What does a pediatric surgeon look at at 3 months. Orthopedist for children

The formation of the musculoskeletal system continues from the moment of birth until the age of 15, which is why it is so important for parents to pay attention to the slightest deviations in the development of the child and contact an orthopedist in a timely manner.

The main orthopedic problems in babies are:

• torticollis;
• hip dysplasia;
• flat feet;
• clubfoot;
• rachiocampsis.

Torticollis

If torticollis in an infant is caused by disorders in fetal development, it can be detected as early as the 1st month of life. The acquired (bone) form of the disease develops already at school age.

Congenital torticollis (muscular) is usually diagnosed in the hospital. If this does not happen, then pathology is detected at 2-3 months in boys and at 4-6 months in girls (the development of the musculoskeletal system in girls is slower).

Muscular torticollis is associated with a developmental disorder or pathological muscle spasm on one side. It manifests itself clinically already at the age of one month by constantly turning the baby's head in one direction. At 2-3 months. the head is turned and thrown back a little; at the same time, the scapula are deployed to the sides.

By 5-6 months, there is already asymmetry of the neck, face and shoulder girdle, curvature of the spine in the cervicothoracic region, a pronounced turn of the head. Later develops. It is difficult not to notice these manifestations.

From the first weeks or months of life, installation (or habitual) torticollis may also develop, associated with the constant position of the child in the crib. Sometimes the baby is carried on the same side in the arms. Such torticollis can be eliminated in a few weeks by placing the child alternately in different directions of the crib.

The earlier the pathology is detected, the more effective the treatment will be. Massage, therapeutic exercises, physiotherapy (electrophoresis with lidase, paraffin applications) are prescribed.

In the absence of the effect of conservative therapy (more often this happens when diagnosing torticollis by 6 months), a rather complicated surgical treatment is performed (after 1.5-2 years). If treatment is not carried out at this age, then after 6 years, even surgery is not always effective.

Watch the video about this disease:

hip dysplasia

It may not have clear manifestations in the first months of life and may not be diagnosed even by experienced orthopedists at the first examination.

Due to the weakness of the ligamentous apparatus, the head of the femur moves out of its normal position in the joint.

This may result in:

• predislocation: the head of the femur moves freely inside the joint;
• subluxation: the head of the femur can dislocate from the acetabulum at the joint and return to it;
• true dislocation: the femoral head is outside the joint.

The incidence of pathology: preluxation and subluxation occurs in 1 out of 100 newborns, and true dislocation - in 1 out of 800-1000 infants. Moreover, 60% of children with dysplasia are first-born, and 30-50% had a breech presentation (the highest risk of true dislocation). Maternal hormones before childbirth also contribute to joint instability.

Before the age of 4 months, dysplasia is diagnosed using ultrasound, since the cartilage tissue of the femoral head is not visible on the radiograph until this age.

From the age of six months, you can notice the asymmetry of the skin folds and the different lengths of the baby's legs.

The unequal length of the limbs subsequently leads to a "duck" gait (waddle), lameness, walking on fingers, curvature of the spine.

Treatment should be prescribed by an orthopedist. Wide swaddling of the baby, with the help of which parents try to cope with the problem themselves, is not only ineffective, but can even lead to excessive stretching of the articular bag, i.e. to abnormal joint development.

Optimal is the use within 1-2 months. Pavlik's stirrups or Freik's tires. They help to ensure the correct position of the femoral head in the acetabulum, the normal development of the femoral head and ligamentous apparatus.

Stirrup efficiency reaches 95%. The timing of treatment is monitored by ultrasound.

If parents miss the treatment time before 6 months of age, then a closed hip reduction is performed under anesthesia. Until the age of 1.5 years, closed reduction is the main method of treatment.

At an older age, surgical treatment is performed.

flat feet

All children are noted at birth. Being engaged with the child in massage and gymnastics, parents strengthen the muscular-ligamentous apparatus of his feet. By the year when the child begins to walk, you need to choose the right shoes for the formation of a normal arch of the foot, formed by interosseous ligaments.

