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Common Childhood Orthopedic Problems


Now that the weather is warmer and your child is more active, you may notice that his or her growth isn’t occurring completely on the straight and narrow. Many kids exhibit flatfeet, toe walking, pigeon toes, bowlegs, and knock-knees in their first years of life.

Some of these conditions correct themselves without treatment as kids grow. Others that persist or become more severe may be linked to other conditions. Many orthopedic conditions, just like dimples or cleft chins, are just normal variations of human anatomy that don’t require treatment.


Most babies that are born with flatfeet develop arches as they grow, but for some, the arch never fully develops. Parents often first notice their child has what they describe as “weak ankles.” The ankles appear to turn inward because of the way the feet are planted.

Flatfeet usually do not represent an impairment of any kind, and doctors only consider treatment if it becomes painful. Parents sometimes report that their flatfooted kids are clumsier than other kids, but doctors say that being flatfooted isn’t a cause for concern and shouldn’t interfere with playing sports. Sometimes, doctors will recommend inserting arch supports into shoes to reduce foot pain.

Flat feet

Toe Walking

Toe walking is common among toddlers as they learn to walk, especially during the second year of life. Generally, the tendency goes away by age 2, although it persists in some kids.

Intermittent toe walking should not be cause for concern, but kids who walk on their toes almost exclusively and continue to do so after age 2 should be evaluated by a doctor. Persistent toe walking in older kids or toe walking only on one leg might be linked to other conditions, such as cerebral palsy or other nervous system problems. Persistent toe walking in otherwise healthy children occasionally requires treatment, such as casting the foot and ankle for about 6 weeks to help stretch the calf muscles.

In-Toeing (Pigeon Toes)

In-toeing, or walking pigeon-toed (with feet turned inward), is another normal variation in the way the legs and feet line up. Babies may have a natural turning in of the legs at about 8 to 15 months of age, when they begin standing.

Treatment for pigeon-toed feet is almost never required. Special shoes and braces commonly used in the past were never proved to speed up the natural slow improvement of this condition. In-toeing typically doesn’t interfere with walking, running, or sports, and resolves on its own as kids grow into teens and develop better muscle control and coordination.



Bowleggedness is an exaggerated bending outward of the legs from the knees down that can be inherited. It’s common in infants and, in many cases, corrects itself as a child grows.

Bowleggedness beyond the age of 2 or bowleggedness that only occurs in one leg but not the other can be the sign of a larger problem, such as rickets or Blount’s disease. Rickets, a bone growth problem usually caused by lack of vitamin D or calcium in the diet, causes severe bowing of the legs and can also cause muscle pain and enlargement of the spleen and liver. Rickets is much less common today than in the past. Rickets and the resulting bowlegs are almost always corrected by adding vitamin D and calcium to the diet. Some types of rickets, however, are due to a genetic condition and may require more specialized treatment by an endocrinologist.

Blount’s disease is a condition that affects the tibia bone in the lower leg. Leg bowing from Blount’s disease is seen when a child is about 2 years old, and can appear suddenly and quickly become worse. The cause of Blount’s disease is unknown, but it causes abnormal growth at the top of the tibia bone by the knee joint. To correct the problem, kids may need bracing or surgery when they’re between 3 and 4 years old.

You should also take your child to the doctor if bowleggedness occurs only on one side or gets progressively worse.


Most kids show a moderate tendency toward knock-knees between the ages of 3 and 6, as the body goes through a natural alignment shift. Treatment is almost never required as the legs typically straighten out on their own. Severe knock-knees or knock-knees that are more pronounced on one side sometimes require treatment.

Most of these conditions are not serious and may go away on their own. If further care is necessary, you may need to see an orthopedist or orthopedic surgeon. To schedule an appointment at Primary Children’s Hospital, visit our website or call (801) 662-5600.

This information is part of Primary Children’s KidsHealth website. This resource features information on a variety of health topics for you and your children.

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How to Raise Earth-Friendly Kids

Whether you’re a diehard recycler who shops with canvas bags and keeps a compost bin in the corner of your backyard, or a busy parent looking for some quick tips on sorting glass from plastic, it’s easy to get your family on the path to greener living. The best earth-friendly practices require the cooperation of everyone in the household. By showing that you care about and respect the environment, your kids will do the same.

