesday.
First of all, what is Joint HyperMobility?
You might be more familiar with the terms ‘ligament laxity’ or more commonly, ‘double-jointedness’ used for joint hypermobility. Generalised joint hypermobility (GJH) is a common condition of childhood, occurring in 8–39% of school age children (big range I know, but taken from 4 different studies which of course never give the same results….) . Girls are generally more hypermobile than boys, and children from Asian backgrounds are generally more hypermobile than Caucasian children. It is generally accepted that GJH runs in families.
Generalised joint hypermobility can be symptomatic or asymptomatic.
It is important to note that many hypermobile children will not have any adverse symptoms arising from their joint hypermobility. This is not meant to be a freak-you-out kinda blog, a lot of ‘stretchy’ kids are able to function completely normally, it’s just important to monitor them to ensure they stay that way.
Hypermobility Spectrum Disorder (HSD) is the correct term for a child diagnosed with symptomatic generalised joint hypermobility.
HSD can be isolated (can be found on its own with no other underlying condition) or can be a symptom of a range of genetic conditions; the most common being Ehlers –Danlos syndromes (EDS) or Marfan syndrome.
HSD is a disorder of the connective tissue in your body, and basically means the tissue is floppier/stretchier than normal. This can cause a range of issues in the muscles, ligaments and joints, ranging from delayed milestones in a baby or toddler, to clumsiness, falls and difficulty with fine-motor tasks, especially writing, in an older child.
Children and adults with flexible joints are also more likely to have injuries such as strains and sprains during sports or in activities where they don’t have full control of how their body moves (e.g. trampolining). Fatigue, joint pain, and recurrent joint dislocations (in severe cases) are among the complaints in teenagers and adults with HSD.
Because connective tissue is all throughout your body (including your skin and organs) there are various other physiological symptoms associated with HSD that I won’t go into today, but just know it can effect the whole body, not just the joints and ligaments. She’s a complicated beast the old HSD.
It can also be associated with low muscle tone or hypotonia. These two conditions are often inter-twined, but a person can certainly have one without the other. I’ll chat more about hypotonia here because #toomuchinformation.
There are a number of ‘markers’ that might indicate your child has joint hypermobility, remembering that almost all babies will have very flexible joints in the ankles, wrists and fingers, and therefore usually not a cause for concern. Younger children are more flexible in general, but this resolves with increasing age in typically developing children.
some signs of hyperMobility Spectrum disorder in a baby might be:
A persistent very rounded back in sitting might be an indication of joint hypermobility in a baby.
Hates tummy time (please note this is just one of the many reasons a baby might hate tummy time)
Late learning to roll and sit
Sits with a very rounded back, or w-sits
Skips crawling and bottom shuffles instead
Sits or attempt to crawl with very splayed (wide) hips
Has tight hip muscles which affects crawling, walking and balance
Avoids activities that are new or require effort
In an older child you might see:
Extra flexible fingers, thumbs, wrists, elbows, and knees (be known as ‘double jointed’ - which is not actually a thing by the way)
Can easily do the splits or other ‘party tricks’ with their body
Poor posture / sitting between the legs (w-sitting)
Poor walking or even standing endurance
Pain and fatigue when handwriting
Unusual patterns of gross motor development (e.g clumsy running)
Difficulty with prolonged exercise
Recurrent sprains, strains and dislocations
More prone to injury in general
Painful joints and muscles
Loose joints surrounded by tight muscles (usually around hips and shoulders)
Very stretchy and soft ‘velvety’ skin which bruises easily
Flat feet
A cautious nature (this may be secondary to their movement problems)
Difficulty maintaining focus at school/difficulty with attention
Anxiety related to movement
Because of all of the complexities of HyperMobility Spectrum disorder, if you suspect your child might be displaying signs of it, then it is important that you seek the advice of a specialist, so they can assess your child thoroughly, and give you the best plan of action. As with all intervention, early is always best, to enable the best outcomes for your child.
It takes a multidisciplinary team to look after a person with Hypermobility Spectrum Disorder, and might include a GP, paediatrician, rheumatologist (joint specialist), physiotherapist and occupational therapist. As a first point of call, a physiotherapist will often be the one to assess your child or baby using a measure called the ‘Beighton’s Score’ (which is modified for babies and pre-schoolers) and will give an accurate indication if your child does have joint hypermobility. From there they will start the ball rolling in regards to diagnosis and management.
A tailored exercise program, with focus on stability, strength and endurance in a low-impact environment (a hydrotherapy pool is a good start!) is the direction that most physiotherapists will take, in combination with pain relief techniques, muscle release, and education as to how you can help your child look after their bodies holistically. We want to keep our kids with HSD as active and strong as possible, avoid the use of over prescription of pain medication, and to keep them happy and confident in the home, classroom, and in the community.
Remember, its okay to be flexible, as long as you are strong too.
If you’d like a beautifully designed, very detailed 10-Step guide to nurturing your baby’s development, from birth through to walking, check out my book My Strong Little Body here.
And if you’d like more blogs like this one, don’t forget to sign up here.
And finally, I know there’s a few big ol’ movement nerds like me out there….so here is a link to a great review of the literature on differential diagnosis of children with HSD. Happy reading.