Child Hypermobility: Signs, Symptoms, and Support Strategies

How do I know if my child is hypermobile?

Identifying hypermobility in a child involves observing specific joint ranges of motion that extend beyond typical limits, coupled with an awareness of associated physical symptoms and challenges like pain, fatigue, or clumsiness, which may indicate a need for professional evaluation.

Understanding Hypermobility in Children

Joint hypermobility, often colloquially referred to as being "double-jointed," describes a condition where joints move beyond their normal physiological range of motion. This increased flexibility is due to laxity in the connective tissues (ligaments, tendons, and joint capsules) that stabilize the joints. While often benign, when hypermobility leads to symptoms like pain, instability, or other systemic issues, it may be classified as Generalized Joint Hypermobility (GJH) or part of a Hypermobility Spectrum Disorder (HSD), or even a specific genetic condition like Ehlers-Danlos Syndrome (hEDS).

It's important to differentiate between general flexibility, which can be beneficial for activities like dance or gymnastics, and hypermobility that causes problems. Many children are naturally more flexible than adults, but true hypermobility extends beyond this normal developmental range.

Common Signs and Symptoms of Hypermobility

Observing your child's movement patterns and listening to their complaints are key steps in identifying potential hypermobility. Look for a combination of the following indicators:

• Excessive Joint Flexibility: This is the most obvious sign. Your child might be able to perform movements that seem unusual or impossible for others, such as:
  • Hyperextending elbows or knees significantly (bending backward beyond straight).
  • Touching their thumb to their forearm.
  • Bending their pinky finger back beyond 90 degrees.
  • Placing their palms flat on the floor easily with straight legs.
• Joint Pain: Children with hypermobility often experience unexplained or recurrent joint pain, particularly in the knees, ankles, hips, or fingers. This pain can be diffuse, migratory, or worsen after activity.
• Fatigue: Chronic fatigue is a common complaint, even after adequate rest. The body may expend more energy to stabilize hypermobile joints.
• Clumsiness or Poor Coordination: Due to reduced proprioception (the body's sense of its position in space) in hypermobile joints, children may appear clumsy, stumble frequently, or have difficulty with fine motor skills or balance.
• Recurrent Injuries: Frequent sprains (especially ankles), strains, or even partial (subluxations) or full dislocations of joints can occur due to instability.
• "Growing Pains": While many children experience growing pains, persistent or severe pains, particularly at night, can sometimes be linked to hypermobility.
• Clicking or Popping Joints: Joints may make noise during movement, though this alone is not definitive of hypermobility.
• Skin Characteristics: In some specific hypermobility disorders (like Ehlers-Danlos Syndromes), skin may be noticeably soft, stretchy, or bruise easily.
• Other Systemic Symptoms: In more complex cases, hypermobility can be associated with issues like digestive problems, autonomic dysfunction (e.g., POTS - postural orthostatic tachycardia syndrome), or anxiety, though these are typically assessed by a medical professional.

Observing Joint Flexibility: A Parental Guide

While a formal diagnosis requires a medical professional, you can observe certain movements that are part of clinical assessments like the Beighton Score. These observations are not for self-diagnosis but to help you understand what to look for and discuss with a doctor.

1. Elbow Hyperextension: Ask your child to fully straighten their arm. Does their elbow bend backward more than 10 degrees past straight?
2. Knee Hyperextension: Have your child stand with legs straight. Do their knees bend backward more than 10 degrees past straight?
3. Thumb to Forearm: Ask your child to bend their thumb back as far as possible. Can they touch their thumb to the front of their forearm?
4. Little Finger Hyperextension: With their palm flat on a table, ask your child to bend their little finger backward. Does it bend back beyond 90 degrees (forming an L-shape or more)?
5. Trunk Flexion (Palms to Floor): Ask your child to bend forward from the waist with straight legs. Can they place their palms flat on the floor without straining?

Important Note: Passing one or two of these tests does not automatically mean your child has symptomatic hypermobility. Many healthy children can perform some of these movements. It's the combination of multiple hypermobile joints along with associated symptoms (pain, fatigue, injuries) that points towards a potential issue requiring professional evaluation.

When to Consult a Professional

If you observe several signs of hypermobility in your child, particularly if they are experiencing pain, fatigue, frequent injuries, or functional limitations, it is crucial to consult a healthcare professional.

• Pediatrician: Start with your child's primary care physician. They can conduct an initial assessment and refer you to specialists if needed.
• Pediatric Rheumatologist: These specialists focus on musculoskeletal conditions and can diagnose and manage hypermobility and related disorders.
• Physical Therapist (Physiotherapist): A physical therapist can assess joint stability, muscle strength, balance, and proprioception, and develop a targeted exercise program to improve stability and reduce symptoms.
• Geneticist: In cases where a specific underlying genetic condition like Ehlers-Danlos Syndrome is suspected, a geneticist can provide a definitive diagnosis.

Potential Challenges Associated with Hypermobility

While many hypermobile individuals live without significant issues, some challenges can arise:

• Chronic Pain: Persistent pain can impact daily activities, school performance, and quality of life.
• Increased Risk of Injury: Ligamentous laxity can make joints more prone to sprains, strains, and dislocations.
• Fatigue: The body expends more energy to stabilize joints, leading to increased tiredness.
• Proprioceptive Deficits: Impaired joint position sense can affect coordination and balance.
• Muscle Weakness: Muscles may work harder to compensate for lax ligaments, sometimes leading to overuse or weakness in supporting roles.
• Psychological Impact: Chronic pain and physical limitations can contribute to anxiety or depression.

Supporting a Hypermobile Child

If your child is identified as hypermobile, a proactive approach focusing on stability and strength is essential:

• Strength Training: Emphasize exercises that build strong muscles around the joints to provide stability. Focus on core strength, hip, knee, and shoulder stabilizers.
• Proprioceptive Training: Activities that challenge balance and coordination (e.g., balance boards, uneven surfaces, single-leg stands) can improve the body's awareness of joint position.
• Low-Impact Exercise: Encourage activities that build strength without putting excessive stress on joints, such as swimming, cycling, or Pilates.
• Avoid Extreme Stretching: While flexibility is present, overstretching can further destabilize joints. Focus on maintaining functional range of motion rather than increasing hypermobility.
• Proper Footwear: Supportive shoes can help stabilize ankles and feet.
• Pain Management: Work with healthcare professionals to develop strategies for managing any pain, which may include physical therapy, anti-inflammatory medications, or other modalities.
• Education: Help your child understand their body and the importance of protecting their joints.

Identifying hypermobility early allows for targeted interventions that can significantly improve a child's quality of life, reduce pain, and prevent future injuries. Always seek professional medical advice for a definitive diagnosis and personalized management plan.