A 2-year-old child with bowing of the legs; the PNP should

A 2-year-old child with bowing of the legs; the PNP should

• A. Assures normal development
• B. Obtains a detailed family history for genu varum
• C. Refers the child to an orthopedic clinic for evaluation
• D. Suggests that the child may need bracing

Answer: (C)

In toddlers, bowing of the legs can be a normal finding known as physiologic genu varum, which often corrects itself as the child grows. However, when bowing is persistent, worsens, or is asymmetrical, it may indicate an underlying problem such as Blount disease, rickets, or another bone-growth issue. Because these conditions can progress and require specific treatment or monitoring, the best step for a 2-year-old with bowing is to refer for orthopedic evaluation. The orthopedic clinician can perform a focused physical exam, assess alignment and leg length, and order appropriate imaging to differentiate benign, self-limited bowing from pathology. Early referral helps ensure timely management if intervention is needed. Choosing to reassure normal development without evaluation isn’t appropriate when there are signs that bowing may be pathologic, and waiting on bracing or other treatment without a diagnosis isn’t ideal. A detailed family history alone doesn’t address the current deformity, and bracing is typically reserved for confirmed conditions identified on evaluation rather than applied presumptively.

In toddlers, bowing of the legs can be a normal finding known as physiologic genu varum, which often corrects itself as the child grows. However, when bowing is persistent, worsens, or is asymmetrical, it may indicate an underlying problem such as Blount disease, rickets, or another bone-growth issue. Because these conditions can progress and require specific treatment or monitoring, the best step for a 2-year-old with bowing is to refer for orthopedic evaluation. The orthopedic clinician can perform a focused physical exam, assess alignment and leg length, and order appropriate imaging to differentiate benign, self-limited bowing from pathology. Early referral helps ensure timely management if intervention is needed.

Choosing to reassure normal development without evaluation isn’t appropriate when there are signs that bowing may be pathologic, and waiting on bracing or other treatment without a diagnosis isn’t ideal. A detailed family history alone doesn’t address the current deformity, and bracing is typically reserved for confirmed conditions identified on evaluation rather than applied presumptively.