From the Guidelines
Bone pain in children around 7 years old is most likely caused by osteomyelitis, a bone infection, which is a common cause of bone pain in this age group, as stated in the study by Shet et al 1. When evaluating a child with bone pain, a thorough analysis should include a detailed medical history focusing on pain characteristics (timing, location, severity), physical examination checking for swelling, redness, or limited mobility, and appropriate laboratory tests such as complete blood count, inflammatory markers (ESR, CRP), and vitamin D levels. Some key points to consider in the evaluation of bone pain in children include:
- The distribution of septic arthritis and osteomyelitis varies by age, with children between 2 and 10 years old being more likely to have osteomyelitis than septic arthritis, as reported by Shet et al 1
- The most commonly implicated pathogen in pediatric osteomyelitis is Staphylococcus aureus, but other organisms should be considered in select populations, such as group B streptococcus in neonates, Kingella kingae in children <4 years of age, and Salmonella spp. in patients with sickle cell disease, as stated in the study by Shet et al 1
- Imaging studies like X-rays or MRI may be necessary to rule out fractures or bone abnormalities, and to characterize and differentiate septic arthritis from osteomyelitis, as recommended by Shet et al 1 and the European Society for Medical Oncology 1
- Referral to a pediatric orthopedic surgeon may be necessary for children with bone or joint infection, such as osteomyelitis or septic arthritis, as stated in the study by the American Academy of Pediatrics 1 However, persistent, severe, or nighttime pain that wakes the child, pain accompanied by fever, weight loss, fatigue, or pain that limits activities requires prompt medical evaluation to rule out more serious conditions, such as bone tumors or leukemia, as recommended by the European Society for Medical Oncology 1. In terms of management, typical management of uncomplicated osteomyelitis in the pediatric population consists initially of intravenous (IV) antibiotic therapy followed by a prolonged course of outpatient antibiotics, either oral or IV, as stated in the study by Shet et al 1. It is essential to prioritize the evaluation and management of bone pain in children to prevent long-term morbidity and mortality, and to improve their quality of life, as the prompt diagnosis and treatment of osteomyelitis and septic arthritis can significantly impact the outcome, as reported by Shet et al 1 and the European Society for Medical Oncology 1.
From the Research
Possible Causes of Bone Pain in Children
- Bone pain in children can be caused by various factors, including traumatic, infectious, or inflammatory origins 2, 3
- Acute leukemia (AL) can sometimes begin with osteoarticular signs, and radiological investigations such as magnetic resonance imaging (MRI) can help guide the diagnosis 2
- Children with sickle cell disease (SCD) are at increased risk for bacterial infections, including osteomyelitis (OM), which can cause bone pain 4
- Other possible causes of bone pain in children include:
- Nonspecific pain or muscle strain
- Herniated disk
- Spondylolysis
- Scoliosis
- Scheuermann's kyphosis
- Tumor
- Infection
- Sickle cell crisis 5
Diagnostic Tools
- Magnetic resonance imaging (MRI) can be helpful in diagnosing the cause of bone pain in children, particularly in cases of osteomyelitis or acute leukemia 2, 4, 6
- Plain X-ray radiograph (PXR) can also be a useful diagnostic tool to detect possible acute leukemia in patients presenting with bone pain, even when there are no abnormalities in blood cell counts 6
- Complete blood count, erythrocyte sedimentation rate, and C-reactive protein measurement can also be performed to help diagnose the cause of bone pain 5