What causes knee pain in a toddler?

Posted on Fri, 25 Apr 2014

Question: Hi. My 15 month old daughter has been having right knee pain for 3 weeks now. No falls--except from a walking position--or injury/trauma. When she wakes up in the morning she is unable to bear weight on it or fully straighten the knee. Typically I will give her Tylenol and the gentle massage 30 mins later. This will allow her to walk on the leg with a limp, but she is still unable to fully straighten even the--about 10 degree bend at all times. Knee is slightly more swollen than left. No redness, bruising, or wounds. Today it feels slightly warmer than the other. She is also starting to keep her right foot slightly pigeon toed when walking. Both legs are the same length with no muscle atrophy. No chronic health history or medications. Beginning of January she had a head cold and another one two weeks ago. She is able to sleep with no complaints of pain. Any clue on what could be happening? Growing pains?

Answered by Dr. Karl Logan (1 hour later)

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,

Above answer was peer-reviewed by : Dr. Raju A.T