Serious joint and back problems are uncommon in children. A painful or swollen joint is most often the result of a minor strain or sprain of the muscles and ligaments surrounding the joint. However, joint pain or swelling can be caused by arthritis (joint inflammation). Arthritis is less common in children than in adults. However, in childhood the disease can also involve internal organs such as the heart and kidneys. Problems with the spine may be noticed for the first time in adolescence and need medical assessment. Severe back pain in a child of any age needs prompt medical attention.
Warning
Danger signs Call an ambulance if your child sustains a back injury and has either of the following symptoms:
Difficulty with bladder or bowel control
Weakness or numbness in a limb
1Does your child have pain that followed an injury or fall?
Possible cause Your child may have a serious injury such as a fracture affecting a joint or the spine.
Action Your child will probably need an X-ray to detect any damage. If a spinal injury is suspected, he or she may also need CT or MRI scanning. The treatment depends on the extent and the site of the injury.
15
Possible cause A minor sprain or strain of a ligament or muscle is the most likely cause of your child's pain.
Possible cause Septic arthritis, inflammation of a joint due to infection, is a possibility.
Action Your doctor will probably arrange for your child to be seen in hospital. Fluid may be removed from the joint and analysed to confirm the diagnosis. If septic arthritis is confirmed, your child will need treatment in hospital with antibiotics.
17
Possible cause Pain in any of these areas may indicate a hip-joint problem, which can often cause a child to limp.
Possible cause Your child may have Henoch-Schönlein purpura, a condition in which small blood vessels become fragile and leak blood. Small amounts of blood can leak into the joints, skin, intestines, and kidneys, causing pain; however, the condition is not serious.
Action Your doctor will examine your child and may arrange for blood and urine tests to confirm the diagnosis. If your child's symptoms are mild, no treatment is required. If his or her pain is severe, corticosteroid drugs may be prescribed. The condition usually clears up in less than a month with no permanent damage.
19See your doctor within 24 hours
Possible causes and action Your child may have a serious problem such as a bone disorder or arthritis of the spine. Your doctor will probably arrange for X-rays of the back and blood tests to make a diagnosis and determine the appropriate treatment.
20See your doctor within 24 hours
Possible cause A sideways curvature of the spine is called scoliosis. Some children are born with it and are treated in their first few years. However, some children develop the curvature later in childhood, most often in adolescence.
Action Your doctor will assess the curvature of the spine and will probably refer your child to a specialist. In many cases, no treatment is needed, but if the curvature is severe, treatment with exercises and sometimes a brace may be needed to correct the problem and prevent it from progressing.
21
Possible cause A minor sprain or strain of a ligament or muscle in the back is the most likely cause of your child's pain.
Action Give your child the recommended dose of a painkiller. Your child should avoid sports until he or she is free of pain. See your doctor within 24 hours if the pain is severe or if it has not improved by the next day.
22See your doctor within 24 hours
Possible cause and action Your child may have systemic juvenile arthritis, in which the immune system attacks the joints and, in some cases, the internal organs. Your doctor will probably refer your child to hospital or a specialist for tests. If the diagnosis is confirmed, treatment will include nonsteroidal anti-inflammatory drugs and, in some cases, corticosteroid drugs.
23See your doctor within 24 hours
Possible cause and action Reactive arthritis, inflammation of the joints in response to a recent infection, is possible. Your doctor may arrange for tests to confirm that the infection has cleared up and may prescribe nonsteroidal anti-inflammatory drugs. Reactive arthritis usually improves within weeks.
24See your doctor within 24 hours
Possible cause Juvenile chronic arthritis, in which the immune system attacks the joints and, in some cases, the eyes, is possible.
Action Your child may be referred to hospital for blood tests and a full eye examination. Nonsteroidal anti-inflammatory drugs and corticosteroids may be prescribed.
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See your doctor within 24 hours if you are unable to make a diagnosis from this chart.
26
Consult your doctor if you are unable to make a diagnosis from this chart.
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Consult your doctor if you are unable to make a diagnosis from this chart.
Self-Help Treating sprains and strains in a child
Cold compress If your child has a sprain or strain, a cold compress will help reduce the swelling.
If your child has a sprain or strain or a deep bruise, the appropriate treatment for the injury can be remembered as RICE - Rest, Ice, Compression, and Elevation (seeTreating sprains and strains). If necessary, give your child the recommended dose of a painkiller. If the injury is no better within 24 hours, consult your doctor.
Your child should avoid sports or any unnecessary exercise involving the affected part of the body until it is free from pain. If necessary, write your child's school a note explaining the problem.
Family Doctor Health Advisor is for information purposes only, and is designed as a general reference and catalyst to seeking further information.
The RACGP is not engaged in providing medical or other advice or services, and is not responsible for the results of any actions taken by any person on the basis of any information in this publication, or for any error in, or omission from, this publication.
Publication Date: 31 March 2009 Authorised By: RACGP
