Aches & PainsAlternative MedicineChildren's HealthDisabilitiesDisease, Illness & ConditionsEye CareFirst AidHealth Care IndustryInjuriesMental HealthOlder AdultsOral HealthReproductive HealthWellness

Common Causes of Leg Pain in Children

Updated on April 5, 2017
BoneMD1 profile image

I am a children's orthopedic physician. I am interested in children's health issues as well as healthcare in the developing world.

Leg Pains in Children

There are a number of causes of leg pain in children. These range from overuse syndromes, to fractures and other injuries, to more worrisome problems like tumors and infections.

Most of the causes of leg pain in children, however, are benign. There are some red flags to watch out for though. They include:

  • Night pain consistently in only one leg
  • Worsening pain
  • Fevers and/or weight loss
  • Self-limitation of activities

These red flags require immediate evaluation and you should consult your pediatrician right away.

In the rest of this article, you'll learn about some common causes of leg pain in kids as well as the red flags that indicate your child might need further evaluation by a specialist.

Common Causes of Leg Pain in Children

Condition
Age Range
Type of Pain
Cause
Injuries (Bruises, Sprains, or Fractures) — Most Common Cause of Acute Pain
Any age
Varies depending on injury, but usually short-lived and easily treated
Physical trauma of some sort
"Growing Pains" — Most Common Cause of Chronic Pain
3 - 10
Chronic, almost always in both legs, doesn't interfere with play, is usually worse in the evenings
Overuse
Osgood-Schlatter's Disease
Boys ages 13 - 14, Girls ages 11 - 12
Swelling just below the knee; can be one or both knees
Overuse syndrome caused by jumping, running, or kneeling
Legg-Calvé-Perthes Disease
3 - 12
Rarely occurs in both legs at once. Presents with a painless limp
Blood supply problems to the top of the femur
Transient or Toxic Synovitis
3 - 10
Child limps and complains of some discomfort
Viral infection of hip joint
Juvenile Inflammatory Arthritis (JIA)
Any age
Pain in knees or ankles, multiple joints or just one affected
Auto inflammatory disease
Joint Infections
Most common in younger children
When in the hip, child will refuse to walk and hold leg out to the side; when in the knee, it will be swollen and bent at 20 degrees; rarely occurs on both sides
Bacterial infection — this is a medical emergency
Bone Infections
Most common in younger children
Child may limp or have a fever, but will not refuse to walk; rarely occurs on both sides
Bacterial infection
Malignant Tumors
Any age
The child's activity level is affected, child may wake up with pain in the middle of the night; rarely occurs on both sides
Malignant tumor growth
See below for more details and information on treatment

Injuries

Perhaps the most common cause of leg pains in children are injuries. These include:

  1. Contusions (bruises),
  2. Sprains (injury to a ligament),
  3. Fractures.

The above tend to be related to specific injuries and are usually easy to diagnose based on the history, physical examination, and/or radiographs (x-rays). The pain is generally short-lived and easily treated.

Bruises and sprains are treated with ice, elevation, and anti-inflammatory medications. More severe sprains of the knee or ankle may require greater intervention such as casting or physical therapy. They may also require evaluation by a specialist.

"Growing Pains"

The most common cause of chronic leg pains is often referred to as “growing pains.” In actuality, it has nothing to do with growth, but is really an overuse syndrome.

It typically affects children between the ages of 3 and 10 years, and it is almost always in both legs. They are running around so much that their muscles ache at the end of the day. It never interferes with play and other activities, tends to occur towards the end of the day and in the evenings, improves with leg massages, and resolves in early adolescence.

Osgood-Schlatter's Disease
Osgood-Schlatter's Disease | Source

Osgood-Schlatter's Disease

  • Osgood-Schlatter's disease is also an overuse syndrome. It is a result of excess stress on the upper growth plate of the tibia, just below the knee in adolescents, and can result in swelling over the tibial tubercle (lump where the patellar ligament attaches).
  • They often develop pain with jumping, running, and particularly with kneeling.
  • The condition is benign and most often is treated with stretching and anti-inflammatory medications. It disappears when the growth plates close.