Shoes should have a small heel that lifts the heel and helps strengthen and develop the ligaments. A good fit is also important. Shoes with an open heel ("flip flops", sandals) up to 3 years are not recommended.

Foot deformity in the form of flat feet is the most common pathology of the musculoskeletal system. It is the arch of the foot that provides cushioning of the body during movement. There are 2 longitudinal and 1 transverse arch. The deformation of these arches leads to transverse or longitudinal flat feet.

There is also a congenital form (rare) of longitudinal flat feet, as a malformation of intrauterine development. It is diagnosed in the maternity hospital: the forefoot is "turned" outward, the sole has a noticeable bulge. One foot is most commonly affected. Treatment consists in the gradual correction of the defect with the help of plaster casts. If there is no effect, surgical treatment is carried out.

Children under 2 years of age have a flat longitudinal arch. The role of the shock absorber is performed by the fatty "cushion" on the sole. The process of foot formation continues up to 5-6 years. At this age, the presence or absence of acquired flat feet is determined.

Types of acquired flat feet:

• paralytic (a consequence of damage to the nervous system, for example, with);
• rickets (excessive elasticity of the ligaments with weakness of the muscles of the foot with or exhaustion of the child);
• static (most common, develops due to overload with excess weight);
• traumatic (after a fracture of the foot bones with damage to the ligaments and prolonged use of a plaster cast).

At 3 years old, the doctor can conduct a preliminary assessment of the foot and identify a tendency to develop flat feet or its initial manifestations.

Early signs of developing flat feet can be noticed by parents in a baby from 2-3 years old:

• fatigue with a short walk (the child asks for a stroller or in his arms);
• new shoes after 1-2 months of wear are trampled on the inner edge of the heel or sole, the top is deformed inward).

The earlier flatfoot is detected, the more favorable its correction is. Of the conservative methods, therapeutic massage and special exercises (skating with the feet of a special roller, etc.), physiotherapy, baths with sea salt are prescribed. Choosing the right footwear is also important.

Clubfoot

It is called a congenital deformity of the baby's foot. In this case, the foot has a plantar flexion, is given and turned inward. In the process of child development, the deformation increases, the load on the outer edge of the foot increases, where calluses form.

Clubfoot ranks first among congenital pathologies of the musculoskeletal system and occurs in 1-4 newborns out of 1000, in 10% of cases it is combined with other malformations. More often there is a 2-sided anomaly, in girls in 2-3 p. less frequently than boys. In severe cases, deformity of the bones of the lower leg, ankle, knee and hip joints, muscle atrophy subsequently develops.

Possible causes of congenital clubfoot:

• malposition;
• oligohydramnios;
• the impact of chemical hazards on the mother's body;

Congenital clubfoot is determined immediately after birth, the diagnosis is confirmed by ultrasound (examine the cartilaginous tissue of the foot).

The earlier the treatment is carried out, the more successful it is.

The main methods of treating clubfoot:

1. plaster fixation of the foot is applied from 5-7 days of life, the bandage is changed every 2 weeks; its efficiency is 58%;
2. plastering from 2 weeks of life using the Ponseti method: a special plastering technique with changing bandages every 5-7 days contributes to sprain; treatment lasts up to 2 months, after which the child is assigned to wear special fixing shoes; the efficiency of the method is about 90%;
3. super elastic constructions; splints are made from a special material with shape memory, allowing for permanent correction;
4. bandaging in combination with special gymnastics is used for mild defects;
5. surgical treatment according to various methods (with the ineffectiveness of conservative treatment, with late diagnosis);
6. shin and foot massage (toning and relaxing), as a component of complex treatment;
7. kinesitherapy (active therapeutic exercises) or manual therapy aimed at increasing muscle activity, stretching tissues;
8. physiotherapy to increase muscle extensibility and contractility, improve blood circulation; applied after 2 years;
9. drug therapy: the appointment of drugs that improve the patency of nerve impulses (vitamins of group B, prozerin).