Do Your Part

  1. Teach respect for the outdoors. This can start in your own backyard. Help kids plant a garden or tree. Set up bird feeders, a birdbath, and birdhouses. Kids can clean out and refill the bath daily, and clean up seed debris around feeders and restock them. On a larger scale, you can plan family vacations that focus on the great outdoors. Maybe a summer trip to the Grand Canyon or Yellowstone Park appeals to your adventurous clan. Shorter trips might include a day at a state or national park. Even a couple days at the beach can offer plenty of opportunities for you to point out and discuss the plants and animals you see and why it’s important to protect their habitats.
  2. Recycle. Recycling is easy, and in some communities, mandatory. Check with your local recycling office and be sure you know all the rules. Some communities allow co-mingling — all recyclables can be placed in one container — while others require sorting into separate containers. You may need bins for each type of recyclable: One for plastic, one for glass, one for paper, and one for cans. Kids can sort (and rinse, if necessary) items, place them in the correct bins, and take the containers out to the curb for collection. After the bins have been emptied, ask your kids to rinse them out (if they’re dirty) and bring them back into the house or garage.
  3. Drink your own water. Bottled water is expensive and, experts say, not any cleaner or safer than tap water. In fact, much bottled water is actually tap water that has been filtered. The water that comes out of home spigots in the United States is extremely safe. Municipal water supplies are monitored constantly and the test results made public. And unless they’re recycled, the plastic bottles — most commonly made from polyethylene terepthalate (PET), which is derived from crude oil — can end up in landfills. So have your kids tote water from the tap (you can add a filter to improve its taste) in reusable bottles.
  4. Clean green. Many natural products can replace commercial — and possibly hazardous — cleaning preparations. Just a few examples: to deodorize carpets, sprinkle them with baking soda, wait 15 minutes and then vacuum; use vinegar and baking soda for everything from oven cleaning and drain clearing to stain removal and metal polishing. Lots of websites offer green cleaning tips, and many stores carry pre-made nontoxic cleaners for those who don’t want to make their own.
  5. Lend a hand. Many communities sponsor green activities, like pitching in to help clean up a local park or playground. Maybe the area around your child’s school could use sprucing up.


Get Kids to “Go Green”

In their own day-to-day activities, encourage kids to find ways to limit waste, cut down on electricity, avoid unnecessary purchases, and reuse items that they already have. Here’s how:

  1. Conserve energy. Remind kids to turn off lights when they’re not in use, power down computers, turn off the TV when nobody’s watching, and resist lingering in front of the refrigerator with the door open.
  2. Hoof it. If kids can safely ride a bike or walk to school or to visit friends rather than catch a ride from parents, encourage it! Or if safety is a concern, consider organizing a “walking school bus” — this activity allows kids to walk or bike to and from school under the supervision of an adult.
  3. Let there be (more) light. Older kids can help replace regular light bulbs with energy-efficient ones. Compact fluorescent light bulbs provide about the same light output as incandescent bulbs, but last much longer and use a fraction of the energy.
  4. Reuse and recharge. Buy rechargeable batteries for your kids’ electronics and toys and teach them how to care for and recharge them. This reduces garbage and keeps toxic metals, like mercury, out of landfills.
  5. Pass it on. Ask kids to gather toys, books, clothes, and other goods that they no longer use or want for donation to local charities. Have them ride along for the drop-off so they can see how groups such as Goodwill and the Salvation Army use donations to help others.

These tips are just some ways to get your family to become more earth-friendly. Once you get everyone on board with conservation, challenge your kids to come up with new and interesting ways of going green. Engaging your kids in this way will get them to start thinking about how their individual efforts affect the world they live in, and how little changes can — and will — make a difference.

This information is part of Primary Children’s KidsHealth website. This resource features information on a variety of health topics for you and your children.

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Keep Your Child Safe from Scald Burns

Child in bathtubby Sara Jackson, CSW
Center for Safe & Healthy Families

Most people easily recognize the dangers of stoves, radiators, candles, and matches around their children and take the necessary steps to protect their children from burns. Water scald burns are a less anticipated injury due to the fact that we don’t generally expect water to injure our children. However, young children, older adults, and people with disabilities are more at risk for being injured by scalds. In fact, according to the American Burn Association, more than 30% of patients cared for at burn centers in the U.S. are treated for scalds.

