scarlet PRECAUTIONS • Do not use orthopedic shoes unless prescribed by your doctor. • To prevent rickets (a deficiency of vitamin D, which may cause bowlegs and knockknees), all children should receive recommended amounts of vitamin D. (Milk is a good source of vitamin D.) • Do not give your child supplements of vitamin D unless your doctor has prescribed them. Overdoses of vitamin D are harmful. Bowlegs and knockknees Bowlegs and knockknees are two conditions in which the legs are not as straight as they are in most persons. In bowlegs, the legs bend outward so that the knees are farther apart than usual. In knock knees, the legs bend inward so that the knees are closer together than normal. Theoretically, when a child stands straight, the ankle bones should touch or almost touch each other, and the knee bones should touch or almost touch each other. With an infant lying on the stomach or back the legs can be pulled straight with the toes and knees pointed straight ahead to determine whether the bones of the knees and ankles come together. If the ankles touch but the knees do not, the child can be said to be bowlegged. If the knees touch but the ankles do not, the child is knockkneed. By these standards, however, all infants, children, and adults are bowlegged or knockkneed to some degree, so you should not become alarmed. Most infants appear bowlegged. and when they start to walk, they walk cowboystyle. This condition usually corrects itself by age two. Most preschoolers stand knockkneed, especially if they are plump. This condition also corrects itself. Very young children often appear bowlegged (as shown on the left). Preschoolers may stand knockkneed (as shown on the right). Both conditions may correct themselves as the child grows older. Bowlegs and knockknees т ie bowlegs and knockknees either are due to rickets (vitamin D • ncv) or are inherited. Although common 50 years ago, rickets is rare in the United States. An unusual form of bowlegs, often °0W ring on only one side, is Blount's disease, in which the top of the tibia (shin bone) becomes deformed. SIGNS AND SYMPTOMS Have the child stand with the legs straight and the toes pointed forward. Then observe if there is any distance between the knees or between the ankles. Remember that the distance between the ankles or the knees varies from person to person and that these differences are usually normal. If you think that there might be a problem, ask your doctor. HOME CARE In most cases, no home care is needed. To prevent rickets, children should receive about 400 international units of vitamin D daily. This amount is found in many commercial infant formulas and in most commercial milk. Some vitamin D is present in breast milk, but the amount varies. If your child is being breastfed, ask your doctor whether the child is receiving enough vitamin D. PRECAUTIONS • If you think your infant or child is bowlegged or knockkneed, watch to see if the condition worsens after several months. erythema