title: Epidemiology of generalized joint laxity (hypermobility) in fourteen-year-old children from the UK: a population-based evaluation.
abstract: OBJECTIVE
  Although diagnostic criteria for generalized ligamentous laxity (hypermobility) in children are widely used, their validity may be limited, due to the lack of robust descriptive epidemiologic data on this condition. The present study was undertaken to describe the point prevalence and pattern of hypermobility in 14-year-old children from a population-based cohort.
  
  
  METHODS
  We performed a cross-sectional analysis using the Avon Longitudinal Study of Parents and Children, a large population-based birth cohort. Hypermobility among children in the cohort (mean age 13.8 years) was measured using the Beighton scoring system. Objective measures of physical activity were ascertained by accelerometry. Data on other variables, including puberty and socioeconomic status, were collected. Simple prevalence rates were calculated. Chi-square tests and logistic regression analyses were used to assess associations of specific variables with hypermobility.
  
  
  RESULTS
  Among the 6,022 children evaluated, the prevalence of hypermobility (defined as a Beighton score of ≥4 [i.e., ≥4 joints affected]) in girls and boys age 13.8 years was 27.5% and 10.6%, respectively. Forty-five percent of girls and 29% of boys had hypermobile fingers. There was a suggestion of a positive association between hypermobility in girls and variables including physical activity, body mass index, and maternal education. No associations were seen in boys.
  
  
  CONCLUSIONS
  We have shown that the prevalence of hypermobility in UK children is high, possibly suggesting that the Beighton score cutoff of ≥4 is too low or that this scoring is not appropriate for use in subjects whose musculoskeletal system is still developing. These results provide a platform to evaluate the relationships between the Beighton criteria and key clinical features (including pain), thereby testing the clinical validity of this scoring system in the pediatric population.
authors.affiliation: Bristol Royal Hospital for Children, University of Bristol, Bristol, UK. jacqui.clinch@UHBristol.nhs.uk
authors.forename: Jacqui
authors.initials: J
authors.lastname: Clinch
authors.forename: Kevin
authors.initials: K
authors.lastname: Deere
authors.forename: Adrian
authors.initials: A
authors.lastname: Sayers
authors.forename: Shea
authors.initials: S
authors.lastname: Palmer
authors.forename: Chris
authors.initials: C
authors.lastname: Riddoch
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Tobias
authors.forename: Emma M
authors.initials: EM
authors.lastname: Clark
mesh_terms: D000293:Adolescent; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D007596:Joints / Q000503:physiopathology*; D008297:Male; D015995:Prevalence; D006113:United Kingdom / Q000453:epidemiology