In young children, hot water scalds typically occur in the home when a child is left unattended in the bathroom, when he/she is placed in water that is too hot, when another child turns on the hot water while the child is in the tub, or when the child is bathed by an inexperienced caregiver.

Here are some tips from the American Burn Association for preventing water scalds:

  • Set home water heaters no higher than 120° F
  • The safest temperature for bathing an infant is 98° F
  • Consider installing an anti-scald device on your faucet and shower heads. These devices stop the flow of water when the temperature reaches a pre-determined level, preventing hot water from coming out before scalding occurs
  • Avoid flushing toilets, running water or using the dish/clothes washer while anyone is showering/bathing to avoid sudden jumps in water temperatures
    Ensure young children have constant supervision while bathing
  • Fill the tub to the desired level and turn the water off. Mix the water thoroughly and test its temperature with your elbow or wrist before letting anyone get in
  • If filling a container with water for rinsing, test the water in the container before using it
    When not in use, turn the faucet to the cold position

Following these guidelines should help prevent hot water scald burns. Generally, with water at 120° F, serious injury can occur in 5 seconds. Water that is 140° F can cause serious injury in as few as five seconds and water at 155° F can cause serious injury in just one second. Remember, scald burns are preventable! For more information, see the American Burn Association.

Sara graduated with her Master’s in Social Work from Portland State University, and is a Certified Social Worker. She is currently working towards becoming a Licensed Clinical Social Worker. She moved to Salt Lake City and has been enjoying getting to know the Southwest. In her free time, she loves hiking, biking, running, taking her dogs to the park, speaking Spanish, learning about other cultures, cooking, and creating self-serve frozen yogurt creations.
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Ear Infections: Why Antibiotics Aren’t Always the Answer

child with nurseby Sharon Soutter, BSN, RN
Infection Prevention Coordinator
Primary Children’s Outpatient Clinic

Middle ear infections are one of the most common of all childhood infections. Half of all children will have a middle ear infection by their first birthday. But did you know that not every ear infection needs to be treated with antibiotics?

Parents have long been used to the idea of treating every ear infection their child experiences with an antibiotic. However, many ear infections are caused by a virus. Viruses are the most common cause of colds and other upper respiratory infections, which may precede an ear infection, and antibiotics will not help an infection caused by a virus to get better.

Common symptoms of ear infections include:

  • Ear pain, pulling or rubbing on the ear
  • Fussiness
  • Fever
  • Headache
  • Nausea, vomiting, loss of appetite
  • Loss of hearing

Your child’s doctor may recommend waiting two or three days to see if symptoms go away on their own without antibiotics. If a doctor does recommend antibiotics, it is very important to take that medicine until it is completely gone, even though the child may seem to be better after a day or two. Using all antibiotics as prescribed will help prevent the infection from returning and also help prevent bacteria from becoming resistant. Resistant bacteria cannot be killed by common antibiotics.


You can help reduce the risk of ear infections in your child by doing the following:

  • Keep your child away from cigarette smoke. Ear infections are more common in children exposed to cigarette smoke.
  • Avoid having your child go outside when air is polluted.
  • Hold your child upright when feeding from a bottle. Children who are bottle fed while lying flat are more prone to ear infections.
  • Consider stopping pacifier use.
  • Avoid sending your children to day care if possible, or enroll your child in a daycare with small class sizes.
  • Keep up on your children’s immunizations.

Find out more about Middle Ear Infections in children.

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From Cancer Battle to Olympic Dream: Nicole’s Story

photo 15Every four years, all eyes focus on the best athletes in the world as they compete in the Olympics and Paraolympics. This year in Sochi, Russia, a former patient of Primary Children’s Hospital represented the U.S. and realized her Olympic dream–something that would have seemed improbable years ago.

Nicole Roundy’s journey to the Paralympics began nearly 20 years ago. In July 1994, just four months after her 8th birthday, Nicole was diagnosed with Osteogenic Sarcoma, a form of bone cancer. She started chemotherapy immediately, but several months later she was faced with a difficult decision.

Nicole_00072A“I remember my mother standing in the doorway of my bedroom and I was sitting on my bed, tears slipping down my cheeks,” says Nicole. “My mom just said. ‘I can’t make this decision for you.’ I chose what I thought would give me the best chance. I’ve never second guessed it. I chose life.” Nicole chose to have her right leg amputated in order to beat cancer, and have a normal life.