Legg-Calve'-Perthes Disease of the left hip.
Legg-Calve'-Perthes Disease of the left hip. | Source

Legg-Calvé-Perthes Disease

This is a vascular abnormality involving the blood supply to the femoral head.

  • It occurs between the ages of 3 and 12 years and can occur bilaterally. However, when it is bilateral, it occurs at different times.
  • Children often present with a painless limp. On radiographs, the femoral head looks more dense and may eventually collapse (flatten).
  • Perthes disease tends to occur more commonly in boys than in girls.
  • When it occurs in younger children, the prognosis for the hip recovery is better. In older children, the hip may become permanently deformed and eventually result in arthritis.
  • The treatment varies, depending on the amount of femoral head involvement, and can range from simple observation to physical therapy to casts and surgery.

Transient or Toxic Synovitis

This is a self-limited condition thought to be a viral infection of the hip joint. The child limps and complains of some discomfort, but has no significant fever or other signs of infection.

Anti-inflammatory medications like ibuprofen significantly improve the pain and limp. Blood tests will show limited inflammation but no evidence of systemic infection. It usually resolves within 7-10 days.

Juvenile Inflammatory Arthritis (JIA)

  • This can present with pain in the knees or ankles.
  • Swelling of the joint greater than six weeks with no underlying cause has a high likelihood of being JIA.
  • Some children present with only one joint involved, others may present with multiple joints, and some with systemic symptoms and a rash.
  • Other than elevation of inflammatory markers such as an erythrocye sedimentation rate (ESR), most lab studies will be normal.
  • Children with an unexplained joint swelling need evaluation by a pediatric rheumatologist. Since JIA can also result in inflammation of the iris and loss of sight, these children will usually be evaluated by a pediatric ophthalmologist.

Joint and Bone Infections

Infections of bones and joints are most common in younger children. They may cause acute or chronic leg pain. In children, bone and joint infections are most often spread through the blood stream.

Joints:

Infections that occur in joints (septic arthritis) are considered emergencies because they can destroy the joint surface very quickly.

  • When infection occurs in the hip joint, the child often will refuse to walk and will hold the hip flexed and abducted (out to the side).
  • When it occurs in the knee joint, the knee will be bent about 20 degrees and will be swollen.

Children with joint infections will often but not always have a fever. Blood tests usually reveal an elevated white blood cell count. These children will usually require emergency surgery and then antibiotics to prevent permanent damage to the surface of the joint.

Bones:

Infection in the bone (osteomyelitis) can be more subtle, and the child may limp and have a fever but may not refuse to walk altogether. Thus, diagnosis may be delayed. Eventually, changes may be seen on an X-ray, although an MRI may show changes earlier.

Treatment for bone infections is usually intravenous antibiotics followed by oral antibiotics, often for 6 weeks or more. If an abscess is present in the bone, surgery may be required.

Tumors

Thankfully, bone tumors are very rare in children.

There are different types of tumors (which simply means "bump" in Latin). Tumors can be benign (won't spread to other areas and won't cause loss of life) or malignant (they often spread and usually are life-threatening).

  • Benign tumors include such things as fibrous dysplasia, simple bone cysts, osteoid osteomas, and non-ossifying fibromas or fibrous cortical defects. These are often noted on X-ray when it is taken for an injury or fracture.
  • Malignant tumors tend to be more symptomatic. They often affect the child's activity level. In addition, they may wake up with pain in the middle of the night. Fever and weight loss may also be associated. This may cause swelling, fracture of the bone, and severe pain. It is really important to remember that malignant tumors and infections generally don't occur bilaterally (on both sides).

Synovial cell sarcoma of the leg
Synovial cell sarcoma of the leg | Source

Red Flags

Like I said at the beginning of the article, most of the causes of leg pains in children are benign. If you see any of the following, though, you should have your child immediately evaluated and call your pediatrician right away.

  • Night pain consistently in only one leg
  • Worsening pain
  • Fevers and/or weight loss
  • Self-limitation of activities

Comments

    0 of 8192 characters used
    Post Comment

    • profile image

      Emma 27 hours ago

      My 9 year old is as woken last few mornings with leg pain And also loss of appetite

    • profile image

      Mary beth 3 months ago

      My 2 year old son is waking up every morning with left knee pain. It is swollen on the inside area of the knee. I read this article but can't seem to figure out what it could be. Any ideas?? He has no other symptoms and his physical activity is the same. Thanks!

