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Your double-jointed child

Online since 15.01.2018 • Filed under Feature • From Sixteen - January to March 2018 page(s) 30-31
Your double-jointed child

Hypermobility or in layman’s terms being double jointed, refers to extreme flexibility in the body. Marene Jooste, a Kinderkineticist, explains what hypermobility is, the signs and symptoms to look for and, if coupled with other symptoms, the effect it has on the body.

When a mother came to see me, worried about her three-year-old daughter, she explained she’d already seen an urologist, paediatrician and an occupational therapist who all said her child was fine.

Nonetheless, she had a nagging feeling that this was not the case. The preschool teacher was also worried about how clumsy her little girl was.

Over the years, I’ve learned to trust a mother’s instinct and we went through their medical history form. My eye caught the following words: ‘severe constipation, continuous bladder problems, bruises easily, battles to sleep through the night, Complains of pain and tummy aches, very clumsy’. I sat uprightin my chair as the mom gave me more detail about her own development as a child. It sounded like acookie-cutter pattern – what mommy had been struggling with for years seemed to be troubling her child too. The clues slowly started to line up. Could this be genetic? Could this child have something that has been overlooked for the past three years?

I took the little girl by her hand, which immediately gave me another clue, and started to play various gross motor games as part of our formal assessment. I quickly noticed that this child was indeed very clumsy.

Although she could perform all the skills that I was testing, it was her way of execution that finally showed me what this family may have been dealing with for years. Holding her hands out to catch a ball, I noticed that her arms made an X when she lifted them in front of her, her elbows coming very close together.

What is hypermobility?

I had a proper look at the range of all hermovements. Indeed, this child was extremely flexible.

Her skin, full of bruises, had a velvety texture and it stretched further than normal. Although flexibility itself is not always a bad thing, it was all the other symptoms that were present with her extreme flexibility that made me suggest that she sees a paediatric rheumatologist. To cut a long story short, this little girl was diagnosed with Ehlers Danlos Syndrome and immediately began physiotherapy at a practice specialising in hypermobility.

What on earth is hypermobility, you may ask? It’s just a fancy word for describing how flexible someone is. Some people may refer to it in layman’s terms as being double jointed, and it is quite common in children because they have an inherently greater range of motion in their joints than adults do. According to the Hypermobility Syndrome Association, between 10 and 50% of all children are hypermobile, with girls being more flexible than boys. However, most of these children do not experience any symptoms but rather see themselves as having super powers, like Elasti-Girl in the movie The Incredibles.

Their bodies allow them to do crazy stunts like putting their feet behind their necks. Flexibility can also be an advantage in activities and sports such as athletics, dancing and gymnastics. But sometimes being hypermobile or bendy can cause problems or ‘symptoms’. This is what the word ‘syndrome’ means – other symptoms. In the past, children with mild symptoms were often diagnosed with Joint Hypermobility Syndrome. But since March 2017, this terminology has been changed internationally to Hypermobility Spectrum Disorder.

Some hypermobile children may also be diagnosed with more serious disorders such as Ehlers-Danlossyndrome or Marfan syndrome. Joint hypermobility can also be seen in children with Down Syndrome.

What causes hypermobility?

Low muscle tone may allow more movement in the joints. The shape of bones may also play a role in hypermobility as shallow sockets allow for a greater range of movement, which can also lead to dislocations. Although this is likely to affect only one joint in the body, it isn’t a common cause of hypermobility. On the otherhand, ‘loose’ ligaments are likely to cause hypermobility in many joints of the body.

Ligaments are made from several types of protein fibre, including elastin that provides stretchiness, and collagen that provides strength. Think of them as stretchy Elasti-Girl and her strong husband,

Collagen. They need to work in harmony to make the relationship successful. Small changes in the chemical processes of the body can result in weakened collagen fibres and more elasticity in the ligaments, which help hold the joints together. This causes people to be super flexible. Evidence exists that hypermobility caused by abnormal collagen can be inherited. If one parent has this type of hypermobility, then half of their children are likely to also inherit it, though members from the same family may not be affected the same.

Signs and symptoms of hypermobility

What are the signs and symptoms of hypermobility that warrant the attention of a professional? Children may complain about pain in their joints or muscles. They also tend to fidget a lot and generally tire easily. Growing pains, especially at night, are also often associated with hypermobile children. Remember, in most cases these children’s joints and muscles are too ‘loose’. They need to put in extra effort to do the same things everyone else does. These symptoms may begin suddenly after the child has an accident, is ill, has a big growth spurt, or if the child doesn’t exercise enough. Hypermobile children are also prone to sprains, soft tissue injuries and dislocations of their affected joints. Some complain of stomach aches and feeling dizzy. Others may have loose skin, increased bruising and thin scars. In more severe cases, children may have reoccurring bladder infections or digestive problems such as diarrhoea or constipation. Because eyes are made of 80% collagen, a child with severe hypermobility may also experience eye problems.

Collagen is also found in all the tissues and structures involved with speech and swallowing. Children with severe hypermobility could have problems chewing, speaking and swallowing.

On the gross motor side, these children may have flat feet, poor balance and coordination, and an impaired sense of where their joints are in space in relation to the rest of their bodies.

Treatment for hypermobility

Most children become less flexible as they grow older and their symptoms improve. However, if you are concerned in any way, consult with your paediatrician. There are certain procedures, such as the Beighton scoring, that can be followed to determine if a child is hypermobile. If hypermobility is confirmed and your child displays some of the signs and symptoms mentioned above, it may be worth seeing a paediatric rheumatologist to determine the effect of hypermobility on your child’s health. You can also see a physiotherapist that specialises in hypermobility. It is important to remember that children with extreme hypermobility need to keep moving.

Although lying on a bed engaging in screen time can feel nice at the time, it can make the pain worse in the long term. Children should therefore engage in lots of gentle stretching and moving. They should also build strong muscles and a good core to minimise the effect that hypermobility can have on their bodies.

A registered Kinderkineticist can help with this aspect of your child’s development and can provide the child with an exercise programme that suits the exact needs of the child. For further guidelines and strategies for parents to follow, visit hypermobility.org. You are also welcome to contact our paediatric development centre or visit our website at www.kwandakinetics.co.za. Until next time, happy moving moments!

Marene Jooste has a masters’ degree in Kinderkinetics and serves on SAPIK’s board as one of two vice-presidents. She is also an integrated learning practitioner and the founder of

Kwanda Kinetics, an innovative paediatric development centre in Gauteng. To find a Kinderkineticist practicing in your area, visit http://www.kinderkinetics.co.za

Sixteen - January to March 2018

Sixteen - January to March 2018

This article was featured on page 30-31 of Babys and Beyond Sixteen - January to March 2018 .

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