Van Aswegen, MariaanCzyz, Stanisław H.Moss, Sarah J.Steffens, Francois E.2022-07-182022-07-182022-02-15van Aswegen, M.; Czyz,˙ S.H.; Moss, S.J.; Steffens, F. Back-Carrying in Children Is Related to Lower Limb Development. Children 2022, 9, 263. https://doi.org/10.3390/children9020263.2227-9067 (online)10.3390/children9020263https://repository.up.ac.za/handle/2263/86258This is a part of the Ph.D. thesis of Mariaan van Aswegen at North-West University, Potchefstroom 2520, South Africa.Back-carrying of children is a culturally accepted method of transport and safekeeping of babies in many cultures. Developmental consequences related to back-carrying practices have not been directly investigated. This study determined the relationship between frontal and transverse plane lower limb (LL) development, and back-carrying practices, in black Setswana-speaking children. In 691 2- to 9-year-old Setswana-speaking children, the tibiofemoral angle, intermalleolar distance, femoral anteversion angle (AVA) and tibial torsion angle (TTA), were measured to determine LL development. Back-carrying practices were recorded with a questionnaire and Classification and Regression Tree (CART) was used for the analyses. Significant (p < 0.001) relationships, between back-carrying practices and LL development, were discovered. Statistically significant greater genu valgum (F(5, 690) = 7.2, p < 0.001), greater internal TTAs (F(9, 684) = 17.8, p < 0.001), and smaller AVAs (F(13, 685) = 5.1, p < 0.001) were observed in children back-carried more frequently than children back-carried less frequently. There are relationships between back-carrying practices and LL development in both the frontal and transverse plane. However, the genu valgum, internal TTA and smaller AVA noted in more frequently back-carried children is still within normal limits, thus no educational intervention in back-carrying methods or durations is required. Further research should determine the exact back-carrying practice factors (age until which the child is back-carried) impacting lower limb development the greatest.en© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.Back-carrying;Lower limb developmentTibiofemoral angleSetswana childrenTibial torsion angle (TTA)Intermalleolar distanceFemoral anteversion angle (AVA)Article