Orthopedics-Online

Leg pain in children

definition

Leg pain that occurs in children is in most cases harmless growing pains. Nevertheless, the leg pain should be observed and, if in doubt, clarified by a doctor.

introduction

In general, it can be assumed that one in three children will experience such leg pain at some point. The Majority of children suffer growth-related complaints between the ages of two and three. In addition, leg pain is often seen in primary school children.

Most commonly, leg pain in children is so-called Growing pains traced back in the course of the growth of the bony skeleton, but its exact origin is not fully understood. Such pain typically only occurs in the evening / night and subsides completely over the course of the day.

However, if there is any doubt, persistent or recurring leg pain in children should be urgently clarified by a pediatrician. The diagnosis is then less based on the detection of growing pains, but rather on the Exclusion of other relevant causes.

Symptoms

Possible accompanying symptoms of leg pain in children can provide a crucial clue as to the underlying condition.

In case of growth-related leg pain the discomfort occurs in children typically at night on. In the case of leg pain that occurs during the day or during exercise, growth pain can usually be ruled out.

The intensity The leg pain varies greatly depending on the causes. At growth-related leg pain in children the intensity of pain is very variable. As a rule, affected children speak of one pulling, pressing pain, which extends over the entire legs. In comparison, leg pain that is so pronounced that the affected child can no longer walk can be an indication of a so-called "hip runny nose".

The localization the leg pain in children is at harmless leg pain. However, a child can very precisely indicate a painful area, parents should mark this point with a pen and consult a pediatrician as soon as possible.The leg pain should be in such cases urgently clarified become.

In addition, symptoms such as morning leg pain and joint stiffness are considered Warning signalswhose causes must be investigated. Same goes when having leg pain in children Concomitant symptoms how Tiredness, paleness, or fever accompanied.

Leg pain with fever

If children experience leg pain with a fever, chances are they will have a bacterial or viral infection causes both symptoms in the leg area. One of the most common causes in this case is the Runny nose (Coxitis fugax). This is described in more detail in the subsection "leg pain after an infection".
If, in addition to the leg pain, also Swelling and redness occur at the hip joint, must be a bacterial infection of the hip joint.

The occurrence of leg pain along with a fever is also a sign of a rheumatic disease in children under 16 years of age. In systemic arthritis (Still disease; a special form of rheumatic diseases in children), the fever shows up in a very special way. It occurs over at least 2 weeks and then mostly in the morning and evening. This is how Still's disease presents itself especially in earlier phases. Later on, the affected children mainly have joint problems.
If a child has leg pain and fever in this way, they should speak to their pediatrician to rule out rheumatic disease or to detect it early.

Leg pain and abdominal pain

If children have abdominal pain and leg pain, then it should generally be considered that the children report the stomach pain because it is simple not describe precisely enough know exactly where the pain is. Small children like to report pain in the stomach, even though they are somewhere else.
Even so, this pain should be taken seriously. A wide variety of diseases can make themselves felt, such as a leukemia or one systemic scleroderma. But this is not the norm. In the event of persistent or recurring symptoms, a doctor should be consulted.
Another possibility can also be with this constellation Runny nose be. The pain radiates from the inflamed hip joint to the abdomen and legs.

causes

The possible causes of leg pain in children range from harmless growing pains to malignant tumors. Different causes can be considered depending on when the pain occurs.

Nocturnal pain

Growing pain is one of the most common causes of leg pain in children that occurs at night. In general, it can be assumed that one in three children will experience such leg pain at some point. The majority of children suffer from growth-related complaints between the ages of two and three. In addition, leg pain is often seen in primary school children. An important indication that the leg pain is only a harmless growth pain is the fact that the symptoms not exactly localizable are. In addition the pain often changes from one leg to the other. Which one mechanism it is precisely these growing pains that are provoked so far not clear. However, experts believe that various growth hormones, which are mainly released at night, are associated with this type of leg pain. The growth hormones induce a growth acceleration in the organism, whereby the sensitive bony membranes severely stretched and irritated can be. The affected child feels in this case tension-like leg painIn addition, it is discussed whether poor posture and excessive strain on the musculoskeletal system promote the development of growth-related leg pain in children. However, if there is any doubt, persistent or recurring leg pain in children should be urgently clarified by a pediatrician. The diagnosis is then less based on the detection of Growing painsbut rather about excluding other relevant causes.

