A child's posture changes continuously through growth. Some appearances are normal stages for a given age and resolve on their own; others need monitoring or treatment. Telling them apart prevents both unnecessary worry and delayed care.
What is normal, and when
| Appearance | Normal at | When to assess |
|---|---|---|
| Flat feet | 0–6 years (the arch has not developed) | Persisting past 8, or with pain or fatigue |
| Bow legs (genu varum) | 0–2 years | Increasing after 2, or one-sided |
| Knock knees (genu valgum) | 3–6 years | Marked after 8 |
| In-toeing | 1–4 years | Frequent falls, persisting past 8 |
The "normal" column describes expected stages of healthy growth. Flat feet is the heading parents worry about most unnecessarily.
What does need assessment
- Asymmetry of the back: One side higher than the other on forward bending (scoliosis screening)
- One-sided findings: Only one shoulder low, flat foot on one side only
- Pain: Persistent back, low back or leg pain in a child is not normal and should be investigated
- Night pain: Pain that wakes the child always warrants medical assessment
- Rapid change: Posture changing noticeably over a short period
- Loss of function: Fatigue, frequent falls, not keeping up with peers
- Gait pattern: Walking on tiptoe without heel contact continuing past age 3
Are backpacks really a problem?
There is no strong evidence that backpacks cause lasting deformity. A heavy bag carried on one shoulder does distort posture while it is being carried, and causes muscle fatigue and temporary pain.
Practical advice:
- Keep the bag under 10–15% of the child's body weight
- Use both straps, tightened so the bag sits above the waist
- Pack heavy books closest to the back
- Consider a wheeled bag, or a locker at school
Screens and sitting
The clear rise in neck and back complaints among children tracks screen time. The problem is not the screen itself but the time spent motionless.
- Get up and move every 30 minutes of screen time
- Hold tablets and phones closer to eye level, not in the lap
- Match the desk to the child's height: feet on the floor, elbows reaching the desk comfortably
- Physical activity after homework, always
Weekly activity target for school-age children
The World Health Organization recommends at least 60 minutes of moderate-to-vigorous physical activity a day for children aged 5–17, including muscle- and bone-strengthening activity on at least three days: climbing, jumping, running games.
This does not require a sports club. Running in a park, cycling, skipping and swimming all count.
What physiotherapy does
Assessing a child differs from assessing an adult and takes the growth stage into account:
- Measuring range of motion and muscle length
- Strength and balance testing
- Gait and running analysis
- Scoliosis screening and referral where indicated
- Play-based exercise that keeps the child engaged
- Advice for the home and school set-up
A programme that is long and boring will not be done. Short, gamified programmes folded into the daily routine succeed.
A five-point checklist for parents
Once a month, with your child standing relaxed and their back visible:
- Are both shoulders level?
- Is one shoulder blade more prominent?
- Are the waist creases symmetrical?
- With arms hanging, are the gaps on each side equal?
- When bending forward, is one side of the back higher?
A positive on the fifth point warrants assessment by a doctor or physiotherapist.
Frequently asked questions
Does telling my child to "stand up straight" help? Constant correction does not produce lasting change and can create anxiety. Changing the environment and increasing activity works better.
Do flat feet need insoles? Routine insoles are not advised for painless, flexible flat feet. Pain, fatigue or a rigid flat foot warrant assessment.
When should I seek an opinion? Do not wait if there is pain, asymmetry, loss of function or rapid change. During growth, early assessment keeps more options open.
Is sport risky? The opposite — regular, varied sport is the best support for postural development. Varied activity is preferable to early specialisation in one discipline.
This article is general information and does not replace an examination. If you are concerned about your child's posture, book an assessment at our clinic in Muratpaşa, Antalya.