Curvature of the spine

There are quite a few reasons for the occurrence: hereditary predisposition, birth trauma, different leg lengths, etc.

With different leg lengths (common pathology), at an early stage it is necessary to use orthopedic insoles, selected by a doctor, to align the pelvis, prevent the development of scoliosis and form the correct curves of the spine.

Already at the age of 2-3 years, the orthopedist assesses the correct posture, the condition of the feet during examination. Longitudinal flat feet will lead to the occurrence of static scoliosis in the future (curvature of the spine to the side), and transverse flat feet to static scoliosis (curvature of the spine in the anterior-posterior direction). The combination of both types of flat feet will cause kyphoscoliosis.

In addition, infantile (idiopathic) scoliosis can be detected in infants. It is less common than in older children. It is detected by pediatricians when examining a baby in the prone position: the spine has an arc, and the fossa on the back of the head is not in line with the intergluteal gap.

But more often this pathology is detected at 5-6 months, when children sit confidently. It becomes noticeable that in the sitting position the baby does not have a straight back, but the head is somewhat tilted to the side. In these cases, the orthopedist prescribes an x-ray of the spine to rule out other causes of scoliosis.

Infant scoliosis can be corrected within 2-3 months with the help of therapeutic exercises selected by the doctor. It can be carried out daily by an exercise therapy methodologist or a mother trained by him. In severe cases, exercise therapy supplements the use of a plaster "crib", in which the child is placed at night and for several hours during the day.

The outcome of untreated idiopathic scoliosis varies: in some cases it resolves spontaneously, in others the prognosis is very poor. The earlier infantile scoliosis is detected and treated, the better the prognosis. Up to 2 years, the deformity may reverse, but self-healing is rare. With the initial development of idiopathic scoliosis in children after 2 years, the prognosis is unfavorable.

The health of the baby in infancy is closely monitored by doctors. It is very important that the development of the child is evaluated by an orthopedist, this will help prevent various problems associated with the musculoskeletal system, as well as with overall harmonious development. In this article, we will talk about orthopedics and evaluate the importance of visits to such a specialist, because it is on them that your baby’s ability to hold his head, sit and walk on his own largely depends.

Orthopedics is one of the branches of surgery, this science studies a variety of disorders of the musculoskeletal system, as well as its structure and functional activity. A timely visit to an orthopedic doctor allows you to avoid or timely identify and cure ailments of the baby's bone and muscle system, ligaments and joints.

There is a specific schedule according to which a small child should visit such a specialist. It is very important to adhere to the recommended terms, and, if necessary, adjust the development of the crumbs. The first visit to an orthopedic doctor should occur at the age of one month, after that - at three months and at one year.

One month child health assessment

A newborn baby normally has an increased muscle tone. His arms are tightly clenched into fists, his elbows are bent and pressed to his sides. The legs are also bent at the knees and pulled up to the stomach. A thorough examination by an orthopedic doctor is carried out after some relaxation of the crumbs' muscles has occurred, and he adapts to completely new types of movement, possible after the mother's tummy. At this stage, the mother will be able to get used to the baby somewhat, recognize his habits and assess the degree of development. It is possible that she will notice some problems.

During the appointment, the doctor will carefully examine the baby, starting from his crown and ending with the feet, assess the size and shape of all parts of the body, as well as their proportionality, symmetry and harmony of development, check the movements of the legs and arms. At the same reception, the presence or absence of any congenital anomalies and signs of such an ailment as rickets is determined.

The specialist will carefully check all joints for mobility, paying special attention to the hips. During such an examination, such common diseases as dysplasia or dislocation (subluxation) of the hip joints, torticollis and clubfoot can be detected. Early diagnosis by an orthopedist plays a very important role and determines the effectiveness of future treatment.

It may well be that one course of physiotherapy or massage will be enough to get rid of a certain disease, and in an advanced case, more serious measures would have to be taken.

