Joint pain is a common paediatric presentation, particularly an acute limp.
Hip pain will present differently depending on the developmental age of the child. They may present with:
- Limp
- Refusal to use the affected leg
- Refusal to weight bear
- Inability to walk
- Pain
- Swollen or tender joint
TOM TIP: Examiners like to test your knowledge about the causes of hip pain in a child. It is worth being familiar with the differential diagnosis and distinguishing features of each cause.
Causes of Joint Pain
It is helpful to remember the differential diagnosis in the context of the age of the child. There is some overlap in ages.
0 – 4 years:
- Septic arthritis
- Developmental dysplasia of the hip (DDH)
- Transient sinovitis
5 – 10 years:
- Septic arthritis
- Transient sinovitis
- Perthes disease
10 – 16 years:
- Septic arthritis
- Slipped upper femoral epiphysis (SUFE)
- Juvenile idiopathic arthritis
Red Flags for Hip Pain
Suspect serious pathology if there are red flags:
- Child under 3 years
- Fever
- Waking at night with pain
- Weight loss
- Anorexia
- Night sweats
- Fatigue
- Persistent pain
- Stiffness in the morning
- Swollen or red joint
Management
Criteria for urgent referral for assessment in a limping child, adapted from NICE clinical knowledge summaries:
- Child under 3 years
- Child older than 9 with a restricted or painful hip
- Not able to weight bear
- Evidence of neurovascular compromise
- Severe pain or agitation
- Red flags for serious pathology
- Suspicion of abuse
Management will focus on identifying the underlying cause. Investigations that can be useful include:
- Blood tests including inflammatory markers (CRP and ESR) for JIA and septic arthritis
- Xrays are used to diagnose fractures, SUFE and other boney pathology
- Ultrasound can establish an effusion (fluid) in the joint
- Joint aspiration is used to diagnose or exclude septic arthritis
- MRI is used to diagnose osteomyelitis
Last updated January 2020