From the Guidelines
The most appropriate next step in diagnosing a 10-year-old boy with intermittent bilateral lower leg pain for a month, without signs of trauma, swelling, ecchymosis, or tenderness, and normal vitals, is to consider the diagnosis of growing pains, a benign condition common in children, and not to immediately proceed with diagnostic testing. This decision is based on the fact that the child's symptoms are consistent with growing pains, which typically present as bilateral leg pain with no objective findings on examination and no functional limitations 1. Given the absence of concerning features such as point tenderness, swelling, limited mobility, systemic symptoms, or signs of trauma or abuse, the child's presentation aligns more closely with a benign condition rather than an acute infection like osteomyelitis or septic arthritis, which are discussed in the context of pediatric musculoskeletal infections 1. Key considerations in the diagnosis of osteomyelitis and septic arthritis include the presence of fever, pain, and diminished mobility, but these symptoms are not present in this case, making growing pains a more likely diagnosis 1. Therefore, no diagnostic testing is initially warranted, and reassurance along with symptomatic treatment should be the approach, as unnecessary investigations could expose the child to unnecessary risks without changing the management of growing pains.
From the Research
Diagnostic Approach
To approach the diagnosis of a 10-year-old boy presenting with intermittent bilateral lower leg pain for a month, with no signs of trauma, swelling, ecchymosis, or tenderness, and normal vitals, including no signs of abuse, the following steps can be considered:
- The patient's symptoms and presentation do not directly align with the cases described in the provided studies 2, 3, 4, 5, 6.
- However, the study on benign acute childhood myositis (BACM) 4 suggests that viral infections can cause muscle pain and difficulty walking, which might be relevant in this case.
- Another study on C reactive protein, erythrocyte sedimentation rate, or both, in the diagnosis of atraumatic paediatric limb pain 6 recommends measuring both CRP and ESR to identify orthopaedic infection as the cause of paediatric atraumatic limb pain.
- Given the lack of direct relevance of the provided studies to the patient's symptoms, a thorough medical history, physical examination, and laboratory tests such as complete blood count, blood chemistry, and inflammatory markers (e.g., CRP and ESR) 6 may be necessary to determine the underlying cause of the leg pain.
Potential Causes
Potential causes of intermittent bilateral lower leg pain in a child include:
- Benign acute childhood myositis (BACM) 4
- Orthopaedic infection 6
- Other conditions not directly related to the provided studies, such as growing pains, overuse injuries, or neurological disorders.
Laboratory Tests
Laboratory tests that may be helpful in diagnosing the cause of leg pain include: