Child with recurrent Leg Pain

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Pediatrics Oct 16, 2020 0

Extremity pain is a common complaint in primary care pediatric practice. Up to 16% of school-aged children report at least 1 episode of activity-limiting extremity pain annually.

Among surveyed 8- to 18-year-old Norwegian children, 38.9% of girls and 46.6% of boys reported lower extremity pain during the 3 months prior to survey, while 13.9% of girls and 18.4% of boys reported arm pain. In a 9-year, 6-point, longitudinal survey, British researchers found that 56.6% of caregivers of 5- to 13-year-olds reported that their child often experienced extremity pain at the time of at least 1 survey. Over the 9-year course of the study, caregivers reporting extremity pain in their child increased from 15.1% for 5-year-olds to 32.5% for 13-year-olds.

There is some evidence that extremity pain is more common in obese children than in controls. Overall, approximately 6% of pediatric office visits are related to extremity pain. Fortunately, most of these visits involve pain caused by minor trauma, overuse syndromes, and normal skeletal growth variants.

Occasionally, however, limb pain is the presenting complaint of a systemic illness, a neoplasm, an infectious process, a nutritional derangement, a specific orthopedic disorder, or a rheumatologic disease. The challenge for the physician is to determine when the pain is significant without exposing the child to excessive diagnostic studies and without delaying treatment or referral. For the most part, this determination is based on the history and physical examination alone.

 

Overview

  • Pain in the legs (hip to foot)
  • Includes hip, knee, ankle, foot and toe joints
  • Includes minor muscle strain from overuse
  • Muscle cramps are also covered
  • The pain is not caused by an injury

Causes

  • Main Causes.
  • a)      Muscle spasms (cramps) and strained muscles (overuse) account for most leg pain.

             Muscle Cramps. Brief pains (1 to 15 minutes) are often due to muscle spasms (cramps). Foot or calf muscles are especially prone to     cramps that occur during sports. Foot or leg cramps may also awaken your child from sleep. Muscle cramps that occur during hard work or sports are called heat cramps. They often respond to extra fluids and salt.

 

       b)Muscle Overuse (Strained Muscles). Constant leg pains are often from hard work or sports. Examples are running or jumping too      much. This type of pain can last several hours or up to 7 days. Muscle pain can also be from a forgotten injury that occurred the day before.

 

  • C. Growing Pains. 10% of healthy children have harmless leg pains that come and go. These are often called growing pains (although they have nothing to do with growth). Growing pains usually occur in the calf or thigh muscles. They usually occur on both sides, not one side. They occur late in the day. Most likely, they are due to running or playing hard. They usually last 10 to 30 minutes.Nocturnal Leg Cramps - American Family Physician
  • Low Calcium Level. Low calcium and vitamin D levels can cause minor bone pains. Pain is mainly in the legs and ribs. Children on a milk-free diet are at risk.
  • Osgood Schlatter Disease. Pain, swelling and tenderness of the bone (tibia) just below the kneecap. The patellar tendon attaches to this bone. Caused by excessive jumping or running. Peak age is young teens. Harmless and goes away in 1 – 2 years.
  • Viral Infections. Muscle aches in both legs are common with viral illness, especially influenza.
  • Serious Causes. Fractures, deep vein thrombosis (blood clot in leg). Also, neuritis (a nerve infection) and arthritis (a joint infection).
  • Septic Arthritis (Serious). A bacterial infection of any joint space is a medical emergency. The symptoms are severe joint pain, joint stiffness and a high fever.
  • Toxic Synovitis of the hip is a harmless condition. It can imitate a septic arthritis of the hip. The symptoms are a limp, moderate pain and usually no fever. Toxic synovitis tends to occur in toddlers after jumping too much.

Pain Scale

  • Mild: Your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.
  • Moderate: The pain keeps your child from doing some normal activities. It may wake him or her up from sleep.
  • Severe: The pain is very bad. It keeps your child from doing all normal activities.

Symptoms

What other symptoms might occur with leg pain in children?

Leg pain in children may accompany other symptoms, which vary depending on the underlying disease, disorder or condition. Conditions that are known to cause leg pain in children may also involve other body systems.

 

Leg symptoms that may occur along with leg pain in children

Leg pain in children may accompany other symptoms affecting the leg including:

  • Bleeding or bruising
  • Deformity or instability of a joint
  • Limited ability, or inability, to move the leg
  • Muscle weakness or spasm
  • Pain, whether at rest or during specific movements, that may be described as dull, sharp, burning, stabbing or aching
  • Pus or discharge
  • Redness, warmth or swelling

Generalized symptoms that may occur along with leg pain in children

  • Leg pain in children may accompany symptoms related to other body systems including
  •     Fever and chills
  •     Pain or swelling in other joints
  •    Swelling or lump in other areas of the body

Symptoms that might indicate a serious condition

In some cases, leg pain in children may occur with other symptoms that might indicate a serious condition that should be immediately evaluated in an emergency setting.

  • Seek immediate medical care

    for leg pain in children that occurs along with other serious symptoms including:

Not moving or too weak to stand

You think your child has a life-threatening emergency

  • Call Doctor or Seek Care Now

    • Fever and pain in one leg only
    • Can’t move a hip, knee or ankle normally
    • Swollen joint
    • Calf pain on 1 side lasts more than 12 hours
    • Numbness (loss of feeling) lasts more than 1 hour
    • Severe pain or cries when leg is touched or moved
    • Your child looks or acts very sick
    • You think your child needs to be seen, and the problem is urgent

    Contact Doctor Within 24 Hours

    • Walking is not normal (has a limp)
    • Fever and pain in both legs
    • Bright red area on skin
    • You think your child needs to be seen, but the problem is not urgent

    Contact Doctor During Office Hours

    • Cause of leg pain is not clear
    • Leg pain lasts more than 7 days
    • Leg pains or muscle cramps are a frequent problem
    • You have other questions or concerns

    Self Care at Home

    • Muscle cramps in the calf or foot
    • Strained muscles caused by overuse (exercise or work)
    • Growing pains suspected
    • Cause is clear and harmless. (Examples are tight new shoes or a recent shot)
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