Genu varum is a relatively common finding in children. There are numerous conditions, both congenital and acquired which can be responsible with varying prognoses and treatments. Physiological bowing is seen most commonly and has a benign course, usually spontaneously resolving with growth. Idiopathic tibia vara (Blount's disease) is the most frequently encountered pathological condition; treatment is dependent on the age of the child and severity of the deformity at presentation. Systemic conditions, most of which also result in short stature can also result in genu varum – these include achondroplasia, rickets, renal osteodystrophy and osteogenesis imperfecta. This article gives an overview of clinical assessment of children presenting with tibial deformity, normal variants and discusses frequently encountered pathology in children with genu varum along with current treatment modalities.