How is joint hypermobility assessed in children and adolescents?
In children, joint mobility changes with growth: a specific pediatric framework avoids applying adult criteria too early.
- 6 sources
- 6 min read
- Clinical review
- Verified 9 November 2026
Key points
- The 2017 adult criteria for hypermobile Ehlers-Danlos syndrome (hEDS) should not be applied to biologically immature children and adolescents: their presentation can change with growth [1].
- The 2023 international pediatric framework proposes assessing hypermobility from age 5, with a Beighton cutoff of at least 6 out of 9, and classifies children into eight subgroups based on hypermobility, skin signs, musculoskeletal complications and comorbidities [1].
- The framework provides for reassessment against the adult criteria once biological maturity is reached, defined as growth of less than 1 cm per year on two measurements at least three months apart, or a mature bone age (skeletal maturity assessed on an X-ray) [1].
- A 2026 scoping review (27 pediatric studies) describes symptom clusters — pain, subluxations or dislocations, fatigue, orthostatic intolerance, digestive symptoms — without providing prevalence figures [2].
- A 2026 meta-analysis estimates generalized hypermobility in 5- to 18-year-olds at 13.1% in girls and 6.2% in boys, with very high heterogeneity; it does not allow the frequency of hEDS or HSD in children to be estimated [3].
For parents. This page describes how professionals classify hypermobility in children. The Beighton score and the pediatric framework are part of a full clinical examination; they are not meant to be done at home.
Why a separate pediatric approach?
Age at assessment and the Beighton score
The eight pediatric subgroups
The four categories, each with or without skin involvement, are [1]:
| Category | Musculoskeletal complications | Key comorbidities |
|---|---|---|
| Pediatric generalized joint hypermobility, asymptomatic | Absent | Absent |
| Pediatric generalized joint hypermobility with comorbidities | Absent | Present |
| Pediatric HSD, musculoskeletal subtype | Present | Absent |
| Pediatric HSD, systemic subtype | Present | Present |
Symptoms described in children
The possible coexistence of hypermobility and POTS in young people is covered in POTS in adolescents and Hypermobility and POTS. Coexistence does not mean that one condition causes the other.
Prevalence: hypermobility is not hEDS
Frameworks and resources by country
International. The framework by Tofts et al. (2023) is a consensus proposal, built from a literature review, the group’s clinical experience and stakeholder consultations. It aims to harmonize pediatric diagnosis and research; it still needs to be tested, particularly in prospective cohorts [1].
France. The French national diagnosis and care protocol (PNDS) for “non-vascular Ehlers-Danlos syndrome” (2020) states that it does not cover hypermobility spectrum disorders. It has not been validated by the French National Authority for Health (HAS), which did not take part in drafting it [4]. The literature search did not identify a PNDS devoted to pediatric HSD.
United Kingdom. The NHS offers a public page, Joint hypermobility syndrome, which states that the condition mainly affects children and young people and often improves with age [5]. This page still uses a term that predates the 2017 HSD/hEDS nomenclature.
United States. Articles aimed at primary care describe the assessment of HSD and hEDS and when to refer to a specialist [6]. The literature search did not identify a single federal guideline; international criteria should be distinguished from the protocols specific to each pediatric center.
Limits of the pediatric framework
References and level of evidence
- Tofts LJ, Simmonds J, Schwartz SB et al. Pediatric joint hypermobility: a diagnostic framework and narrative review. Orphanet Journal of Rare Diseases, 18(1):104 2023. DOI: 10.1186/s13023-023-02717-2. PMID: 37143135.(guideline or consensus)Limitations: Consensus framework from the pediatric working group of the International Consortium; literature too heterogeneous for a systematic review, studies not quality-assessed; framework still to be tested prospectively. Read: full text (PMC10157984).Declared conflicts of interest: The authors declare no conflict of interest
- Pochcial P, Solomon SC, Bruno KA, Fairweather D, Kinane A, Letzkus L, Gurka KK, Stephens I, Knight DRT. Age-related symptom clustering in pediatric hypermobility spectrum disorders: a scoping review. Orphanet Journal of Rare Diseases, 21(1):264 2026. DOI: 10.1186/s13023-026-04424-0. PMID: 42218552.(evidence synthesis)Limitations: Scoping review (27 studies, ages 0–18, 1974 to May 2025): maps themes without estimating prevalence; heterogeneous included studies. Read: abstract and full text (PMC13435761).Declared conflicts of interest: The authors declare no conflict of interest
- Carnerup I, Bondesson E, Ahl E, Schouenborg AT, Jöud AS. Prevalence of generalized joint hypermobility, hypermobility spectrum disorders and Ehlers-Danlos syndrome: systematic review and meta-analysis. Rheumatology International, 46(11):306 2026. DOI: 10.1007/s00296-026-06346-3. PMID: 42986321.(evidence synthesis)Limitations: 17 general-population studies (age 5 and older); very high heterogeneity; a single study for HSD and hEDS, in people aged 18–50. Read: full text (PMC13739981).Declared conflicts of interest: The authors declare no conflict of interest; Swedish public funding
- French reference center for constitutional bone diseases, OSCAR rare-disease network (published by HAS). Syndrome d'Ehlers-Danlos Non Vasculaire (SED NV) — Protocole national de diagnostic et de soins. 2020.(guideline or consensus)Limitations: Not validated by the HAS, which did not take part in drafting it; does not cover hypermobility spectrum disorders. Read: institutional page and excerpts from the PDF.Declared conflicts of interest: Not reviewed in the part of the source that was read
- NHS. Joint hypermobility syndrome. 2023.(expert opinion)Limitations: Public information page (last review shown: August 30, 2023); uses the older JHS terminology.Declared conflicts of interest: Not applicable
- White L, Procknow SS. Hypermobile Ehlers Danlos for the Primary Care Provider. Missouri Medicine, 121(4):289–296 2024. PMID: 39575079.(expert opinion)Limitations: Clinical guidance article for primary care, not a national guideline. Read: abstract.Declared conflicts of interest: Not reviewed in the part of the source that was read