Leg Pain in Children

Musculoskeletal pain in the lower extremity is very common in children. By observing your child, providing your pediatrician a complete history and arranging for a thorough physical examination the right decision can be made about what tests and evaluations are necessary to assess and diagnose the pain.

Common causes include traumatic strains, sprains, dislocations and fractures as well as pain from infection or immune mediated pain. The pain may be referred from or due to age related issues including a slipped capital femoral epiphysis or Legg-Calve-Perthes disease. Although rare the risk of cancer and pain due to leukemia, lymphoma or a sarcoma must also be considered. The most common pains other than due to trauma are benign growing pains and tendonitis.

By providing an in depth pain history the possibility of missing an untreated disease is minimized. Provide information about when the pain began and the events surrounding the onset. Was there any trauma and how did your child respond when the event or trauma occurred? Were there any signs of bruising, swelling, warmth or localized tenderness? How has your child been acting since the onset of the pain? Are they easily distracted? Has your child been limiting any of her previous activities? Was a witness present?

Other information includes when the pain occurs. Immune mediated pain as is seen in rheumatoid arthritis is present in the morning and improves throughout the day.

Growing pains occur mostly at night as do pains from malignancy. The pattern of pain in terms of making it worse or better is helpful as are any associated symptoms such as fever, fatigue, weight loss, rashes, and appetite loss or sleep changes.

Since most children have difficulty providing much of the above information you must be a good observer and use “point and ask” questioning techniques to gather as much information as possible. These same techniques can be used for the physical examination that will include a general exam as well as pertinent orthopedic and neurologic examinations.

With your help the pediatrician can usually narrow a long an extensive list of possible causes to a very short list and allow a decision to be made as to what test(s) are needed and whether patience and observation are all that is needed.