If leg pain occurs mainly at night, a so-called "osteoid osteoma" may be present. An osteoid osteoma is one benign bone tumor. In addition, can also malicious changes the bones lead to leg pain in children. A classic example of a tumor relevant in this context is the so-called "Ewing sarcoma". Ewing's sarcoma mainly affects the pelvic or thigh bones and is the second most common bone cancer in childhood.

Persistent pain during the day

Another harmless cause of leg pain in children is sore muscles caused by high stress. In this case, the symptoms typically appear in the morning after the causal stress and persist throughout the day.

After a traumatic eventFor example, a fall or accident, the cause of leg pain in children can also be a broken bone or a Joint injury be. In addition, injuries to the tendons, ligaments or muscles are among the most common causes of leg pain in children that persist during the day.

Other causes of leg pain that persists during the day in children can be Bone necrosis be. Typical examples of such changes in the skeleton are Legg-Calvé-Perthes disease or Osgood-Schlatter disease.

Morning leg pain

Leg pain that occurs especially in the morning should be examined more closely. This is not a typical time for growing pains. Symptoms that occur in the morning, such as stiffness and pain, are possible signs of a child's condition rheumatic disease. This affects the large joints in the legs, such as the hips and knees. Especially in the morning it takes some time before the child is pain-free and can move properly.
If symptoms of this type and others, such as tiredness or fatigue, occur, you should discuss with your pediatrician whether a Blood draw for control is made of inflammatory markers and rheumatoid factors.

An infection (arthritis) of the joints in children can also be caused by a Lyme disease be conditional. Borrelia are the smallest bacteria found in many places transmitted by ticks become. The arthritis is not an initial symptom, but a sign that occurs after weeks to months. Due to the late appearance, parents often don't even think about whether or when the child has had a tick. The diagnosis can be confirmed by a serological blood test for Borrelia antibodies and then treated with an antibiotic.
Read about this: Lyme disease test and Treatment of borreliosis

Leg pain after exercise

The main cause of leg pain in children is what is known as growing pain. If the pain occurs, however only dependent on load on, or increase significantly in intensity after exercise, can he Pain in growth usually excluded and other causes that require treatment must also be considered.

If the pain arises after an accident or a fall, you have to traumatic changes muscles, tendons, joints, or bones should be considered. It could be a broken bone or just harmless sore muscles.

Another condition that can often lead to severe leg pain in children is leukemia. Children with blood cancer often report severe leg pain. The complaints also occur at rest, however, worsen dramatically with exerciseso even that Almost impossible to run becomes. If the symptoms appear, affected children must be presented to a pediatrician as soon as possible.

Leg pain after exercise

Exercise-related leg pain in children is not uncommon. One of the most common causes is simple muscle soreness. The child has made an effort and accordingly the muscles are painful.
Furthermore, the child may have suffered a slight bruise somewhere on his leg while playing, which is now causing him discomfort. An examination of the leg would show this bruise with a bruise, swelling and tenderness. L.

Read more interesting information on the topic at: Bruise in the child

In addition to these benign harmless causes, Ewing's sarcoma must also be considered here. This is a bone tumor that can occur in both younger and older children. At the beginning it is often noticeable through intermittent, i.e. non-permanent, pain that occurs after exercise and can be confused with growing pains. In addition to the pain, there are often other symptoms such as fever, a general feeling of illness and weight loss. In addition, minor paralysis in the leg area can occur if the tumor presses nerve structures. It is important to keep in mind that statistically only about 2-3 children out of 1,000,000 will develop Ewing's sarcoma. So it's a rare problem.

Leg pain after an infection

In the case of leg pain in children after an infection in the airways or the gastrointestinal tract, it is important to rule out inflammation of the hip joint. Colloquially, the so-called hip rhinitis is also popular. Usually the children have a simple one viral upper respiratory tract infection. After about 1–2 weeks, the children experience pain in the hip and knee area:
The strain on the leg is often painful for children. The mobility in the hip joint is limited. In particular, the internal rotation in the hip is significantly reduced. The kids like to take one Relief of the hip a. The hip is flexed and kept in external rotation, as this minimizes the pressure on the inflamed hip joint. The complaints are caused by an inflammation effusion (Fluid) in the hip joint.

