Flexible Joints

Dear Lisa,

My 2 ½ yr old child, for the past year, curls her body into a U shape, stretching her limbs 3 or 4 times a day (approximately 4 to 6 hours apart) lasting each time about 3 to 5 minutes and making a straining sound each time she stretches. She is able to stop at will, but does this each day consistently. Is this something to be concerned about or is this normal behavior in some children?

“Stretchy Girl”

Dear “Stretchy Girl”,

First, it would be important to know if your daughter’s stretching and straining sounds are related to passing a bowel movement. Since her stretching started at such a young age this may be a consideration. Sometimes children may put their bodies into a different position in order to help push their stool out (or for some children to hold the stool in). Straining in particular is commonly found in children with hard stools or constipation. If your daughter engages in these stretching activities around toileting time or if she has a history of constipation, you may want to discuss her stooling pattern with her doctor. If it is determined that her stretching is not related to having a bowel movement then others reasons for her stretching can be considered.

Children are very flexible and are able to move their joints in a way that adults can’t. As children grow older, they lose this natural flexibility. As their flexibility decreases, their muscular strength increases.(1) By the time a child reaches adolescence they lose the flexibility in the movement of their joints that they experienced when they were younger.

In most cases, the flexibility that parents notice is normal flexibility due to their child’s young age. Some children experience more laxity than others. There is a concern if a child has too much flexibility, too much joint laxity, muscle weakness or low muscle tone. If a joint has too much laxity a child is at risk for injury due to the inadequacy of the supporting structures around the muscle and bone. (1) For some children, marked joint laxity and muscle weakness can be a sign of a musculoskeletal problem.(2) Your daughter's Pediatrician will be able to tell you if her level of flexibility is normal for her age.

Since your daughter has control over her movements and her activity can be stopped when asked, she could be mimicking activities that she has witnessed. It is very common for toddlers and preschoolers to copy the behavior of their parents or siblings. This is a normal step in childhood development. Children may copy their parents by make believing that they are cleaning the house, talking on the telephone or playing dress up. (3)

Your daughter may be stretching because she is trying to act like someone in the house who exercises. The only part that doesn't make sense is the length of time this has been going on. If she started this behavior a year ago, she would have been quite young to be imitating behavior.

You did not mention how your daughter behaves during the rest of the day. Information about a child's developmental status and social development is needed whenever there is a question about a particular behavior. Normally by the time a child is 2 ½ years old she should be able to run quickly with only a few falls, walk down steps holding on to a rail, stack six blocks, turn pages of a book, use a spoon successfully, turn a doorknob, engage in pretend play, use two-word sentences and dress with help.(3)

If your daughter is engaging in these activities and is not experiencing any physical or social development delays there is probably nothing to be concerned about. Although, the only way to be sure is to ask the physician who performs regular physical examinations on your daughter. He will be able to tell you if her physical development, muscle strength, flexibility, coordination and behavior are normal for her age.

Concerning signs include; uncontrollable movements, shaking, jerking of the extremities, staring spells, unintentional extension of an extremity, muscle rigidity or marked laxity. (2) I would suggest showing your daughter's Doctor this stretching behavior that she is having. A physical examination performed by your doctor can tell you if your daughter’s behavior is normal for her age. A Video recording of your daughter’s stretching can give your Doctor the visual information that he needs to make his assessment.

References:
(1)Schwartz M, Charney E, Curry T, Ludwig S. Pediatric Primary Care. A Problem Oriented Approach. 2nd Ed. Littleton, Mass:Year Book Medical Publishers, Inc. 1990:140.
(2)El-Bohy A, Wong B. The Diagnosis of Muscular Dystrophy. Pediatric Annals. 2005.34(7):525-530.
(3)Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994:203,190-191.


Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice About Childhood Development