Hip pain in the child

General

The hips in adults are no different from those in children; the only difference is that the hips in younger children are not completely fused together.

The hip socket generally consists of 3 different bone parts (Ischium, Os ilium and Pubis). Small children still have open growth plates here, namely exactly where these bone parts have not yet grown together. If it comes to hip pain, one of the many causes can be harmless growth pain. Other causes can e.g. the childhood illness Perthes disease or a so-called hip rhinitis (Coxitis fugax) be.

causes

Since the hip is required for standing upright and walking, hip pain in the child should be taken very seriously.
A doctor (pediatrician or, better still, a pediatric orthopedist) should always be consulted in case of doubt.

Growing pains

If the pain occurs mainly at night and disappears after a few days, the cause can be the so-called growth pain.

Hip sprain / ligament stretch

However, there are also more serious causes.
In principle, a child as well as an adult can suffer from a hip fracture or from muscle tension in the hip area.
Overstretching or even tearing of the ligaments at the hip joint are possible.
These possible causes of hip pain can include e.g. Occurring while playing, a fall on the hip from the monkey bars or twisting the leg while playing football can be the cause.
It is important to note, however, that children's bones are much softer than adult bones and therefore break much less often. Torn ligaments or tendons are also more likely in adults than in children.

Runny nose

In addition to these causes, there are typical hip rhinitis in children (Coxitis fugax). This is a non-infectious inflammation of the hip joint. This usually occurs between 3-10. Year of life. Most of the children had had a viral inflammation of the respiratory tract or gastrointestinal tract a few weeks earlier. The children sometimes project the hip pain into the knee and have particularly severe pain when they have to turn the leg inward.
The inflammation, and thus the hip pain, spontaneously disappears after a few weeks. Since the disease is preceded by an infection, the runny nose usually occurs in spring, when the rate of colds is greatest.

Read more on this topic at:

• Runny nose
  and
• Coxitis fugax

Perthes disease

Another cause of hip pain in children can be Perthes' disease. This is an orthopedic childhood disease in which, due to circulatory disorders, bone tissue in the hip button dies (Os femoris) is coming.

Read more about this topic at: Perthes disease

Inflammation of the hip

There is severe hip pain and the children try to avoid the pain by adopting an appropriate posture and reduced movement. How exactly Perthes disease develops is not certain and can vary from child to child. One cause can be a hormonal imbalance, another cause is a circulatory disorder due to malformation of the supplying vessels. However, genetic factors also seem to play a role, since a sibling of the affected child is much more likely to fall ill than a child without a genetic predisposition.
In the initial stage there is an inflammation in the area of ​​the femoral head and the acetabulum, later it comes to a misalignment of the femoral head and socket and accordingly to hip pain and difficult walking.

Read more on the topic: Inflammation of the hip in the child

Epiphyseal capitis femoris

A final cause of hip pain in children is capitis femoris epiphysis. This is a so-called epiphyseal solution. You have to know that the thigh bone, which forms the hip joint with the pelvic bone, consists of a head and a long shaft. In small children, there is a small gap between the long shaft bone and the head, the growth gap, which only grows in the course of growth. If the head is now detached from the legal shaft of the thigh bone, this sometimes leads to hip pain in the affected children, but knee pain or pain in the thigh is even more common.

Read more on this topic at: Epiphyseal capitis femoris

Symptoms and typical age of onset

Depending on the clinical picture, a distinction is made between typical pain in children. The age at which the children become ill also plays an important role.

At Growing pains kick the pain typically at night on. The children then have slight pain for several days, but these then disappear. Such growing pains can theoretically occur during the entire growth phase. The most decisive “age of onset”, however, is from around 3-13 years.
A fracture has of course no classic age of onset. However, it is unlikely until about 10 yearsthat a child breaks a bone quickly because the bones are still very soft and pliable. Here occurs the Pain suddenly and usually doesn't go away either.

At a Coxitis fugax, so the runny nose, the pain occurs sooner continuously on. Especially the Internal rotation of the leg is painful. . After a few weeks the pain just disappears. The age of onset is 3-10 years.

With Perthes' disease it has to not necessarily in pain. Mostly, however, are kicking Pain at rest, stress or start-up pain in the Knee and / or hip area. However, the first symptom is usually this limp of the child noticed. The age of onset is here 3-12 years, in which 5-7 year old boys with white skin are particularly common are affected.

The Epiphyseal capitis femoris expresses itself mainly through Pain in the knee or thigh, rarely also in the strip. Hip pain doesn't always have to be present be. To reduce the pain, the children hold this Leg mostly in external rotation. Again, it can gentle limping come. About from the 9th year of life can above all obese boys get sick with this disease.

diagnosis

If a child complains of hip pain and has also previously had an infection, a blood test is usually ordered. It must be ruled out that the child suffers from a bacterial infection.
If there is no evidence of an infection in the blood count, it can be assumed that the child is suffering from the non-infectious runny nose.In order to rule out Perthes disease, an x-ray should also be taken. This x-ray also shows whether the child may have epiphyseal capitis femoris.

Read more about this: X-ray examination of the child

therapy

For growing pains there is no proper therapy. It is only important that the children do not get used to incorrect relieving postures. By physical therapy or cold or warm envelopes can you try that Relieve growing pains and to prevent them.
The Coxitis fugax can be primarily heal through rest. At least The hips should be spared for 2-4 days, with severe pain NSAIDs how Ibuprofen are given. After a week, the pain should be gone.

There are several different therapeutic approaches for Perthes disease.
With mild forms one tries to conservatively bring the leg into the correct position and it using Splints and orthoses to leave in this position. One is also important absolute ban on sports; Children are not allowed to hop or jump as this puts too much strain on the hips.
At advanced stages is one surgery indexed. There are several procedures here that can be used depending on the extent and anatomy.

In the therapy of the Epiphyseolysis capitits femoris it depends very much on the severity. Surgery is almost always necessary. An attempt is made to hold the bones together in the correct position using so-called Kirschner wires or lag screws.
In severe cases, the Imhäuser operation the head is reinserted correctly into the socket and stabilized with plates and lag screws to prevent it from slipping out again.

prophylaxis

For most hip pain in children there is no prophylaxis. Every child has growing pains once, but the severity depends on the speed of growth. However, apart from changing diapers or relaxing baths, there is not much that can be done to alleviate the pain of growing.
Since the exact cause of coxitis fugax is unknown, of course it is difficult to prevent hip rhinitis.
One Unfortunately, Perthes disease cannot be prevented at all.
Also the Epiphyseal capitis femoris is difficult to prevent. It is noticeable, however, that obese (overweight) children in particular suffer from this disease. Therefore it can be assumed that Exercise and a healthy lifestyle can help children avoid such illness.

forecast

The prognosis of most diseases related to hip pain in children is this very good. Growing pains and colds from the hip go away spontaneously. With perthes disease and epiphyseal capitis femoris, success can also be expected with timely diagnosis and correct therapy.