Important Questions When Evaluating a Child with Knee Pain
When evaluating a child with knee pain, it is essential to ask questions that assess pain characteristics, functional impact, and red flags to identify potentially serious conditions requiring urgent intervention.
Pain Characteristics Assessment
- Pain quality and intensity: Ask about what the pain feels like, how much it hurts (using age-appropriate pain scales), and whether it's mild, moderate, or severe 1
- Pain location: Determine the exact spatial distribution of pain and whether it's localized or diffuse 1
- Pain duration: Ask how long the pain has lasted and whether it's acute or chronic 1
- Pain timing: Determine if pain is constant, intermittent, or related to specific activities 2
- Pain triggers: Ask what activities or positions worsen or relieve the pain 2
Mechanism of Injury and History
- Mechanism of injury: Ask about the specific mechanism and timing of injury if traumatic 1
- History of recurrent sprains/injuries: Determine if there's a pattern of previous injuries to the same knee 1
- Swelling: Ask about the presence, timing, and extent of swelling (rapid onset suggests hemarthrosis) 1
- Mechanical symptoms: Inquire about locking, catching, giving way, or instability 2
- Activity level: Ask about sports participation, recent changes in activity, or training regimens 3
Red Flags Assessment
- Fever or systemic symptoms: Critical to rule out septic arthritis or osteomyelitis 4
- Weight-bearing ability: Inability to bear weight suggests a more serious injury 1
- Neurological symptoms: Ask about numbness, tingling, or coldness in the affected limb 1
- Night pain: Pain that wakes the child at night may suggest more serious pathology like tumors 4
- Constitutional symptoms: Ask about fever, weight loss, fatigue (may suggest infection or malignancy) 4
Functional Impact Assessment
- Impact on daily activities: Ask how the pain affects school attendance, participation in sports, and other activities 1
- Emotional impact: Assess the emotional distress caused by the pain 1
- Sleep disturbance: Determine if pain interferes with sleep 2
- Response to previous treatments: Ask about previous treatments tried and their effectiveness 2
Age-Specific Considerations
- For adolescents: Ask specifically about sports participation, as teenage girls are more likely to have patellar tracking problems while teenage boys more commonly have extensor mechanism issues 3
- For younger children: Consider referred pain from hip pathology (such as slipped capital femoral epiphysis) that may present as knee pain 3
- Growth-related concerns: Ask about recent growth spurts that may contribute to conditions like Osgood-Schlatter disease 3
Treatment History
- Previous treatments: Ask about previous medications, physical therapy, or activity modifications 2
- Response to NSAIDs or acetaminophen: Determine if anti-inflammatory medications have helped 1, 2
- Use of supportive devices: Ask about use of braces, supports, or other assistive devices 1
Remember that the history and physical examination are the key components to establishing a diagnosis and directing initial management of knee pain in children 4. The most critical step is identifying emergent conditions, including limb- and life-threatening conditions such as septic arthritis, osteomyelitis, and malignancy 4.