Grand Rounds

Waddling Gait

Medical Services Department, Pediatric Oncall, Mumbai

Address for Correspondence: Dr Ira Shah, Medical Sciences Department, Pediatric Oncall, 1, B Saguna, 271, B St. Francis Road, Vile Parle {W}, Mumbai 400056.

Clinical Problem :
A 2 year old boy born of non consanguineous marriage presented with complaints of not walking properly. He achieved normal milestones. These were no frequent falls or any neurological insult or trauma. Birth history was normal. He had neonatal hyperbilirubinemia on Day 3 of life for which phototherapy was given for 3 days. Immunization was upto date. He was on a poor diet of only rice and dal with no milk or vegetable intake. On examination, gait was waddling with lumbar lordosis and wide based gait. CNS system was normal. He had wrist widening and other systems were normal.

What is the cause of his gait disturbance_? Why_?

Discussion :
Expert’s opinion: This child has a poor diet in vitamins and minerals and also has wrist widening and lumbar lordosis suggestive of vitamin D deficiency. Vitamin D deficiency can lead to hypotonia, exaggerated lumbar lordosis due to pot belly and muscle weakness in addition to rickets. As a result pelvic muscles also become lax and due to that a child may waddle when walking. Hypotonia and muscle involvement is commonly seen with hypophosphatemia rather than hypocalcemia. In this child, serum calcium was 8.8 mg, dl {Normal = 8.5 to 11 mg, dl}, serum phosphorus was 2.9 mg, dl {Normal = 3 to 7 mg, dl} and alkaline phosphatase was 1820 IV, L. X-Ray wrist showed active rickets. The child was treated with vitamin D and calcium supplements following which the gait improved.

E-published February 2009, Vol 6 Issue 2 Art No. 8

Correct Answers :  yes 100%
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