Children who experience hip pain may be dealing with irritable hip, a condition that usually gets better on its own but should still be monitored for potential serious underlying issues.
What is Irritable Hip?
The primary cause of hip pain in children, irritable hip leads to discomfort and inflammation in the hip joint.
While it can be uncomfortable, irritable hip typically resolves without any complications.
Other less common but more severe reasons for hip pain in children include septic arthritis, injuries, and Perthes’ disease.
Recognizing Symptoms
- If a child suddenly experiences hip, thigh, or knee pain, along with limping or difficulty bearing weight on one leg, seek medical attention.
Evaluating Hip Pain
To identify the cause of hip pain in children, healthcare providers may conduct examinations of the affected areas, ask about recent injuries or illnesses, and perform tests such as X-rays or blood tests.
In addition to these evaluations, healthcare providers may also consider the child’s medical history, including any previous hip injuries or conditions that may contribute to the current pain. They may also discuss any activities or sports the child participates in to assess if there may be any repetitive motion or overuse causing the hip pain.
It is important for healthcare providers to take a comprehensive approach to evaluating hip pain in children to accurately diagnose the underlying cause and develop an appropriate treatment plan.
Treatment and Recovery
Irritable hip typically improves within one to two weeks without any lasting effects. Home care includes rest, follow-up appointments, and gradually returning to regular activities.
Tips for a Speedy Recovery:
- Follow your healthcare provider’s instructions for rest and activity.
- Use ice packs to reduce pain and swelling.
- Take over-the-counter pain medications, as recommended by your doctor.
- Do gentle hip stretches and exercises as directed by your healthcare provider.
- Avoid high-impact activities that may worsen your symptoms.
Published: Jan 26, 2020; Requested Revision: Feb 16, 2020; Accepted: Feb 20, 2020; Data Collection: Sep 2020.
Medical Referrals and Consultations
A report from the King’s Fund in 2010 revealed that GPs tend to refer younger children more frequently than older ones, possibly due to lower confidence levels. Musculoskeletal issues account for around 30% of GP consultations, with a quarter of all yearly patients being children.
Limping is a common reason for children to visit a GP, often resulting in referrals to orthopedic specialists for further evaluation and treatment.
Age-Specific Considerations
Various factors specific to different age groups can contribute to limping in children. Proper clinical assessment and referrals are essential.
Key Points for Evaluation
Take into account the common issues related to limping in children as detailed in the table below.
| Conditions affecting individuals of all age groups | |
|---|---|
| Fractures and soft tissue injuries | Cellulitis infections |
| Injuries not caused by accidents (NAI) | Tumors |
| Infections in the joints (septic arthritis) | Related to nerves and muscles (Neuromuscular) |
| Bone infections (Osteomyelitis) | |
Conducting a detailed interview with both the child and their parents is essential. It is crucial to differentiate between joint infections and less serious conditions such as transient synovitis in order to provide timely treatment.
Box 2.
The risk of septic arthritis rises with the presence of multiple positive Kocher criteria during assessment.
| Risk Assessment for Pediatric Septic Arthritis Using Kocher Criteria | |
|---|---|
| Avoid putting weight on the affected side | Probability of septic arthritis increases with the number of findings: 1 = 3%, 2 = 40%, 3 = 93%, 4 = 99% |
| Elevated erythrocyte sedimentation rate (>40 mm/hour) | |
| Temperature above 38.5°C | |
| High white cell count (>12,000 cells/ml) | |
Evaluating risk factors for hip dysplasia is essential for children under the age of three. Early detection can help prevent potential hip problems in the future.
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The assessment of a limping child commences with observing their walking pattern, searching for common irregularities that may indicate acute or chronic issues.
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It is crucial to determine if a child’s walking pattern is typical for their age when diagnosing acute or chronic conditions. Various abnormal walking patterns can provide valuable diagnostic information.
An antalgic walking pattern suggests an acute issue, while other patterns may indicate chronic conditions.
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A comprehensive examination of the lower limbs can help identify chronic ailments like Osgood–Schlatter disease or slipped capital femoral epiphysis.
Specific tests such as the Galeazzi test and assessments for tenderness can assist in diagnosing underlying chronic conditions in limping children.
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Immediate referral to the emergency department is necessary for acute cases, while chronic concerns require referrals to the elective pediatric orthopedic team.
