Brief Answer: Inflammatory arthritis vs toddlers fracture Detailed Answer: Hi, This is not growing pains. There is almost certainly a medical issue with your daughter. The commonest problems to affect the knee and tibia (shin bone) in this age group are a reactive arthritis of the knee joint, usually secondary to a viral infection such as a cough or a cold or a toddlers fracture of the tibia. What you are perceiving as knee pain could also be referred from the hip joint. If she is well, eating and drinking normally, without a fever then this is reassuring. If it is a reactive arthritis then this should improve spontaneously although If this was the diagnosis I would have expected her symptoms to have improved by now and so this raises the possibility of other diagnosis such as Juvenile Idiopathic arthritis - for which she is a little young - or lyme disease although I'm not sure you are in an endemic area - she would have had to have had a tick bit for lyme disease. If it was a toddlers fracture of the tibia then I would also have expected her symptoms to be improving although she would still likely be limping. If a child presented to my clinic like this I would take a thorough medical history and clinically examine the child which would help me more accurately locate the site of the problem. I would perform blood work and X-rays of the whole leg. She may have an ultrasound of the hip and knee to see if there was fluid in it. This would help slim down the diagnosis. I would also likely ask one of my rheumatology colleagues to asses. I would start her on an anti-inflammatory such as ibuprofen. Regards,

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