Hip Problems, Age 11 and Younger

A hip problem can be hard to deal with, both for the child who has the problem and to the parent or caregiver. A child who has a hip problem may feel pain in the hip, groin, thigh, or knee. A child in pain may limp or be unable or unwilling to stand, walk, or move the affected leg. A baby in pain may cry, be fussy, and have other signs of pain. Hip problems may be present at birth (congenital) or may develop from injury, overuse, inflammation, infection, or tumor growth.

To better understand hip problems, it may be helpful to know how the hip works. It is the largest ball-and-socket joint in the body. The thighbone (femur) fits tightly into a cup-shaped socket (acetabulum) in the pelvis. The hip joint is tighter and more stable than the shoulder joint but it does not move as freely. The hip joint is held together by muscles in the buttocks, groin, and spine; tendons; ligaments; and a joint capsule. Several fluid-filled sacs (bursae) cushion and lubricate the hip joint and let the tendons and muscles glide and move smoothly. The largest nerve in the body (sciatic nerve) passes through the pelvis into the leg.

Hip problems

Hip problems may develop from overuse, infection, or a problem that was present from birth (congenital). Oddly enough, a child who has a hip problem often feels pain in the knee or thigh instead of the hip. Hip problems that affect children include:

• An inflammatory reaction, such as transient or toxic synovitis. This generally occurs after the child has had a cold or other upper respiratory infection. This is the most common cause of hip pain in children.
• A slipped capital femoral epiphysis. This occurs when the upper end of the thighbone (head of the femur) slips at the growth plate (epiphysis) and does not fit in the hip socket correctly.
• Legg-Calve-Perthes disease. This condition is caused by decreased blood flow to the head of the femur. See an image of an X-ray and a magnetic resonance image of a child with this problem.
• An inward twisting of the thighbone (femoral anteversion). This condition causes the knees and feet to turn inward. The child will have a "pigeon-toed" appearance and may have a clumsy walk.
• Developmental dysplasia of the hip (DDH). This condition is caused by a problem in the development of the hip joint. The top of the femur does not fit correctly into the hip socket (acetabulum) so the femur can partially or completely slip out of the socket.
• Juvenile rheumatoid arthritis (JRA). This condition causes inflamed, swollen joints that are often stiff and painful.
• Infection in the joint (septic arthritis), the bursa (septic bursitis), or the hip or pelvic bone (osteomyelitis).
• In rare cases, cancer of the bone, such as osteosarcoma.

Treatment for a hip problem depends on the location, type and severity of the problem as well as the child's age, general health, and activity level. Treatment may include first aid measures; application of a brace, cast, harness, or traction; physical therapy; medicines; or surgery.

Review the Emergencies and Check Your Symptoms sections to determine if and when your child needs to see a health professional.

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your child's hip symptoms.

If your child has any of the following symptoms, evaluate those symptoms first.

• Hip injury: Go to the topic Hip Injuries, Age 11 and Younger.
• Bleeding: Go to the topic Cuts or Puncture Wounds.

	Yes	Does your child have hip pain or tenderness?
	When to See a Doctor See significance of pain or tenderness if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's hip symptoms. Call your child's health professional immediately if you answer "Yes" to any of the following questions. Yes Does your child have severe hip pain? Yes Is your child unable or unwilling to walk? Yes Does your child cry with any hip movement? Yes Is your child's hip painful, red, hot, and swollen? Yes Does your child have hip pain and a fever? Call your child's health professional today if you answer "Yes" to the following question. Yes Did your child's hip pain or limping begin following a cold or other upper respiratory infection? You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Does your child still have moderate hip pain after 24 hours of home treatment? Yes Does your child still limp after 48 hours (or the time frame given by a doctor) of recommended home or medical treatment? Your child needs an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Has your child had mild hip pain off and on for 1 week or longer? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Is your child limping or unable or unwilling to put weight on one leg?
	When to See a Doctor See significance of limping or the inability or unwillingness to put weight on one leg if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's hip symptoms. Call your child's health professional immediately if you answer "Yes" to any of the following questions. Yes Is your child unable or unwilling to walk? Yes Is your child unable or unwilling to put weight on one leg? Call your child's health professional today if you answer "Yes" to any of the following questions. Yes Is your child walking with a new limp? Yes Did your child begin limping following a cold or other upper respiratory infection? Yes Does your child's leg look different than the other leg? Yes Do you think your baby has a hip or leg problem, such as hip dysplasia? You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Has your child's limp become worse since being seen by a doctor 2 days ago? Your child needs an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Has your child been limping off and on for more than a week? Yes Does one of your child's legs look shorter than the other one? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Is your child unable to normally bend, straighten, or move a leg?
	When to See a Doctor See significance of an inability to normally bend, straighten, or move a leg if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's hip symptoms. Call your child's health professional immediately if you answer "Yes" to any of the following questions. Yes Is your child not able to bend, straighten, or move a leg normally? Yes Does your child have severe hip pain and he or she does not want to move the affected leg? Yes Has your child had hip surgery and now has sudden moderate to severe hip pain and cannot move the hip or leg? Yes Is your child unable to move a leg normally after having a leg brace, cast, or splint put on (not because the splint is in the way)? You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes After 48 hours of home treatment, is your child's hip still stiff and he or she cannot move the hip normally? Your child needs an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Does your baby have extra skin folds on the inner side of one thigh compared with the other thigh so the skin folds do not look like the same pattern on each thigh? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Does your child have signs of inflammation or infection in the hip?
	When to See a Doctor See significance of signs of inflammation or infection if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's hip symptoms. Call your child's health professional immediately if you answer "Yes" to any of the following questions. Yes Does your child have increased swelling, redness, or warmth around the hip? Yes Does your child have increased pain with movement of the hip? Yes Does your child have red streaks extending from the hip? Yes Is your child's hip tender to the touch? Yes Does your child have any drainage of pus from the hip? Yes Does your child have swollen lymph nodes near the hip? Yes Do you think or know your child has a fever? Yes Does your child have any other medical conditions, such as diabetes, leukemia, or hemophilia? Call your child's health professional today if you answer "Yes" to any of the following questions. Yes Does your child have mild pain and swelling with redness less than 2 in. (5 cm) around the hip? Yes Does your child have swollen lymph nodes in the groin? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Does your child have pale, white, blue, or cold skin after a brace, cast, or splint was put on?
	When to See a Doctor See significance of pale, white, blue, or cold skin if you need information to help you answer the question below. Review health risks that may increase the seriousness of your child's hip symptoms. Call your child's health professional immediately if you answer "Yes" to the following question. Yes Does your child have pale, white, blue, or cold skin after a brace, cast, or splint was put on? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Does your child have any of the following symptoms?