Urgent referrals are essential for cases of trauma, septic arthritis, or suspected slipped capital femoral epiphysis to ensure prompt treatment and management.
NICE guidelines recommend referring limping children over nine years with specific symptoms to the emergency department to rule out severe conditions.
Red-flag symptoms for a limping child
| Indication | Possible reason |
|---|---|
| Discomfort disturbing the child’s sleep | Cancer |
| Symptoms such as redness, swelling, or stiffness in the joint or limb | Possible signs of infection or inflammatory joint condition |
| Symptoms like weight loss, anorexia, fever, night sweats, or fatigue | Could indicate malignancy, infection, or inflammation |
| Mysterious skin irritation or discoloration | Blood-related or joint inflammation condition, or intentional harm |
| Increased limp and stiffness during the morning hours | Condition characterized by inflammation in the joints |
| Intense discomfort, stress, and restlessness post a sudden injury | A developing compartmental syndrome |
In addition to the mentioned referrals, children with suspected developmental delays or concerns about their growth and development may also benefit from being referred to developmental pediatricians or early intervention programs. Furthermore, children with chronic conditions such as asthma, diabetes, or epilepsy may need ongoing care from outpatient specialists like pediatric pulmonologists, endocrinologists, or neurologists.
It is important for healthcare providers to closely monitor children who are referred to outpatient services to ensure that they are receiving the appropriate care and follow-up. Collaboration between different specialists, primary care providers, and parents is essential to ensure the best outcomes for children referred to outpatient services.
TAKE HOME MESSAGE
A child with a limp can have various causes, so it is crucial to rule out a septic joint using the provided algorithm. By following this systematic approach, referring clinicians can gain confidence in dealing with a limping child and making appropriate referrals.
Provenance
This article was freely submitted and externally peer-reviewed.
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REFERENCES
- 1. Foot C, Naylor C, Imison C. Improving the quality of GP diagnosis and referral. 2010 (Accessed on 31 Jul 2020).
- 2. NHS England Musculoskeletal conditions. (Accessed on 31 Jul 2020).
- 3. National Audit Office Survey of general practitioners in England on autism. 2008 (Accessed on 31 Jul 2020).
- 4. Krogstad P. Osteomyelitis and septic arthritis. Textbook of pediatric infectious diseases. 6th edn. Philadelphia, PA: Saunders; 2009.
- 5. Kocher MS, Zurakowski D, Kasser JR. Differentiating between septic arthritis and transient synovitis of the hip in children. J Bone Joint Surg Am. 1999;81(12):1662–1670. doi: 10.2106/00004623-199912000-00002.
- 6. National Institute for Health and Care Excellence. Clinical Knowledge Summary: acute childhood limp. 2015 (Accessed on 31 Jul 2020).
Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners
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If you are experiencing persistent leg pain, it is important to seek medical advice to determine the underlying cause. Leg pain can be a symptom of various conditions such as muscle strain, nerve damage, or vascular issues. It is important to consult with a healthcare professional for a proper diagnosis and treatment plan.
Key facts
- There exists a wide range of leg pain types.
- Leg pain could be localized or spread across the legs, sharp or dull, burning or numbing.
- The treatment for leg pain depends on its underlying cause.
There are various causes of leg pain, including muscle strain, overuse, injury, nerve damage, poor circulation, and underlying medical conditions such as arthritis, diabetes, or peripheral artery disease.
Treatment for leg pain depends on the underlying cause and may include rest, ice, compression, elevation, physical therapy, medications, injections, or surgery.
If you are experiencing persistent or severe leg pain, it is important to consult a healthcare provider for an accurate diagnosis and appropriate treatment plan.
Leg pain can also be caused by conditions such as muscle strain, overuse injuries, arthritis, nerve damage, blood clots, or peripheral artery disease. It is important to consult a healthcare provider for an accurate diagnosis and proper treatment.
In addition to medical evaluation, self-care measures such as rest, ice, compression, and elevation (RICE) can help alleviate mild leg pain. Strengthening exercises, stretching, and maintaining a healthy weight can also contribute to overall leg health and reduce the risk of pain and injury.
Remember to listen to your body, rest when needed, and seek professional advice if the pain persists or worsens. Prioritizing your leg health is essential for maintaining mobility and overall well-being.
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