In some cases, the doctor may advise an ultrasound scan or some other research methods in order to clarify the diagnosis or more accurately assess the developmental picture.

Three month checkup

A follow-up visit to the orthopedist is important for assessing the development of the baby. In the first months of life, the baby grows very quickly, all systems of his body continue to develop and strengthen. At this stage, it is necessary to assess how correctly the muscular system is formed and how the load is distributed on the joints and muscles. The normal development of both the skeletal and muscular systems is important so that the baby learns to roll over from his back to his stomach and to the other side in a timely manner, as well as to perform actions aimed at a goal, for example, to get a toy or other object that he likes.

This examination is similar to the one conducted two months ago. Now some diseases may appear that did not manifest themselves during the first visit. In the event that the doctor advises to undergo an additional examination, you should not refuse, as modern equipment makes it possible to carry out diagnostics without harm to the child's body. If the treatment is started on time, you can not only save yourself time and nerves, but also get the best possible result.

Inspection per year

As the baby grows, he learns to perform many independent actions. By the year the baby crawls, and possibly walks, takes out toys and throws them. All his actions are meaningful and differ in direction. In order for development to proceed correctly and further, it is important to timely control the development of the spinal column and arch of the foot.

Such an examination is markedly different from the past, as the doctor closely monitors the movements of the child in order to assess how correct they are and to identify possible violations. The orthopedist is interested in how the baby puts the legs when walking, how the foot and its arch develop, how the fingers and heels are directed, how the muscular system and spinal column are formed, how the body is held in the correct position.

This age is still too early to diagnose "" or "scoliosis", but a specialist may recommend massage for their prevention. In addition, the doctor may prescribe special insoles for the baby or prescribe an orthopedic mattress or pillow, as well as exercise therapy.

Remember that the health of their children depends only on the parents. Visit doctors at the specified time, do not neglect their advice and strictly follow the recommendations. All diseases are much easier to prevent than to treat.

Ekaterina, www.site
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In the first year of a baby's life, his health must be monitored especially carefully, so the doctor repeatedly examines the child. This is a pediatrician and specialized specialists: a neurologist, a surgeon, an oculist, an ENT specialist. A regular checkup by an orthopedist is indicated. It is possible to call a doctor at home.

Specificity of the orthopedist

Doctors are called upon to monitor the child's condition, identify deviations, apply preventive measures, and prescribe treatment. The orthopedist deals with the problems of the development of the musculoskeletal system, the condition of muscles, ligaments, bones. He treats the identified pathologies, prescribes measures to prevent deviations in the development of the newborn.

Conducting regular examinations during the first year of life, the doctor evaluates the overall development of the baby, checks him for congenital, acquired abnormalities. He determines what kind of preventive, therapeutic gymnastics the baby needs. Examination allows you to prevent many serious diseases, identify pathologies, prescribe timely treatment and avoid complications.

First inspection

For the first time, an orthopedist checks a newborn during the first days of life, when the baby is in the hospital. He checks for the presence of injuries in the baby during childbirth: fracture of the collarbone, dislocation of the hip. The doctor examines the condition of the fingers (fused, additional). It is important to exclude congenital defects of the organs of movement, deviations in the development of the muscular and skeletal systems, the condition and functioning of the ligaments.

He checks the motor ability of the arms and legs, the head, looks at the reaction of the child .. Many are afraid that the doctor will harm the child. But the orthopedist knows in which direction to move.

The first examination reveals visible abnormalities, but many abnormalities develop gradually and may not be noticeable in the newborn. It is necessary to make more than one visit to the doctor, or issue a call to the orthopedist at home in 1, 3 months, six months and a year.

Baby check up at 1 month

At the age of one month, the baby is already adapted to the environment: his muscles are relaxed, he actively moves his arms and legs. Within a month, parents look closely at the child, they may notice deviations, report suspicions to the doctor.

The orthopedist conducts a thorough examination of all parts of the baby's body, evaluates their size and ratio. He draws attention to the harmony of development and the correctness of symmetries. Examination allows you to identify congenital anomalies, determine the presence of rickets in a child.