    • profile image

      sharlene 5 months ago

      My child's leg pain was Leukemia (acute lymphoblastic leukemia)

    • profile image

      harshavardhan 6 months ago

      my son after getting up from the bed complaints of leg pain may i know the reason

    • profile image

      Nora Parkman 7 months ago

      my daughter had just turned 5 a few weeks ago and I had forgotten to measure her, so before bed we measured her height... that night she woke up with severe leg pain so the next day I remeasuered her and sure enough she had grown almost a whole inch over night -- growing pain is real guys!

    • profile image

      ilvemy3kids 7 months ago

      Lauren, I went through this for years for my son who had leg pain starting at age 3 til even now (hes 9). We went to Ortho, Rhuem. ect. Finally I took him to a podiatrist and she he had flat feet. It was so bad that it was causing shin splits and extreme pain. She said his muscle was literally tearing away from his shin bone. He had surgery on the one foot where they implanted a small screw to keep the foot from swaying and ordered orthodics. I can say he is 90 percent better in his one foot. Hardly any pain anymore and if he does its because he is running around bare foot. Waiting on the other foot for surgery which is soon. Hoping it does the trick. He may have other issues but this at least solved some of them. You have to push and go around the Ped if needed. I felt like no one listened. The Rheumy actually told me it was behavioral. Yah right for 5 years! Good Luck!!!

    • profile image

      Lauren Noble 7 months ago

      My daughter started having leg pain in her thighs and knees when she was about 3. It was only at night but it was so bad she would wake up screaming. Typically, she is not one to complain so I knew it was bad! We took her to an orthopaedic paediatrician who said it was unexplained night pain(formally known as leg pain).

      When she was 5/6 her class teacher pulled me to the side one day to tell me that she was very concerned about my daughter because she frequently complained of pain in her legs and had to rest frequently. We took her back to the GP with this information and were asked to do a diary of activity, diet and pain to take back to the ortho. When we returned to the ortho we were given the same diagnosis but told she could have hypermobility as well.

      Her condition has continued to worsen so 2 years ago we returned again. I explained that the pain was still getting more frequent and that her ankles were now leaning inwards so much that they are almost touching the floor. We were then told that she didn't have hypermobility because she only met 7/9 criteria (despite the expected eligibility being 5/9). The ortho told us she had flat feet and that she didn't get enough exercise. (We were not very happy with that because not only does she have a visible arch, but at the time she went swimming 2 times a week, attended 2 sports based after school clubs, walked to and from school everyday and visited the park or woods with bikes or scooters at least 2 times a week. On average she did around 8-10 hours of varied physical activity a week.) We were also told at this time that her ankles were extremely weak due to the flat feet, meaning she was using her calfs and thighs to support all the weight. The Dr actually said that if her thighs and calfs were not as strong as they were, she would not be able to stand at all! I was obviously very worried about this especially so after Dr told me they would wait to treat with ortho insoles because she was still quite young. I expressed my concern but the Dr wouldn't budge and insisted that we continue with normal excercise and deliberate excessive use of stairs; which we did. We were then supposed to have a follow up after a year but my daughter also suffers from chronic asthma and was in A&E at the time of her appointment getting oxygen and a nebuliser. Despite me explaining this, they then sent us a letter stating that our case had been closed due to not showing up! I have since taken her back to the GP and demanded further tests because she is still getting worse. She cannot stand for longer than 15 minutes without her ankles giving way, she has pain from her hips to toes every single day and often has to sit out of trips and PE sessions. She also complains of tingling in her feet and feeling like her bone is dislocated at the hip. They have so far tested her blood for Vit D and calcium levels, which were fine, but we are still waiting for a referral appointment from the ortho. We are extremely worried and the Drs are not concerned at all. The GP said, "I don't understand why you're so worried."

      We will be insisting on exhausting all tests and possibilities once we get our appointment.

      Any ideas on what this could be please?