• Groin pain: Go to the topic Groin Problems and Injuries.
• Tailbone or low back injury: Go to the topic Back Problems and Injuries.
• Unexplained leg pain or swelling: Go to the topic Leg Problems, Noninjury.
• A leg injury: Go to the topic Leg Injuries.
• Limping after a toe, foot, or ankle injury: Go to the topic Toe, Foot, and Ankle Injuries.
• Limping after a knee injury: Go to the topic Knee Problems and Injuries.
• A burn, scrape, bite, or bruise: Go to the topic:
  • Burns.
  • Scrapes.
  • Animal and Human Bites.
  • Bruises and Blood Spots Under the Skin.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Home treatment may help relieve your child's hip pain, swelling, and stiffness. If your child will cooperate, use the following tips. If your child becomes upset or will not cooperate, do not force your child.

• Rest. Have your child rest and protect the sore hip. Have your child stop, change, or take a break from any activity that may be causing pain or soreness.
• Ice will help your child's pain and swelling. Put ice or cold packs on the sore area immediately. Put ice on for 20 minutes out of every hour and do this 4 or more times in the first 1 to 2 days. If your child is cooperative, use the ice often. If your child is not cooperative, use the ice as much as you can without struggling with your child. Wrap the ice in a wet towel. Do not put the ice right on the skin. Take the ice off if your child falls asleep.
• Put your child on the uninjured side for sleep.
• Gently rub your child's hip to relieve pain and help blood flow.
• If the swelling is gone, heat can be put on the area. Your child can carefully begin normal activities. Moist heat with a hot water bottle, warm towel, or a heating pad set on low may feel good to your child.

Cast care tips

If your child has a cast, see cast care tips.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your child's symptoms if any of the following occur during home treatment.

• Signs of infection develop.
• Numbness, tingling, or weakness develops.
• Pale, white, blue, or cold skin develops.
• Symptoms do not get better with home treatment.
• Symptoms become more severe or more frequent.

Most of the problems that can affect a child's hips or cause a child to limp cannot be prevented. The following tips can help keep your child's bones healthy and strong.

Keep bones strong

• Have your child eat a nutritious diet with enough calcium and vitamin D, which helps his or her body absorb calcium. Calcium is found in dairy products, such as milk, cheese, and yogurt; dark green, leafy vegetables, such as broccoli; and other foods.
• Have your child stay active. Play and sports are good ways for your child to exercise.
• Do not give your child caffeine, such as in soda pop. This may increase calcium loss from his or her body.

To prepare for your appointment, see the topic Making the Most of Your Appointment

You can help your health professional diagnose and treat your child's condition by being prepared to answer the following questions:

• What are your child's main symptoms? How long has your child had symptoms?
• Has your child had this problem in the past? If so, do you know what caused the problem at that time? How was it treated?
• Does your child limp or complain about pain when he or she walks? Where is the pain felt? How far can your child walk without pain? Does the pain get better or worse as he or she continues to walk?
• Has your child had any recent illness or fever?
• What activities make your child's symptoms better or worse?
• What activities does your child do? Has your child recently started a new activity?
• What home treatment measures have you tried? Did they help?
• What prescription or nonprescription medicines has your child taken? Did they help?
• Does your child have any health risks that may increase the seriousness of his or her hip symptoms?

• Animal and Human Bites
• Arm Injuries
• Arm Problems, Noninjury
• Back Problems and Injuries
• Bruises and Blood Spots Under the Skin
• Burns
• Cuts
• Developmental Dysplasia of the Hip
• Groin Problems and Injuries
• Hip Fracture
• Juvenile Rheumatoid Arthritis
• Knee Problems and Injuries
• Low Back Pain
• Lupus (Systemic Lupus Erythematosus)
• Osteoporosis
• Puncture Wounds
• Rheumatoid Arthritis
• Scrapes
• Tick Bites
• Toe, Foot, and Ankle Problems, Noninjury

Author:	Jan Nissl, RN, BS	Last Updated October 27, 2006
Medical Review:	Michael J. Sexton, MD - Pediatrics Emmett Francoeur, MDCM, CSPQ, FRCPC - Pediatrics
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