The doctor checks the mobility of the joints, especially the hips. Inspection reveals signs of torticollis, clubfoot. An ultrasound is prescribed to exclude hip joints (dislocation, subluxation). The doctor may conduct additional studies to confirm or refute the suspected diagnosis.

In the first months of life, the baby's bones are not fully formed, more than in an adult, partly they consist of cartilaginous tissue. It is softer than bone, easily influenced and strengthens with the age of the child. This feature helps the orthopedist to correct the identified defects without serious consequences for the health of the baby.

At the initial stage, many diseases are cured by a course of massage, special gymnastics, and the progression and neglect of the disease require serious treatment and surgical intervention.

Baby 3 months old

During the first 3 months of life, the baby gains mass especially quickly, muscles, joints, and the skeletal system are strengthened. At this stage, an examination by an orthopedist is necessary to control the correct formation of the motor system, so that the child learns to roll over in time, reach for the object he likes.

The doctor conducts an examination at three months, finds out if any abnormalities have appeared. He checks the symmetry of the folds, the movement of the joints, pays attention to the presence or absence of limited movements.

Evaluates how the baby lies: evenly holds the body, head. Toddlers turn their heads to the side with which parents often approach his crib. This leads to an uneven load on the muscles and their improper development.

Many diseases, imperceptible at the first examinations, manifest themselves by the third month. The orthopedist asks the parents if they notice soreness or unnaturalness in the child during the movements, the baby's motor skills. In the absence of deviations, the next scheduled examination in the hospital, or a doctor's call to the house, is scheduled for six months.

At the age of six months

This examination is aimed at assessing the formation of motor skills: the ability to roll over on the tummy and back on the back, to sit correctly. The orthopedist looks at the dynamics of the baby's development, evaluates the degree of effectiveness of the prescribed prevention and treatment.

Examination of a one year old baby

By this age, the child is already actively crawling, standing on legs, picking up and throwing objects, many children begin to walk. A doctor in the hospital, or called to the house, must control the correct development of the spine, feet - they now have a big load.

Unlike the first examinations, the orthopedist pays more attention to the independent movements of the child, checks whether he puts the leg correctly and holds the body when standing or walking. The doctor examines the condition of the muscles, arch of the foot, fingers.

It is difficult to identify flat feet or curvature of the spine in a one-year-old baby, but the doctor may advise physiotherapy exercises, preventive massage.

Unscheduled doctor visit

Parents should keep a close eye on the child. In case of suspicion, you should immediately contact an orthopedist, without waiting for a scheduled examination. If pathologies are detected, the decisive role of timely treatment increases the likelihood of completely getting rid of the disease and avoiding complications.

A visit to the doctor is necessary, or his call to the house if there are signs:

1. When a child lies on his back, stomach, his inguinal and gluteal folds are located asymmetrically, the spine does not straighten;
2. Legs of different lengths, limbs of unnatural shape;
3. The head most of the time is turned or forced to tilt to one side, which indicates poorly developed muscles, the presence of pathologies, torticollis;
4. Movements of the head, a change in the position of the neck cause anxiety in the child, a change in facial expressions;
5. There is a deformation of the skull, one side of the occiput is, as it were, beveled;
6. The feet rest on the outside or inside when trying to put the baby. In a healthy baby, they are evenly spaced;
7. Joint movements are limited or accompanied by extraneous sounds (crunching, clicking). With a dislocation of the hip joint, it is impossible to spread the child's legs to take the "frog" pose, the dislocation of the knee joint prevents the leg from bending at the knee. Dysplasia is treated by a doctor.

A visit to an orthopedist can be difficult due to the illness of the baby, parents, and domestic reasons. In this case, it is possible to call a specialist at home.

