Flat feet
Flatfeet are very common in children under age three. Usually the foot isn't really flat; rather, the instep hasn't developed because of some residual "baby fat." Flat feet may also be due to ligamentous laxity (double joints) and out-turned feet, in which case it usually resolves itself by age three or four.

Treatment
Flatfeet rarely require treatment as long as they are flexible and not painful. Special shoes or shoe inserts do not help to form the arch and are unnecessary in flexible flatfeet.

Shoes
The best shoes for toddlers are soft, flexible-soled leather shoes. If possible, let the child go barefoot, because there is no evidence that shoes help children walk better. Pre-schoolers do well in a sneaker with a rolled edge around the entire shoe, such as a basketball or court shoe.

If the foot is stiff or painful, however, x-rays and special shoe-inserts may be prescribed. Otherwise they are not needed.

Tripping
and Falling Children trip and fall a lot because their gait is immature and they are in the exploratory phase of walking. For instance:

• They may have a wide-based gait and put their feet down flat, causing the toe or shoe to catch the ground.
• They have less ground clearance than adults.
• To go faster, they must take more steps because they can't take longer steps like adults, and that makes them fall even more.
• They don't walk in a straight line. Instead, they twist, turn, over balance, and fall.
  As toddlers, they walk with their knees flexed which causes in-toeing.

Generally, tripping and falling is common and disappears by itself without any need for treatment. Children trip because they do not automatically lift their toes up.

Growing Pains
Growing pains are not unusual in children between four and eight years old. They are thought to be caused by rapid growth or over-activity and muscle soreness. Typically, growing pains occur at night and will awaken the child, who will complain of pain in the calf and shin area.

Treatment
Growing pains are not serious, although they can interrupt everyone's sleep. Special tests are not needed as long as the child is playing and eating normally and not limping. The best treatment includes:

• Stretching before bed
• Gentle massage
• Reassurance from the parent

Acetaminophen may help, as well. Just don't let growing pains become a nightly occurrence, as some children will use them as an excuse to keep their parents nearby.

If the pains occur only in one leg, during the daytime, cause a limp, or stop the child from playing, however, x-rays or further tests may be needed.