Do you pick up your toddler and feel that shoulder or those wrist bones moving a lot under your touch? Does your child do a “downward dog” and her elbows look like they are bending backward? Does it seem that his ankles are rolling over toward the floor when he stands up? That is hypermobility, or excessive joint movement.
Barring direct injury to a joint, ligament laxity and/or low muscle tone are the usual culprits that create hypermobility. This can be noticed in one joint, a few, or in many joints throughout the body. While some excessive flexibility is quite normal for kids, other children are very, very flexible. This isn’t usually painful for the youngest children, and may never create pain for your child at any point in their lifetime. That doesn’t mean that you should ignore it. Hypermobility rarely goes away, even though it often decreases a bit with age in some children. It can be managed effectively with good OT and PT treatment. And what you avoid doing at this early stage can prevent accidental joint injury and teach good habits that last a lifetime.
- Avoid over-stretching joints, and I mean all of them. This means that you pick a child up with your hands on their ribcage and under their hips, not by their arms or wrists. Instruct your babysitter and your daycare providers, demonstrating clearly to illustrate the moves you’d prefer them to use. Don’t just tell them over the phone or in a text. Your child’s perception of pain is not always accurate when joint sensory aren’t stimulated (how many times have they smacked into something hard and not cried at all?) so you will always want to use a lift that produces the least amount of force on the most vulnerable joints. Yes, ribs can be dislocated too, but not nearly as easily as shoulders, elbows or wrists. For all but the most vulnerable children, simply changing to this lift instead of pulling on a limb is a safe bet.
- Actively discourage sitting, lying or leaning on joints that bend backward. This includes “W” sitting. I have lost count of the number of toddlers I see who lean on the BACK of their hands in sitting or lying on their stomach. This is too much stretch for those ligaments. Don’t sit idly by. Teach them how to position their joints. If they ask why, explaining that it will cause a “booboo” inside their wrist or arm should be enough. If they persist, think of another position all together. Sitting on a little bench instead of the floor, perhaps?
- Monitor and respect fatigue. Once the muscles surrounding a loose joint have fatigued and don’t support it, that joint is more vulnerable to injury. Ask your child to change her position or her activity before she is completely exhausted. This doesn’t necessarily mean stopping the fun, just altering it. But sometimes it does mean a full-on break. If she balks, sweeten the deal and offer something desirable while you explain that her knees or her wrists need to take a rest. They are tired. They may not want to rest either, but it is their rest time. Toddlers can relate.
Although we as therapists will be big players in your child’s development, parents are and always will be the single greatest force in shaping a child’s behavior and outlook. It is possible to raise a hypermobile child that is active, happy, and aware of their body in a nonjudgmental way. It starts with parents understanding these simple concepts and acting on them in daily activities.
Wondering about your child’s speech and feeding development? Take a look at Can Hypermobility Cause Speech Problems? to learn more about the effects of hypermobility on communication and oral motor skills.
Looking for information on toilet training your child with Ehlers Danlos syndrome, generalized ligament laxity, or low muscle tone? My e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, gives you detailed strategies for success, not philosophy or blanket statements. I include readiness checklists, discuss issues that derail training such as constipation, and explain the sensory, motor, and social/emotional components of training children that struggle to gain the awareness and stability needed to get the job done. You will start making progress right away!