Postural defects in children are persistent deviations from a correct body shape, e.g. a round or hollow back, scoliotic posture, knock knees or flat feet. It is worth seeing a physiotherapist when a deviation persists as the child grows, gets worse, is asymmetrical, or causes pain and tiredness. Some changes are a stage of development, e.g. knock knees in 3–4-year-olds.
Below we explain which deviations are often a normal part of development, how a postural defect differs from scoliosis, when to see a doctor first, and what an assessment with a physiotherapist looks like.
In brief
- Knock knees are usually most pronounced at around 3–4 years of age and lessen over time.
- Flexible flat feet are common in pre-school children, and the arch of the foot usually forms by about 6–8 years of age.
- Asymmetry of the back visible when bending forward may indicate scoliosis, which a doctor diagnoses on an X-ray (Cobb angle ≥10°).
- The WHO recommends that children aged 5–17 get an average of 60 minutes of physical activity a day.
- A physiotherapy consultation in Rydułtowy costs PLN 180; the clinic sees private patients only (not covered by NFZ, the Polish public health fund), Mon–Fri 7:00–20:00.
Contents
When should you take a child with a postural defect to a physiotherapist?
It is worth taking your child to a physiotherapist when a postural deviation persists or gets worse despite growth, is clearly asymmetrical, the child tires quickly, complains of back, knee or foot pain, often trips, or cannot keep an upright posture. A consultation also helps to clear up doubts when a parent is not sure whether a change is still within normal development.
The physiotherapist assesses posture, mobility, muscle strength and gait, and then explains whether observation and more movement are enough, or whether exercises or a medical consultation are needed. Not every difference you notice requires therapy – often a check-up in a few months is enough.
What are postural defects in children?
Postural defects are deviations from correct body alignment that persist in a relaxed posture: changes in the curves of the spine or in the position of the shoulder blades, pelvis, knees or feet. Most often they are functional, i.e. they result from habits, muscle weakness or tightness, and the child can correct them. Less often they are structural, when the shape of the bones or joints changes.
A child’s posture changes with development, so it is assessed in relation to age. In a pre-school child, for example, a protruding tummy and a marked lumbar curve are often typical, whereas in a teenager they would already be a deviation. Posture is influenced by, among other things, the amount of movement, trunk muscle strength, long periods of sitting and rapid growth.
Which postural defects are most common in children?
The most common postural defects in children are a round back, i.e. increased thoracic kyphosis, a hollow back with increased lumbar lordosis, a flat back, scoliotic posture, knock knees or bow legs, and flat feet. They often occur together, e.g. a round back with a forward head and protruding shoulder blades. Whether a change requires therapy depends on an assessment of age and severity.
| Defect | What it looks like | Notes |
|---|---|---|
| Round back | rounded upper (thoracic) back, shoulders and head pushed forward | a rigid kyphosis in a teenager requires a doctor’s assessment (e.g. Scheuermann’s disease) |
| Hollow back | increased curve in the lower (lumbar) back, protruding tummy | in young children a marked lumbar curve is often normal |
| Flat back | flattened natural curves of the spine | often less noticeable to parents |
| Scoliotic posture | asymmetry of the shoulders, shoulder blades or waist without rotation of the vertebrae | needs to be distinguished from scoliosis |
| Knock knees | the knees touch, the ankles are apart | in pre-school children usually a stage of development |
| Flat feet | lowered longitudinal arch of the foot | flexible flat feet are common in young children |
Approximate description.
What is normal development and what is already a defect?
In young children many deviations are a stage of development. Babies and toddlers who are starting to walk usually have bow legs, then at around 3–4 years of age knock knees, which gradually straighten by around 7 years of age. Flexible flat feet are common up to pre-school age. A change that is one-sided, getting worse, painful or persisting beyond this age is a cause for concern.
The classic 1975 study by Salenius and Vankka described how the alignment of the knees changes in children over successive years of life. With flat feet, what matters is whether the arch of the foot appears when the child stands on tiptoe – this is a feature of flexible flat feet, which usually do not need treatment if they cause no symptoms. A rigid, flat and painful foot requires a doctor’s assessment.
How does a postural defect differ from scoliosis?
A postural defect, e.g. scoliotic posture, is an asymmetry without rotation of the vertebrae, which lessens or disappears when lying down, bending forward or consciously straightening up. Scoliosis is a structural curvature of the spine with rotation of the vertebrae that cannot be corrected by the child on their own. It is diagnosed by a doctor on the basis of an X-ray when the Cobb angle is at least 10°.
The sign that distinguishes scoliosis from a postural defect is a one-sided bulge of the back in the Adams test, i.e. the forward bend test. We describe how to do it in our article how to spot scoliosis in a child at home, and the whole topic of scoliosis in our guide scoliosis in children. We discuss the effect of school bags and sitting at a desk in our article scoliosis, school bags and desks.
When should you take your child to a doctor first?
