Joint pains are not uncommon in children. Often these pains are non-specific in nature and are not secondary to significant medical conditions. However, there are a small number of children who have joint pains which are caused by underlying diseases or medical conditions.

The painful joint

Joint pain can arise from any of the structures inside or surrounding the joints. Disease processes or mechanical trauma affecting these structures would lead to sensation of pain.

Sometimes the pain in a particular joint does not arise from the joint itself but is actually secondary to a disease process from a distant site of the body. This is termed ‘referred pain’.

Apart from pain, there may be other symptoms which may be associated with the affected joint/s and may imply a more significant underlying condition. These symptoms may be:

• Stiffness.
• Swelling.
• Heat or excessive warmth surrounding the affected joint.
• Limitation of movement.
• Sensation of ‘locking’.

There may be other associated systemic symptoms as well such as:

• Fever.
• Skin rash.
• Loss of weight / loss of appetite.
• Eye inflammation.
• Ulcers in the mouth or genitalia.
• Back pain or stiffness.
• Pain over the buttocks.
• Muscle weakness.
• Bowel symptoms – such as diarrhoea, blood in the stools.
• Symptoms related to other underlying medical conditions – Haemophilia, Chronic Liver Disease, Inflammatory Bowel Disease.

What are the possible causes of joint pains?

There are many diverse causes of joint pains and the following is by no means an exhaustive list.

Causes of pain in a single joint

• Trauma.
• Haemarthrosis.
• Infections in or around the joint – Septic Arthritis, Osteomyelitis, Tuberculous arthritis.
• Osteonecrosis – Osgood Schlatter Syndrome, Severs Syndrome.
• Reactive Arthritis.
• Juvenile Idiopathic Arthritis.
• Avascular necrosis.
• Osteoarthritis / Degenerative joint conditions.
• Idiopathic Chondrolysis.
• Malignancy.

Causes of pain in multiple joints

• Benign hypermobility syndrome.
• Benign nocturnal night pain (Growing pain).
• Juvenile Idiopathic Arthritis.
• Connective Tissue Disorders – Systemic Lupus Erythematosus, Juvenile Dermatomyositis.
• Acute Rheumatic Fever.
• Post Streptococcal Arthritis.
• Henoch Schonlein Purpura.
• Chronic Multifocal Osteomyelitis.
• Cryopyrin Associated Periodic Syndromes (CAPS).

Pain over a joint does not definitely imply that there is pathology in the joint. There are children who experienced pain as part of a chronic pain condition. In these conditions, there is no medical pathology in the joint itself but pain arises from problems with pain modulation in these particular children. These children would need expert medical care as well.

Benign Nocturnal Night Pain (“Growing Pains”)

This a type of limb pain which is quite common in children aged 4-7 years of age. However some children as young as 2 years of age may start to develop symptoms. This is usually a deep, aching pain which typically affects both lower limbs/legs of the child. The pain characteristically occurs at night; usually severe enough to wake the child up from sleep but resolves completely by morning. The child is completely well in between the symptoms. The symptoms are intermittent but may occur almost daily for a small number of children. Symptoms of pain are aggravated by excessive exercises during the day. Often, the symptoms are adequately relieved by massages, heat packs or simple analgesics such as paracetamol.

These symptoms may appear very worrying but they are not dangerous or harmful to the child. Affected children would most often outgrow the pain by 6-7 years of age.

What are the possible complications?

Complications would be related to the underlying pathology of the affected joints.

You should always seek medical attention for symptoms or signs such as these:

• Swelling of joint or surrounding the joint.
• Skin redness or changes around the joint.
• High fever associated with any joint symptoms.
• Multiple joint swelling or redness or pain.
• Severe night pain which does not resolve by morning.
• Stiffness of joints especially in the morning.
• Sensation of joint ‘locking’, ‘triggering’ or ‘gelling’.
• Rashes over the body associated with joint symptoms.
• Any symptoms of pain over joints.
• Limping, ‘funny walk’.
• Difficulty in moving joint in a normal fashion.

How would the diagnosis for any painful joints be determined?

Any painful joints should be assessed by a qualified doctor. Your doctor would often take the necessary steps to determine the cause of the pain. These would include most but not necessarily all of the following:

• History – a clear history of the symptoms, including any associated symptoms or other intercurrent medical conditions.
• Examination – this would include careful examination of the joints and also a systemic examination of the whole body as well.
• Imaging – sometimes imaging such as X-rays may be required for certain conditions. However, imaging techniques cannot be used solely to diagnose most of the conditions mentioned above.
• Blood investigations – your doctor may order certain blood investigations in order to assist in the diagnostic process. However, blood tests should always be interpreted in conjunction with the clinical findings and are often not confirmatory on its own.

How would painful joints be treated?

This would depend on the underlying condition causing the pain. For most conditions such as benign hypermobility syndrome or benign nocturnal pain, there is no need for any specific treatment. Only a small proportion of cases require specific medical therapy. This may involve specific medical therapies, physiotherapy, occupational therapy and counseling.

What should I do if my child has a painful joint / multiple painful joints?

You should consult your child’s doctor and bring your child to be properly assessed by a medical doctor.