Nicole spent many months at Primary Children’s, and underwent numerous tests and needle pokes. She battled pain and sickness. But she mostly remembers the good things at the hospital – hanging out at the nurses station, drinking soda from a giant syringe, mastering Mario Brothers on the Nintendo, and the visits from the therapy dogs and clowns. She remembers the little things that brought joy to that time of her life.

After beating cancer, Nicole was ready to tackle her next challenge.

She had tried many team sports, like volleyball, soccer and basketball. But she felt like she was too slow and not good enough. “I was the water girl for the basketball team in 9th grade. While it was great to go to the games and be involved, it was hard standing on the sidelines while everyone gets to play the game.”

2008 -2Ten years after her initial diagnosis, she hit the slopes for the first time as a three-track skier. But she felt like something was missing. That’s when she discovered her love for snowboarding. “It was the first thing that opened doors for me. There was finally something that I was good at.” Nicole became a natural on the slopes. Not only could she carve her way down the mountain, she could fly through the freestyle park and tackle jumps. Two years later, she was one of the five women invited to compete in the U.S. National Championships. She also became the first above-the-knee amputee to ever compete in snowboarding.

Nicole had a chance to live out her dream of competing in the Paralympics Winter games in Sochi in March. She took on the world’s best athletes in fast-paced snowboard cross event, finishing 8th overall.

photo 1“It was an incredible honor to be a part of the team in Sochi. It’s hard to know what to expect going into the games, but to see that level of support was mind blowing. It’s a once-in-a-lifetime opportunity, but I hope I’ll have another chance in four years.”

For all the children battling the same cancer or facing similar challenges, Nicole offers this advice: “Enjoy the moment. Life isn’t about growing old or achieving so called ‘milestones.’ It’s about learning to love yourself exactly how you are and accepting others how they are. It’s about loving the bad moments just as much as the good ones. It’s about appreciating what we have rather than longing for what we don’t. Keep your head up and keep kicking. In life, the good always comes with the bad. The bad is what makes life worth fighting for. Never quit being happy. Never give up on your dreams; keep kicking.”

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What to Look for in a Pediatric Heart Surgeon

Pediatric SurgeonExcellent cardiothoracic surgeons are confident, precise, and have technical ability, sound judgment, and the ability to solve complex problems quickly under high stress. The best surgeons have expertise that comes from performing hundreds of open heart and other heart surgeries each year, ranging from the correction of simple heart defects to major repairs of the most complex conditions.

Access to Cutting Edge Research

Good heart surgeons are curious and excited about the latest research findings. The development of innovative new treatment options allow them to perform surgeries that were considered impossible a few years ago. Great surgeons quickly adapt to master the latest techniques like the Berlin Heart, the HeartWare System, and advances including the Melody Valve. Motivated surgeons may even pioneer better ways to both save and improve the lives of their patients.

A Strong Supporting Team

Top surgeons are leaders who are surrounded by a great team of specialists, including cardiologists, intensive care specialists, cardiac anesthesiologists, nurse practitioners, physician assistants, administrative assistants, perfusionists, nurses, and surgical technicians—all dedicated to patients with congenital heart disease and other rare heart conditions. The ability to collaborate and to freely share ideas with a larger cardiology team is a huge benefit to cardiothoracic surgeons. When everyone in a heart center understands the needs of a patient, more efficient and effective care is given before, during, and after surgery.


Emotional support for patients and their families is every bit as important to the healing process as the physical care. Great surgeons care deeply about their patients, showing kindness and compassion every step of the way.

So what makes an exceptional pediatric heart surgeon?

At Primary Children’s Heart Center, we believe it’s all of the above.

And, the proof is in the outcomes:

  • The Heart Center is one of the busiest centers in the country, performing over 520 heart surgeries in 2013.
  • Our cardiac surgery survival rate tops 98%, ranking us in the top 10% in the nation!
  • Our Norwood operation survival rate is at 92%, which exceeds the Society of Thoracic Surgeons national standard, and our Arterial Switch operation survival rate is 100%.
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Why We’re One of the Top Ranked Hospitals for Children’s Heart Care

Heart Center Inforgraphic



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