See a doctor first if a change in posture is accompanied by night pain or increasing pain, limping, stiffness, joint swelling, fever, numbness or weakness in the legs, loss of motor skills or frequent falls. A rapidly increasing or one-sided curvature of the legs, a rigid painful foot, a rigid round back in a teenager and asymmetry of the back when bending forward also need to be assessed.
Such symptoms may indicate a disease of the bones, joints or nervous system rather than a typical postural defect. The first step is usually the paediatrician, who refers you to an orthopaedic doctor if needed. You will find the specialists the clinic works with on the Recommended specialists page.
How does a physiotherapist assess and manage postural defects?
During a physiotherapy consultation (PLN 180) the physiotherapist asks about the child’s development, looks at their posture from the front, side and back, and assesses the alignment of the feet and knees, mobility, muscle strength and gait. They then explain the findings to the parents, suggest observation, exercises or a medical consultation, and teach the child exercises to do at home.
Therapy for postural defects is based mainly on exercises suited to the child’s age and problem, often in the form of play, and on educating parents: how to encourage the child to move, how to set up a study area and what to look out for. The physiotherapist decides on the number and frequency of visits individually after the consultation. The child comes to the visit with a parent or legal guardian, wearing shorts and a T-shirt, and the clinic follows a child protection policy.
Physiotherapy consultationassessment of the child's posture, feet and knees, advice for parents and choice of exercises180 PLNPrices valid from 08.2026.
Good to know: bring your child’s comfortable everyday shoes to the visit – the way they are worn helps assess how the child walks and how the feet are aligned.
Summary
Many postural deviations in young children, e.g. knock knees at around 3–4 years of age or flexible flat feet, are a stage of development, but changes that persist, are asymmetrical or painful are worth showing to a physiotherapist. Asymmetry of the back when bending forward, stiffness, night pain or neurological symptoms require a doctor’s visit first; a physiotherapy consultation in Rydułtowy costs PLN 180.
Frequently asked questions
Do postural defects in children go away on their own?
Some deviations, such as knock knees in a pre-school child or flexible flat feet, lessen with development without treatment. Defects resulting from habits and muscle weakness are less likely to go away on their own, especially when the child moves little. That is why, if a deviation persists or gets worse, it is worth consulting a physiotherapist.
Are orthopaedic insoles needed for flat feet?
With flexible flat feet that cause no pain or limitations, insoles are usually not needed, and the evidence of their benefit in children without symptoms is limited. An orthopaedic doctor may recommend insoles when the foot hurts, tires quickly or the flat foot is rigid. Movement and walking on different surfaces support the development of the foot.
Are corrective exercise classes at school enough?
Corrective exercise classes at school can help children with mild postural defects, because they increase the amount of movement and teach good habits. However, group classes do not always take the child’s individual needs into account. With a clear, asymmetrical or painful defect, or if scoliosis is suspected, an individual assessment by a physiotherapist or doctor is needed.
Is a child’s slouching a postural defect?
Occasional slouching, e.g. when tired or after sitting for a long time, is not yet a postural defect if the child can easily straighten up. We speak of a defect when the rounding of the back persists in relaxed standing. A rigid round back in a teenager that cannot be straightened requires a doctor’s assessment, while habitual slouching calls for more movement.
From what age is it worth checking a child’s posture?
It is worth watching a child’s posture from the moment they start walking on their own, and particularly closely when they start school and during the growth spurt in puberty. Routine check-ups with the paediatrician include a posture assessment. If a parent notices a worrying change between check-ups, there is no point waiting for the next one.
Do I need a referral for a consultation for my child?
For a private consultation at the “W zdrowym ciele” clinic a referral is usually not required. The child comes with a parent or legal guardian, who gives consent for the service. The clinic has no contract with the NFZ (the Polish public health fund), is open Monday to Friday, 7:00–20:00, and a physiotherapy consultation costs PLN 180.
Sources
- Salenius P., Vankka E., The development of the tibiofemoral angle in children, Journal of Bone and Joint Surgery, 1975.
- Evans A.M., Rome K., A Cochrane review of the evidence for non-surgical interventions for flexible pediatric flat feet, European Journal of Physical and Rehabilitation Medicine, 2011.
- World Health Organization, WHO guidelines on physical activity and sedentary behaviour, 2020.
- Kasperczyk T., Wady postawy ciała. Diagnostyka i leczenie, Kraków, edition.
- Negrini S. et al., 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth, Scoliosis and Spinal Disorders, 2018.
About the author: Tatiana Grabowska, MSc – master’s degree in physiotherapy, licence to practise number PWZFz 11646 (Polish licence to practise as a physiotherapist). Since 2013 she has run the “W zdrowym ciele” physiotherapy and rehabilitation clinic in Rydułtowy; she has about 12 years of professional experience. Physiotherapist’s profile
- Consultation180 PLN
- Referralnot needed
- ReceptionMon–Fri: 7.00–20.00
