THIRUVANANTHAPURAM: Bone and joint pain in children are one of the common problems which cause anxiety to the parents and urges them to approach a Paediatric or Orthopaedic specialist. The causes of musculoskeletal pain in growing children are numerous and most often not harmful in effect. Nevertheless, there are certain situations where these can be a forerunner of serious illnesses that require early diagnosis and treatment.
Growing pain is most severe for a child aged between three to eight years at night and often it requires a proper massage of the calf muscles. It may run for several weeks, months or even years. Still, the exact cause for growing pain is not known. The extensive evaluation of blood tests and Xrays are not required if there are no clinical signs of serious problems. The parents need to be counselled about the harmless nature of this condition. Usually, the pain will subside with symptomatic measures like massages and local applications.
Infections
Bone pain can happen in children due to the secondary infection elsewhere in the body. The child will be very sick and will have a high-grade fever as opposed to a child with growing pain. If there is pus in the joint or inside the bone it has to be removed surgically.
Inflammatory arthritis
Rheumatoid arthritis can occur in children as juvenile inflammatory arthritis. This disease is characterised by pain and swelling in single or multiple joints. The affected joint will be swollen and stiff. A severe type of inflammatory arthritis is characterised by fever, generalised weakness and multiple joint swellings. Untreated arthritis can cause early joint damage, growth disturbances and deformities of the affected parts. The disease can affect other parts especially the eyes; hence regular follow up by an eye specialist is also mandatory.
Certain tumours affecting the bone or the bone marrow can present only with bone pain initially. Severe bone pain in a child that is localised or generalised, not responding to ordinary painkillers and that is associated with other symptoms like weight loss, unexplained fever and localised swelling is cause for worry.
If recurrent hip or knee pain occurs in children called Perthes disease of the hip. Perthes disease is caused by lack of blood circulation to the upper spherical part of the thigh bone. The affected part of the bone dies and the bone collapses. Luckily, the condition heals spontaneously over a period of time without any problems, especially in children less than 6 years. Older children with this condition may need surgery to prevent damage to the spherical shape of the bone.
Bone pain in adolescents
Localised pain over the growing parts of the bone is very common in adolescents. The condition is called apophysitis (apophysis is the growing part of a bone) and can affect the kneecap (patella), upper of the leg bone or the heel bone. The pain is brought on by strenuous activities like running or jumping. The condition is often harmless; activity restriction and splinting will relieve pain in most situations. Obese adolescents with groin pain and abnormal walking pattern may have a condition called slipped femoral epiphysis.
This is a condition wherein the spherical upper part of the thigh bone (thigh bone is called femur) slips from underlying bone through the growth plate. The growth plate is a weak structure which adjoins the spherical bone end to the main part of the bone.
In adolescent children, who are obese and have hormonal problems which affect the thyroid or other glands, the slippage of bone can cause severe deformity and pain. They need to be treated by early surgery to prevent further slipping or deformity of the bone. If it left untreated, this can cause early wear tear damage to the joint and premature arthritis. From the preceding discussion, it is clear that bone and joint pain in children is very common and often the situation is harmless. Persistent symptoms warrant a prompt referral to a paediatric orthopaedic surgeon for further evaluation and management.
Dr Vinod Krishnan V is the Consultant Orothopaediatric Surgeon, KIMS Thiruvananthapuram (Views expressed by the author are his own).