Basic tips for the harmonious development of the baby's muscular and skeletal system:

1. The baby needs to turn his head both to the right and to the left - this will give a uniform load on the muscles. It is necessary to lay the baby on different sides of the crib, approach him from different sides, turn his face alternately to the right and left. Correct muscle tone will help the child avoid problems with the spine when he starts to sit down;
2. In the first months, the child should spend most of his time on his back or on his stomach. His muscles weren't strong enough to keep him in the right position. The location on the side, an attempt to plant, put it prematurely put the main load on the spine and cause its curvature. Proper muscle development is promoted by turning over in both directions, swimming, gymnastics, massage;
3. The child should sleep without a pillow in order to form the correct curve of the cervical spine, you need a medium-hard mattress so that there are no dents after sleep;
4. The main movements of the kids are performed with one hand. Taking the toy for the first time in the right hand, they later use this particular hand more often. It is necessary to give the child objects in both hands.
5. It is worth abandoning tight swaddling, which can cause spasms of the femoral muscles. The free movement of the baby's legs contributes to proper development and avoids harmful stress on the joints.

If you called an orthopedist at home

With a baby, it is inconvenient to come to the hospital for examination: it takes a lot of time, the baby gets tired, is naughty. A home for a child is a comfortable and cozy place, any change of scenery causes anxiety and stress. And it is not safe for a baby, whose age is 2-3 months, to be in public transport: his body's protective functions have not strengthened.

Many medical centers offer paid services, including a doctor's house call. Such a visit is convenient for parents and the baby. You can choose a suitable time of arrival at home: the doctor will conduct a visual examination and palpation, give advice, tell you if the child needs therapeutic massage, which gymnastics is more suitable.

When calling a doctor at home, it is important to provide a flat surface for examining the baby. This allows you to identify deviations and correctly assess the condition of the baby. It should be taken into account that the doctor examines the child naked, to ensure a comfortable room temperature during the examination.

In the first year of a baby's life, you will have to go to the doctor very often, because it is important not to miss deviations in the development of the body in the early stages. The first scheduled examination of the little one takes place at 1 month of the newborn, and you can find out which doctors you have to go through.

The next scheduled examination of the child is carried out at three months. At the appointment, specialists will check whether the baby is developing according to the norms, whether he holds his head well, whether his fontanel is overgrown, whether the folds on the legs are symmetrical, whether there is an umbilical hernia, whether everything is in order with the tummy and spine, whether the child hears and sees well.

To get started, you need to come to pediatrician and get a referral for tests and to narrow specialists.

Bypass doctors at 3 months

1. Neurologist. After the first scheduled examination at 1 month, something in the child could change in development, or it was not diagnosed earlier, so the doctor will again check the behavior of the little one for external stimuli, muscle reactions. If suddenly the doctor discovers a developmental delay, insufficient motor activity, then he prescribes an ultrasound of the brain (Neurosonography). At this age, a specialist often finds a weak muscle tone in a baby, which is corrected with the help of water procedures, a massage course.
2. Oculist. Checks how the baby reacts to light, for astigmatism, strabismus and other vision problems. Talks about proper care of the baby's eyes.
3. Otorhinolaryngologist (ENT). Assesses the hearing qualities of the baby, checks the neck and nose of a small patient.
4. Surgeon. He checks the general condition of the child, reveals umbilical hernias, in boys he looks at the development of the testicles, the condition of the genital organs.
5. Orthopedist. It checks whether the baby has problems with the hip joints, whether the spine is formed correctly. Assesses the development of the foot, predisposition to flat feet.

Also, the pediatrician can send the baby to the ECHO-KG of the heart to identify hidden defects.

If the baby had underdeveloped hip joints, in the first month, as a rule, wide swaddling, breeding legs would be prescribed. At three months, such an infant is again examined by an orthopedist, and sent for a control ultrasound of the hip joints.

At 3 months, the local pediatrician will give you a referral for testing. You will need to pass a general analysis of blood and urine. To collect children's analyzes, a lot of sterile jars, bags are now sold, which are pressed directly to the intimate places of the child. It remains only to wait until the little one does his business in a bag.