The therapy consists in the Immobilization of the legs and possibly also ibuprofen or paracetamol. The symptoms should be gone after about 1 week.
However, if the problem persists after 2 weeks, then bacterial inflammation of the hip joint, which is causing the leg pain, must be considered. This arises directly, e.g. after a non-sterile joint puncture or via a hematogenous route, for example through gonococci or borrelia that get into the joint. A bacterial inflammation of the hip joint is usually not preceded by an infection.

leukemia

Persistent intense leg pain in children who are worsen with exertion and the Almost impossible to run may be associated with leukemia (cancer of the blood). Children who suffer from leukemia often notice leg pain in addition to the leg pain General symptoms such as exhaustion, tiredness, weight loss, tendency to bleed and increased susceptibility to infections. In addition, affected children can often increased bruising to be watched.

The term leukemia refers to a group of Cancers of the hematopoietic system. Leukemia is a malignant disease of the bone marrow. In the course of the disease they are in the bone marrow too many, usually immature and therefore not functional white blood cells (leukocytes) educated. These then displace both healthy white and mature red blood cells. The term leukemia means freely translated "white blood".

Basically, four types of leukemia have to be distinguished. The chronic forms that chronic myeloid (CML) and chronic lymphocytic leukemia (CLL), as well as acute myeloid leukemia (AML) can mainly be observed in adults and the elderly. In contrast, acute lymphoblastic leukemia (ALL) occurs especially in childrenwho have not yet reached the age of five. Affected children typically suffer from Leg pain, enlarged lymph nodes, Bleeding and noticeably frequent infections. The prognosis of ALL depends on various factors. If this form of leukemia occurs in children, around 80 percent of those affected are still alive five years after therapy.

Growing pains

Growing pains are mostly leg pain, but in rare cases can also affect the hands or arms. It is typical of the so-called growing pains that they occur in the evening or during the night.

The cause of the growing pains is a stretching of the periosteum. This is particularly sensitive and painful because the bone grows faster than the periosteum that surrounds the bone outside. Another typical feature of growing pains is that children often cannot pinpoint the pain. Growing pains also have the habit of being able to switch sides.
In addition, growing pains typically occur in preschool age, i.e. between the ages of five and six in children

Perthes disease

Perthes disease is a disease of the femoral head that usually occurs around school entry. A reduced blood supply to the thigh head causes it to collapse. However, the clinical picture also includes the fact that the head of the femur builds up again on its own.

With this disease, children typically complain of pain in their hips and knees. In addition, the children feel a lot of pain when the children sit cross-legged. When rebuilding the femoral head, however, it is important to ensure that it grows back together in the right shape and in the right place. If this is not the case, conservative or, if necessary, surgical therapy must be used.

Find out all about the topic here: Perthes disease.

Sinding-Larson-Johansson disease

Sinding-Larson-Johansson's disease, or patellar tip syndrome, is an overload of the hamstring that leads to painful, in the worst case permanent, inflammation. The scene of the action is a tendon which - encompassing the kneecap - attaches to the shin.
Excessive tension or compression can cause the kneecap, tendons and bones to rub, which initially causes painful irritation. In the case of permanent irritation, chronic inflammation can develop.

The disease often arises as a result of excessive exercise or improper exercise. Therapy usually includes physical rest with additional physical applications.

You can find more information on this topic here: Patellar tip syndrome.

Osgood-Schlatter disease

Osgood-Schlatter disease is an inflammatory reaction of the hamstring tendon that occurs particularly often in adolescents in early puberty. In doing so, excessive exercise leads to irritation at the attachment point of the tendon on the shin. The inflammatory reaction can also lead to the loosening of small pieces of bone, which subsequently die.

In the beginning, those affected often complain of pain only when they are under strain. However, if the condition is not treated, the pain can also occur at rest. Usually it only occurs on one side, but it can also affect both sides.
Osgood-Schlatter's disease is usually treated with physical restraint, possibly also with anti-inflammatory drugs. Surgical interventions only need to be carried out in rare cases.

Read more about the topic here: Osgood-Schlatter disease.

Osteomyelitis

Osteomyelitis is the technical term for a so-called bone marrow inflammation. This usually arises from the introduction of different pathogens in the case of open fractures or operations on the corresponding bone. As a rule, not only the marrow becomes inflamed, but also the remaining bone and the associated periosteum.

