Skill Checkup: A 20-Month-Old Boy With Varus Deformity, a Waddling Gait, Delayed Tooth Eruption, and Reduced Growth Velocity

Eric T. Rush, MD, FAAP, FACMG


December 08, 2022

The Skill Checkup series provides a quick, case-style interactive quiz, highlighting key guideline- and evidence-based information to inform clinical practice.

An otherwise healthy 20-month-old boy in the United States presents with varus deformity (bowed legs), a waddling gait, delayed tooth eruption, and reduced growth velocity. The patient was adopted at 6 months of age; his birth family health history is largely unknown. The patient was delivered at full term via spontaneous vaginal delivery. Weight, height, and head circumference are at 25th, 5th, and 25th percentiles, respectively. Physical examination reveals frontal bossing and widening of the wrist joints. Diminished muscle tone and power are noted in the lower limbs. There is no history of seizure, trauma, or behavioral disorder. No abdominal or respiratory symptoms are noted, and the patient's renal profile is normal. There is no evidence of nutritional compromise. Vaccinations are up to date.

Radiographs of the lower limbs and hands show abnormal growth plates with widened and partially frayed metaphyses. Cortical bone appears thickened.


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