    • profile image

      Kelley 8 months ago

      This was the most informative (and not scary) article I've found while searching for leg pains for my 5yo. Thank you!

    • profile image

      Anjor Say Banjare 8 months ago

      My 9 years old son suffering from chronic leg pain. Some time he feels the pain some time one leg lower and some time both the legs lower. the place of pain is not fixed . it moves place to place. what is the cause may be?

    • profile image

      Lisa 9 months ago

      My 6 year old son complains of leg pains everytime night and day it doesn't matter whether he's walking, sitting or running. He says most pain is in his knees and now he has a clicky knee. I have told its Osgood Schlatter disease so he has been referred onto a pediatrition to have it checked out.

    • profile image

      naresh 10 months ago

      My 11 years old son suffering from chronic leg pain. Some time he feels the pain at waste, some time one leg and some time both the legs. the place of pain is not fixed . it moves place to place. what is the cause may be?

    • profile image

      Jen 13 months ago

      My daughter has had what she describes as lighting pains in her left knee for the past 3/4 years they come and go she can go months with no pain at all but others it's 15+ bolts of pain in a day one case was where her knee was stuck bent for over a week (unable to straighten or bend more) she is now 10years old and waiting on yet another hospital appointment.

      She has had X-rays mri scans physiotherapy and see a consultant yet nothing is showing they keep saying all is normal, but seeing my baby in pain and crying when it strikes is heart breaking.

      The pain comes and goes she is active always out playing when she can but the pain will happen weather she's sitting still/sleeping or running biking and no pictullar pattern.

      Even our family gp seams to be fed up of hearing about it when I call and say her knee is playing up its as if he's not interested and it's all in her head

    • profile image

      Rmoore0415 19 months ago

      This article really helped in fact my son just tonight 10/7/15 woke up crying all night because he said his left lower leg was hurting...will be calling his Dr. First thing in the morning!

    • peachpurple profile image

      peachy 2 years ago from Home Sweet Home

      wow, there are many possibilities, got to be cautious

    • BoneMD1 profile image
      Author

      BoneMD1 2 years ago from Los Angeles

      Please see my note under "What is the most common cause of leg pains." "Growing Pains" is an overuse problem, not related to growth.

    • smcopywrite profile image

      smcopywrite 2 years ago from all over the web

      great article. my child's leg pain was a result of "growing" . the ligaments and tendons need to grow at the same rate as the bones. if this is not happening leg pain exists. usually in the lower portion of the legs, in the front. the condition is temporary and remedied with ibuprofen and Tylenol. more extensive out of sync syndromes need more attention, but the majority of children are only temporarily disabled.

    • profile image

      elaıne 2 years ago

      Hı My 2 year old babygal complaıns about her legs that paın every nıght and ıt seems to be gettıng worst because she falls asleep cryıng wit the paın

    • profile image

      Angelica 2 years ago

      My 6 year old is complaining of pain in his right leg but it only hurts him when he walks....can it be growing pains or something more serious??

    • profile image

      Dawn 2 years ago

      My 8 yr old son seems to have chronic pain in typically his knees and sometimes pain in his ankles. Advil relieves his pain. He plays several sports and it has started to affect him during play. Hurts worse when running and jumping. He had an illness when he was 6 yrs old that the doctors really were unable to diagnose. He woke up one day and was unable to walk because he was in so much pain in hips and knees. After several days in the hospital the pain went away. Since then he has had the knee pain that comes and goes. Any ideas as to what this could be? They did rule out arthritis because the pain when he was 6 came on suddenly.

    • profile image

      Brooklyn 3 years ago

      Thank you

    • BoneMD1 profile image
      Author

      BoneMD1 5 years ago from Los Angeles

      Absolutely. This should have been included in the hub. I'll add it. Thanks.

    • hecate-horus profile image

      hecate-horus 5 years ago from Rowland Woods

      Interesting hub. When my child complained of sudden and pain hip pain, I found a condition fitting her symptoms called Transient synovitis.

      http://en.wikipedia.org/wiki/Irritable_hip

      The doctor agreed with my Google diagnosis (lol) and an x-ray showed nothing else wrong. Luckily, it's usually a temporary condition. For her, it lasted one day.

    Click to Rate This Article