Hip pain can be a very common complaint in the growing child. It can occur at any age group from the young infant to the adolescent years. Very young children often cannot voice their pain complaints, and hip pain will manifest itself as a refusal to move the joint, a limp or refusal to bear weight, or general symptoms of decreased appetite, crying or fever.
The underlying cause of hip pain in children will vary with difficult age groups. Following are some of the main common causes.
Birth to 2 Years:
Septic arthritis: This is an infection of the hip joint bone surrounding the joint. The patient will usually have had an illness 2-3 weeks prior to the onset of hip pain, such as an upper respiratory cold or an ear infection. The hip joint will be held in flexed position and will be held noticeably still compared to the other leg. Any attempted movements will cause the child to cry out.
A Septic joint in an infant is a real emergency, and must be treated as soon as possible.
Developmental dysplasia: This can occur in all age groups and is a dislocation or slipping of the ball out of the socket. In infants the hip may appear normal early on, but if left untreated will appear shorter and have less movement than the normal side. This is looked for on most visits to the pediatrician in the first four months of life. Early treatment will
prevent major problems at a later age.
2 - 5 Years Old:
Toxic Synovitis: This is the most common cause of hip pain in children 3-5 years old. It will usually present as a limp and may be caused by some type of trauma. The child will usually wake up in the morning and refuse to put his foot down and walk. The child will usually have a fever and will be able to move the hip slowly, unlike a child with an infected hip. Toxic Synovitis usually resolves in a few days. The child should be seen by a doctor if the symptoms last more than a week or if fever, increasing pain or refusal to move the hip develops.
Juvenile Rheumatoid Arthritis: Onset of this disease can occur in a child 2-5 years old up through adolescence. The first symptom is usually a swollen, red joint that is warm to the touch. There may be one, two, or
many joints involved. Unlike other problems, hip pain is usually very mild, and range of motion in the joint is usually normal early on. The patient may present with a number of other complaints, including back pain, neck pain, or eye problems.
Ages 4 to 10 Years:
Legg - Calve ? Perthes Disease: Although the previous problems should be considered in this age group, Leg-Calve-Perthes Disease is by far the most common in this age group. The child is usually small for his age and boys are more commonly affected than girls.
The disease is usually painless early on and will only present with a limp. The hip will become progressively stiff and the child will be limited in their activity. Early treatment of this disease is crucial, and may include exercise, traction, bracing or surgery. A limp not caused by trauma that lasts longer than 1-2 weeks should be seen by a physician.
Diskitis: This is inflammation or infection in the vertebral disc. It is easily confused with hip problems, because the patient may complain mostly of hip pain. The patient will walk very carefully and may refuse to walk at all. The patient will usually be comfortable lying very still in bed or on the back with the hips flexed. The patient may or may not develop fever or chills. Diagnosis usually requires a bone scan or laboratory work. Treatment may consist of antibiotics, bed rest, or casting.
10 - 15 Years:
Slipped capital femoral epiphysis: This is usually caused by trauma, and is a shifting of the growth plate in the hip. The child is
usually heavy for his age, and he may be involved in sports. The pain will present in the hip groin or anterior thigh. It may also be missed in a child presenting only with knee pain. It can occur gradually with progressive pain and limp over a number of weeks, or all at once. The Main symptoms are pain and loss of motion in the hip. Slipped capital femoral
epiphysis is a real emergency, and requires surgery to pin the growth plate. Failure to do so would result in a loss of blood supply to the hip, ending in severe deformity and disability.
Growing Pains: Growing pains can occur in adolescent children who are nearing the end of growth. They are usually mild and do not limit the child's activity. The pain is usually in the front or back of the thigh, and affects both legs at the same time or alternates between the two. Symptoms are greatest at the end of the day or wake the child up after a couple hours of sleep. The child is fine the next morning and will get up and move about without any problems during the day. Examination is usually normal and symptoms will subside with rest, medication, and time.
