When your child is born you may notice that he or she has bowlegs, a condition in which the knees stay wide apart when a person stands with the feet and ankles together.  For children under 18 months of age, the conditions is considered normal, as are "knock knees" when the knees point inward.

Infants are born bowlegged because of their folded position in the mother's womb. Bowed legs begin to straighten once the child starts to walk and the legs begin to bear weight (about 12 to 18 months old).

By the time a child reaches age three or four, they develop a knock-kneed configuration, in which their legs angle inwards.

By around age three, the child can usually stand with the ankles apart and the knees just touching. If the bowed legs are still present, the child may need to see a physician for further followup.

“If a child has this condition after age three we need to evaluate the child for illnesses that can cause bowlegs.  These can include abnormal bone development, Blount’s disease, fractures that have not healed properly, lead or fluoride poisoning and rickets, caused by a lack of vitamin D,” says Ahmed Bazzi, D.O., pediatric orthopedic surgeon at Children’s Hospital of Michigan, part of the Detroit Medical Center.

Dr. Bazzi says most children with bowlegs do not require treatment. In circumstances where bowlegs are caused by diseases or abnormal bone development, a physician may recommend treatment such as orthotic braces, special shoes, casts, or surgery if the condition worsens.

“Treatment may be recommended because bowlegs can cause osteoarthritis or trouble walking as the child ages,” says Dr. Bazzi.

Knock knees are usually not treated because the child often grows out of the condition.

“We may recommend certain exercises to strengthen the knee and make it stronger. In rare cases surgery may be recommended for children who have extreme knock knees that cause pain or difficulty walking, and may develop arthritis later in life. Surgery is usually done at about age 10 or 11, before the child stops growing. It involves placing small plates and screws at certain growth plates so that growth may be restricted in areas that are growing faster than others.  Less often, the bone may need to be cut and re-aligned.  Bracing or orthopedic shoes may also be recommended,” says Dr. Bazzi.