Understanding Hypermobility in Children: What Parents Need to Know Children are naturally flexible, and many can bend or twist their […]
Understanding Hypermobility in Children: What Parents Need to Know
Children are naturally flexible, and many can bend or twist their joints in ways adults cannot. For
most children, this flexibility is harmless and simply part of growing up. However, some children have joints that are “too flexible,” which can sometimes lead to pain, fatigue, or difficulty with everyday movements. Understanding what hypermobility is, how it is diagnosed, and when to seek help can make a big difference in supporting your child.
Key Terms and Definitions
Ehlers–Danlos Syndrome (EDS) is a group of rare, inherited disorders affecting connective tissue, the material that gives our skin, joints, and other tissues strength and elasticity. Children with EDS often have joints that move beyond the typical range, skin that is unusually stretchy or fragile, and a tendency to bruise easily or heal slowly from wounds. There are at least 13 subtypes of EDS, including classical, vascular, and hypermobile EDS (hEDS). Each type has its own diagnostic criteria, often involving a combination of clinical features and, in some cases, genetic testing. If you want to learn more about EDS, the Ehlers-Danlos Society provides comprehensive information for families and carers.
Joint Hypermobility Syndrome (JHS) is an older term that was previously used to describe people with hypermobile joints that cause pain or instability but without the wider systemic features of EDS. Children with JHS might experience frequent sprains or joints that “slip” out of place, but typically their skin and other body systems are unaffected. Today, JHS has largely been replaced by the term Hypermobility Spectrum Disorder (HSD).
Hypermobility Spectrum Disorder (HSD) is a newer umbrella term for people who have symptomatic joint hypermobility but do not meet the full criteria for hEDS or another connective tissue disorder. HSD describes a wide range of presentations, from hypermobility affecting a single joint to widespread generalized hypermobility. Children and adults with HSD may experience pain, fatigue, joint instability, or difficulties with movement, but do not typically have the more systemic features seen in EDS.
In short, EDS is a genetic condition affecting connective tissue, JHS is the old term for symptomatic hypermobility, and HSD is the current diagnosis for children and adults with clinically significant hypermobility when EDS is not present.
Diagnosis in Children
Because children are naturally flexible, diagnosing hypermobility can be challenging. The adult criteria for hypermobile EDS are not reliable for children, which is why the condition is generally not diagnosed before the end of puberty. Diagnosing hEDS too early can cause unnecessary worry and lead to medicalisation.
In 2023, experts released updated guidelines for diagnosing hypermobility in children and teenagers. These guidelines allow clinicians to identify pediatric generalized HSD (pgHSD) in children aged five to eighteen. A child may be diagnosed with pgHSD if they have generalized joint hypermobility alongside musculoskeletal symptoms or other related health issues, provided other connective tissue or genetic conditions have been excluded. Importantly, the diagnosis is flexible and can evolve as the child grows. This approach helps clinicians provide the right support without prematurely labeling a child, while still monitoring and managing symptoms effectively.
Signs and Symptoms to Watch For
Parents and carers should consider consulting a paediatric physiotherapist if their child shows any of the following:
● Frequent or ongoing joint pain – particularly in the knees, ankles, or back, especially if it interferes with play, sports, or school activities.
● Joint instability or recurrent injuries – joints that partially dislocate, “give way,” or frequent sprains with minimal impact.
● Difficulty with movement or fatigue – trouble running, jumping, climbing stairs, or balancing compared to peers; stiffness or tiredness after normal activity.
● Postural issues – slouching, collapsing knees or ankles, or difficulty maintaining good posture during sitting or standing.
● Other signs – unusually flexible fingers, toes, or back affecting movement patterns, or delays in gross motor skills such as hopping, skipping, or catching.
How a Paediatric Physiotherapist Can Help
Paediatric physiotherapists play a key role in supporting children with hypermobility. They can assess joint range, movement quality, and functional skills, then design safe, age-appropriate exercises to target key areas such as improving strength, stability, coordination, and endurance. By helping children build the right movement strategies, physiotherapists can reduce pain, prevent injuries, and support participation in everyday activities, sports, and school.
Key Takeaways
Some flexibility is normal and healthy in children, but ongoing pain, frequent injuries, or difficulty with everyday movements are not. Hypermobile EDS should not be diagnosed in children before puberty. Pediatric Generalized HSD is a flexible diagnosis that allows clinicians to monitor, support, and treat children with symptomatic hypermobility as they grow. Early involvement of a physiotherapist can make a meaningful difference in a child’s comfort, confidence, and participation.
For more information on Ehlers-Danlos Syndrome, visit the Ehlers-Danlos Society
References
Baeza-Velasco, C., Vergne, J., Poli, M., Kalisch, L., & Calati, R. (2025). Autism in the context of joint hypermobility, hypermobility spectrum disorders, and Ehlers-Danlos syndromes: A systematic review and prevalence meta-analyses. Autism, 29(8), 1939–1958. https://doi.org/10.1177/13623613251328059
The Ehlers-Danlos Society. (2025). What is EDS? The Ehlers-Danlos Society. https://www.ehlers-danlos.com/what-is-eds/
Tofts, L. J., Simmonds, J., Schwartz, S. B., Richheimer, R. M., O’Connor, C., Elias, E., Engelbert, R., Cleary, K., Tinkle, B. T., Kline, A. D., Hakim, A. J., van Rossum, M. A. J., & Pacey, V. (2023). Pediatric joint hypermobility: A diagnostic framework and narrative review. Orphanet Journal of Rare Diseases, 18, 104. https://doi.org/10.1186/s13023-023-02717-2
