Bone and Joint pains in Children ? A word of caution
Bone and Joint pains in children are rare and any pain which is persistant or increasing requires prompt medical attention. Diagnosis may be difficult because of communication and examination problems. Obviously a three year old child crying of pain can neither answer your questions nor let you examine him !! ? The eyes do not see what the brain does not know ? hence a high degree of suspicion and relevant investigations are key to early diagnosis. Most commonly affected joint is hip and the problem could be anything from benign transient synovitis to harrowing Perthes or SCFE . While the transient synovitis resolves with rest in couple of weeks but the latter may require surgical intervention however the best results are ensured only with early intervention . In Indian scenario tuberculosis needs to be ruled out and treatment should be prompt to prevent joint destruction. In fact any hip ailment can also present as knee pain. Area around knee joint is notorious for infections and malignancies. These are rapidly progressive ; however early negative Xrays are common hence need for high clinical suspicion and investigations like MRI or CT. Back pain in children is rare and the cause could range from simple muscle sprain , developmental causes , inflammatory causes like discitis , infections or tumors.
Fractures in children are also common and elbow fractures in particular are notorious for associated neurovascular complications. Massage in particular is to be avoided in these cases as these can prove catastrophic . Since the bone ends have growth plates which are responsible for the growth of child so any bone trauma requires expert opinion.
Juveline rheumatoid arthritis affects children below 16yrs who present with pain and stiffness in joints. Its destructive disease with similarities to rheumatoid arthritis of adults however RA factor is normally negative. Any persisting bone pain should be investigated for fractures, infections etc. By and large majority of bone or joint pains in children are benign and tend to improve with time. But still medical checkup with continious observation and follow up is essential since a growing child behaves erratically. In short the message is its better to seek medical advice and investigate or i?ll say overinvestigate and definitely no overtreatment.
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