What rarely occurs in adults, however, is much more common in children: The pathogen colonization of the bone marrow via the blood, i.e. without direct contact between the bone and the external environment. Because the growth plates are still open, bacteria in children can also get from the blood directly into the bones and thus infect the bone marrow.
Bone marrow inflammation usually manifests itself with diffuse pain that cannot be precisely localized. Imaging methods such as X-rays or a subsequent MRI can help in this case.

For more information, read on: Osteomyelitis.

Bone tumor

Bone tumors are relatively more common in children than in adults. Many bone tumors have their frequency peak between the first and second decade of life. Fortunately, not all bone tumors are malignant, but tend to be benign.

The form of the pain as well as its location is of course strongly dependent on the type of bone tumor the child is suffering from. The therapy between benign and malignant bone tumors differs greatly from one another. While surgical removal is usually sufficient for benign tumors, malignant bone tumors are usually treated with radiation and chemotherapy.

Find out more about the topic here: Bone cancer.

The prognosis of a child's bone tumor disease is of course always dependent on whether it is a benign or malignant tumor when the tumor is discovered; means how far the tumor growth has progressed and many other things.
In general, however, medicine has deviated from giving approximate survival periods as forecasts. Rather, you work with percentages that are still alive after five years, for example. For example, malignant bone tumors also have a five-year survival of a little more than 50%. Early diagnosis and a good response to treatment naturally improve the chances of doing this.

Other possible causes of leg pain in children can be

Joint inflammation
Knock knees or bow legs
Scoliosis
Buckle foot
rheumatism
gout
Circulatory disorders
Runny nose
Fibromyalgia
Polyneuropathy

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diagnosis

The diagnosis of leg pain in children is usually carried out in several steps. At the beginning there is a detailed conversation carried out between the treating specialist and the parents of the child concerned (so-called anamnesis). During this interview, the complaints should be described as precisely as possible. Important in this context are particularly localization and temporal occurrence the complaints, as well as any Concomitant symptoms. The fact whether leg pain in children only occurs at night or during the day can provide an initial indication of the underlying disease. Parents can have one Pain diary lead, which can accelerate the diagnosis. In this pain diary, the time at which the leg pain occurred, the localization of the complaints and any accompanying symptoms should be carefully noted.

If the leg pain in children is related to an overload, it is in most cases a simple sore muscles. Leg pain in children who persist over a longer period of time and / or a particularly strong intensity can assume, however, a serious cause to have. In addition, play Diseases that occur in families, plays a crucial role in the diagnosis of leg pain in children.

Depending on the suspected diagnosis, further examinations should be arranged after the anamnesis discussion. If the presence of one is suspected Fracture (Fracture) or one Bone tumor first takes place a radiographic examination. In addition, a Ultrasound examination be performed. Will be during the physical exam Effusions in the area of the joints found, so can a Joint puncture become necessary. Also one Blood test can provide an important indication of inflammatory processes, bacterial infections, cancer or other infectious diseases. In some cases, performing a Magnetic resonance imaging (MRI) or Computed Tomography (CT) must be inevitable. For leg pain in children who also have severe discomfort should go along in the legs Examinations to assess the leg vessels and nerves be initiated.

therapy

The treatment of leg pain in children is primarily based on the causal disease. Here some examples:

Injuries: special bandages and ointment dressings can be useful here.
Bacterial Infections: usually a antibiotic therapy be initiated. This treatment can be either outpatient or inpatient, depending on the extent of the disease.
Rheumatic disease: therapy takes place here with Glucocorticoids.
Bone tumor: surgical removal may be possible, or radiation therapy and / or chemotherapy may be used.
Growing pains: this is the most common cause of leg pain in childhood and does not usually require any special treatment. The symptoms can be relieved by using cold compresses and pain relievers (so-called analgesics).

homeopathy

Especially growth-related leg pain can often be effectively alleviated in children with homeopathic medicines. Treatment usually requires three to four weeks. Especially Calcium phosphoricum D12 and Manganum metallicum D12 are suitable as medicines for leg pain. While Calcium phosphoricum should preferably be taken in the morning, Manganum metallicum must be given in the evening before going to sleep. The application can be supported above all by warmth, loving care and a gentle massage of the painful legs.

Duration

The duration of bone pain in children is understandably difficult to generalize because the causes can be widely spread.

However, one can usually assume that bone pain will last for a longer period of time than is the case, for example, with a simple cold. In addition, if you have long-lasting bone pain in childhood, you should definitely consult a doctor for clarification in order to rule out more serious illnesses or to treat them early.