Children are susceptible to hip pain, either due to genetic conditions or trauma. Many of these conditions are self limiting, but others are serious and require medical attention. Diagnosing any type of pain in children can e difficult, due to their inability to describe pain accurately, including its exact location. Even so, a good physician will be able to identify problems that need attention and may refer the child to a physical therapist or orthopedic doctor who specializes in joint-related diagnoses.
Hip Dysplasia/Dislocation
Developmental dysplasia of the hip is a condition of abnormal bone growth. The head of the femur bone typically sits in alignment within a part of the pelvis called the acetabulum. Abnormal growth causes this alignment to be thrown off and can cause partial or full dislocation. Pain often results and can be the first indicator of this diagnosis. The condition is present at birth but often isn't noticed until the child is older.
Legg Calve Perthes
Legg Calve Perthes disease is most common in boys between the ages of 5 to 7, although it is seen in children ages 3 to 12. Disrupted blood supply leads to degeneration of the joint. Typically only one hip is affected, and a child with Legg Calve Perthes may report pain in the groin or middle of the thigh. It heals on its own within one to three years.
Slipped Capital Femoral Epiphyses
Slipped capital femoral epiphyses happens when the growth plate in the part of the thigh bone nearest the pelvis weakens, causing slippage. It is more common in boys than girls by a 3 to 1 ratio and up to 75 percent of patients with SCFE are obese. The child often walks with a limp and reports pain in the groin, which may also refer pain to the middle of the thigh and knee. If SCFE is suspected, an immediate referral to an orthopedic surgeon is necessary as surgical intervention will be required.
Trauma
The bones in the hip and pelvis don't fully fuse until late childhood, making them susceptible to injury, particularly if the child is involved in sports or experiences a trauma such as a car accident. Pain in the hip can be a result of a stress fracture, sprained or torn ligaments, or strained muscles. These conditions are almost always resolved by rest, giving the injured areas time to heal, although more severe cases may require surgical intervention.
Infection
Osteomyelitis occurs when bone is infected by bacteria that entered the body through a cut or scratch in the skin, an open fracture or penetrating injury. In addition to pain, a child with osteomyelitis experiences high fever, chills, swelling and tenderness over the joint. Septic arthritis, also an infection, occurs in the joint space. This condition is extremely serious because it can destroy the joint within 48 hours from the time symptoms appear. As with osteomyelitis, swelling, fever and tenderness are also present as well as pain. An infant with septic arthritis may not move the limb due to pain. Immediate medical attention is necessary if septic arthritis or osteomyelitis is suspected.
References
- "Physical Therapy for Children"; Suzann Campbell; 2000
- "Handbook of Physical Therapy, 2nd edition"; Toby Long and Kathy Toscano; 2002
- Pubmed.gov: Slipped capital femoral epiphysis: diagnosis and management; Am Fam Physician; Peck, D; Aug 2010
