How to Ask About Bone Pain in Children Suspected of Having Leukemia
When evaluating a child for possible leukemia, ask directly: "Does your child have pain in their arms or legs, especially at night?" and "Do their bones or joints hurt when they walk or play?" This simple, direct language captures the most common musculoskeletal presentation while being easily understood by both children and parents.
Specific Questions to Ask
Primary Screening Questions
- "Does your child complain of leg pain or arm pain?" - Limb pain occurs in 43% of children with leukemia at presentation 1
- "Does the pain wake them up at night or keep them from sleeping?" - Nighttime bone pain is a particularly important predictive factor for pediatric leukemia 2
- "Do their legs or arms hurt so much they don't want to walk or play?" - This assesses functional impact 2
Follow-Up Questions
- "Does your child limp or refuse to walk?" - Limp is a common musculoskeletal manifestation 1
- "Do their joints hurt or look swollen?" - Joint pain occurs in a significant proportion of cases 1, 2
- "Where exactly does it hurt? Can you point to the spot?" - Lower extremities are the most common site 2
- "How long has this been going on?" - Duration helps distinguish from acute injury 2
Important Context to Gather
Associated Symptoms to Ask About
While focusing on bone pain, simultaneously screen for other leukemia features:
- "Have you noticed your child looking pale or more tired than usual?" - Pallor occurs in 54% and fatigue in 46% of cases 1, 3
- "Have they had fevers without a clear infection?" - Fever is present in 53% at diagnosis 1
- "Have you seen unusual bruising or bleeding?" - Bruising occurs in 52% of children 1
- "Have they lost weight or stopped eating as much?" - Weight loss occurs in 25% 3
Critical Clinical Pitfalls
The most important caveat is that bone pain can initially mimic orthopedic or rheumatologic diseases like reactive arthritis, osteomyelitis, or juvenile idiopathic arthritis, potentially delaying diagnosis 2. Blood tests may initially be subtle or within normal limits, making clinical history even more critical 2.
Red Flags That Increase Suspicion
- Multiple symptoms occurring together (fever + pallor + bone pain + bruising) 1
- Nighttime pain that disrupts sleep 2
- Pain in multiple locations or diffuse bone pain 2, 4
- Pain associated with systemic symptoms like fever and weight loss 3
Physical Examination Guidance
When bone pain is reported, the physical examination should specifically include:
- Palpation of long bones for tenderness, particularly in lower extremities 2
- Assessment of gait and willingness to bear weight 2
- Abdominal palpation for hepatosplenomegaly (present in 64% and 61% respectively) 1
- Skin examination for pallor, petechiae, bruising, or rash 1
- Lymph node palpation (lymphadenopathy in 41%) 1
Language Considerations
For non-English speaking families, most pediatric patients and guardians understand symptom terminology in English, but approximately 32% consider translation into their first language very or extremely important 5. When language barriers exist, use simple demonstrations (pointing to legs, mimicking limping) alongside verbal questions 5.
The key is using concrete, observable terms rather than medical jargon - "hurt," "pain," "ache" rather than "musculoskeletal discomfort" or "osseous tenderness" 3.