Do not forget that at 3 months, according to the vaccination schedule, the child will need to be given the DTP vaccine (whooping cough, diphtheria, tetanus, polio), if desired, the vaccine against Haemophilus influenzae type b - 1st vaccination, and those who did not complete it in 1 month 2nd vaccination against hepatitis B.

Naturally, if a mother does not want her “treasure” to be vaccinated at such a young age, or in general throughout life, she can write a refusal, and doctors do not have the right to insist and intimidate. Without vaccinations, they are now accepted into kindergartens and schools.

Dear parents, do not neglect going to the doctors, even if it seems to you that everything is fine. If you think that in a municipal clinic, doctors examine children briefly, missing something important, go to a paid center, they are still more loyal to patients, although they can say too much and shake a lot of money out of parents. However, in paid medical institutions, you can quickly and efficiently do an ultrasound, while in a city clinic there are sometimes queues a month in advance.

However, there are borderline conditions that can be detected already in the first week of life, in these cases, the early start of rehabilitation treatment will be the key to the further well-being of the child.

Let's have a joint orthopedic examination of your baby. First, let's see how the child lies in the crib: whether the body is evenly located, make sure that he is calm, and examine him, as they say, from head to toe.

Head and neck

Carefully inspect your baby's head, pay attention to its shape, it should be symmetrical. But the attention of adults should be attracted not only by the shape, but also by the position of the head. Does her baby turn or strives to look in one direction all the time? In the latter case, the orthopedist can state the formation habitual head turn- a borderline condition, which, if appropriate measures are not taken in time, can lead to the development of a unilateral deformity of the skull, (the so-called "beveled occiput").

The reasons for the formation of a habitual turn of the head can be different - both birth injuries (cephalohematoma, fracture of the collarbone), and improper handling of the child, when parents constantly approach the crib from one side, without shifting the child's head in different directions.

But perhaps the most unpleasant diagnosis associated with an incorrect head position is muscular torticollis(an injury to the sternocleidomastoid muscle of the neck, as a result of which the head assumes an incorrect position). She is not always diagnosed in the maternity hospital, however, already in the first week of life, the mother can pay attention to the forced position of the child's head (tilt to the affected side, turn the chin to the healthy one). When trying to change the position of the head, the baby begins to show signs of anxiety, a painful grimace appears on his face. A little later, parents may notice asymmetry of the face: from the side of the torticollis, there is a decrease in the volume of the buccal muscle. When you try to feel the neck muscle from the diseased side, you can find a dense formation (from 1 to 3 cm), painful to the touch.

Congenital muscular torticollis requires immediate qualified treatment, consisting of courses of physiotherapy, massage, the use of special styling (pillows, rollers, etc.) for the head. With early detection and timely treatment, torticollis is eliminated without surgical intervention.

Spine and chest

Having finished examining the head and neck, we move on to the spine and chest, however, this stage of the examination must be preceded by a short digression into the anatomy.

The spine of an adult is not straight, it has physiological curves - kyphosis(outer bend - if you look at a person from the side, this bend is directed back towards the back) and lordosis(internal - directed towards the chest):

• cervical lordosis;
• thoracic kyphosis;
• lumbar lordosis.

All these curves are formed in the first months of a person's life. With the correct formation of the vertebral bends, a spring effect occurs, and in the future, the spine easily transfers axial loads due to good depreciation of the vertebrae, but if at least one of the bends is smoothed, this effect disappears, and the spine has to experience irrational loads, which contributes to the development of many diseases, such as scoliosis(lateral curvature of the spine), osteochondrosis(limitation of mobility of the spine), etc.

So, back to inspection. Let's put the baby on his stomach with legs bent at the knees ("frog pose"), and make sure that the spine is located in the midline. Sometimes a child may have "infantile scoliosis". Most often, it accompanies neurological symptoms (muscular dystonia, hypertonicity) - when it is eliminated, the normal position of the spine is also restored.

Sometimes, when viewed in this position, the child reveals a deviation of the axis of the spine back - the so-called kyphosis of the lumbar spine; it occurs mainly in children born large enough, and passes rather quickly if the first three months of a child’s life are correctly held in their arms, they do not try to plant, put on legs (many parents like to arrange “jumping” with the child - this cannot be done).

Parents should be aware that the formation of the curves of the spine occurs in stages: first, the child begins to hold his head - this contributes to the formation of cervical lordosis. Here it is appropriate to recall that the use of pillows in children violates the correct formation of this bend. When the baby begins to sit down (and he does this gradually, if adults do not interfere with him), thoracic kyphosis and lumbar lordosis are formed. If the child is put in a chair ahead of time, then instead of the prescribed bends, he may form thoracolumbar kyphosis, the so-called "round back".

If you want to try out the inventions of modern industry on your child, then first try to imagine how this will affect the baby's musculoskeletal system. Do not rush to buy a chair, walkers, jumpers, playpen for your child. First of all, take care of the right mattress: it should be elastic, dense, it should not leave dents after sleep.

The first 2-3 months of life, the child should lie on his back or stomach. You should not turn it on its side, since poorly developed lateral muscles still do not hold the body well, the entire load falls on the spine, and when the child is positioned on its side, scoliosis may occur. From 3-4 months, the child begins to roll over on his own and from that moment he chooses a position that is convenient for himself: on his back, stomach or side. During this period, the mother should see if the baby rolls over the left and right sides with the same frequency. Preference for one side may indicate residual effects muscular dystonia(different muscle tone on the left and right). These phenomena must be eliminated before the child begins to sit down:

• firstly, the different strength of the muscles of the left and right half of the body will make it difficult to develop skills when landing (the child will fall to one side and may lose the desire to continue trying),
• secondly, landing in this position can provoke the formation of scoliosis.

Perhaps during this period it is advisable to conduct a massage course, let the child swim in a large (adult) bath, this will help get rid of unwanted asymmetry in muscle tone.

Hip joints and legs

Let's return to the orthopedic examination of our baby. The next, no less important, stage is the hip joints. To assess the function of the hip joints, the child should be put on his back, bend his legs at the knee joints and try to spread them apart. This should not be done abruptly, with the use of force. The baby may not like it, it will strain the muscles and will not let you spread your legs.

With the correct conduct of this test, it is usually possible to abduct the legs so that the knee joints touch the table on which the child lies. Abduction restriction can be due to various reasons. The most common (and easily eliminated) cause is spasm of adductor (internal femoral) muscles. In this case, wide swaddling will help (that is, one in which the child’s hips do not press against each other, but are divorced for a certain distance), swimming in warm water, and therapeutic exercises. If the mother notes that the abduction of the hips on one side is more limited, this should be brought to the attention of the doctor.

The next stage of the examination is to check the symmetry of the gluteal folds and the length of the legs; to carry it out, put the baby on the stomach. You should contact a specialist if you notice asymmetry of the gluteal folds or different leg lengths. These symptoms may occur with some diseases.

After making sure that the hip joints are formed correctly and their function is not impaired, look at the feet. Pay attention to the position of the foot, it should be in the middle position. If you notice that the foot is not directed strictly forward, but slightly turned in the horizontal plane inward or outward (that is, there is a so-called foot rotation), you need to start a foot massage as soon as possible. A special massage course will eliminate the incorrect position of the foot already in the first month of a child's life. With a more pronounced deformity of the feet, it is possible to use corrective splints, which makes it possible to correct the foot while the child has not yet begun to walk. Remember: any minor deformity of the feet is easily corrected in early life, but much more effort has to be spent on treatment started after the child has gone.

So, we hope that as a result of our examination, you understand how important it is to carefully monitor the child's condition, note alarming symptoms and conduct timely treatment. However, it is equally important not to rush the development of the baby, not to push him, not to try to "help", but to patiently wait for him to want and be able to sit down, get up, go. Parental love must be attentive and patient, only then it will bear worthy results, and your child will grow up healthy and happy.