Pediatric Bone and Joint Health

by Maureen Suhr
10.19 Blog

Being both a pediatric physical therapist and a mom has its pros and cons. My kids don’t always love it – do you remember your mom telling you to sit up straight? Imagine how many more times she would have said it if she were a physical therapist. On the other hand, my friends think it’s great. I’m constantly being asked questions on everything from sprains to strains to normal development. Occasionally I have to remind them that I don’t have an expert answer for everything. But, in honor of World Pediatric Bone and Joint Day and my inquiring friends, here are some pearls of wisdom I’ve gleaned as a physical therapist and a mom.

  1. Don’t ignore a limp: Limping in a child or adolescent is a sign of pain or pathology. If a limp persists more than 24-48 hours it is worth seeing your pediatrician or pediatric orthopedist, regardless of whether or not a child complains of pain.
  2. Bones grow faster than muscles: Because bones grow faster than muscles, children and adolescents tend to get asymmetrical forces about their joints during growth spurts.  When an active child goes through a growth spurt, his muscles suddenly become much tighter and less flexible.  Additionally, in a growing child, the tendons tend to be stronger than the growing bone.  This puts him/her at risk for an avulsion fracture.  A sports injury that would likely result in a muscle strain in an adult, may result in an avulsion fracture (injury where a tendon pulls off a small piece of bone from its attachment) in an adolescent.  Treatment typically involves pain management, possibly with crutches, and rest with gradual restoration of flexibility and strength.
  3. Be aware of the potential for stress fractures: It is common today for children and adolescents to specialize in one sport early on.  This increases their potential for overuse injuries like tendonitis or stress fractures, which are small breaks in the bone that are typically not displaced.  They are particularly common in high-impact sports such as long distance running or gymnastics and tend to be common in females.  Female athletes who train at a high level may present with the “female triad” of poor nutrition, absent menstrual cycles, and weak bones, which predisposes them to stress fracture.  As parents and coaches we need to remember the importance of balanced nutrition and balanced training (cross training).
  4. Knee pain doesn’t always mean a knee injury: Sometimes, as is the case of knee pain in a child or adolescent, it’s not always what it seems.  Pain in the knee may be referred from the nerves in the hip.  In a child between the ages of 4-9 years of age, it may be due to Legg-Calve-Perthes disease which is degeneration of the top of the thigh bone where it inserts in the hip socket. This is a serious condition which may lead to significant loss of motion and potential deformity if left unchecked. Another serious hip condition that presents in adolescents typically between the ages of 10-15 years of age is Slipped Capital Femoral Epiphysis (SCFE). This also presents with a limp, with the child’s foot turned out, and referred pain to the knee.  Symptoms may come on gradually over a few months or it may occur suddenly with severe pain limiting the child’s ability to walk altogether. With SCFE, the growth plate on the top of the thigh bone separates from the shaft of the bone. Again, if left untreated, serious and debilitating consequences may occur including pain and arthritis.
  5. Red Joints = Red flags: If a child’s joint becomes inflamed, red, and hot to the touch, it may be infected.  Check for signs of fever and consult a physician.  Bone and joint infections need to be treated with antibiotics.  If infection is permitted to spread, the health and integrity of the bone or joint is at risk.
  6. Children get arthritis: Juvenile arthritis affects 1 in every 1000 children with severe arthritis affecting 1 in 10,000 children. Symptoms include muscle pain, joint stiffness, “growing pains,” fatigue, and depression.  Proper care of juvenile arthritis requires oversight from a pediatric rheumatologist.


Topics: Pediatrics
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Pete says:

Hello Dr Suhr,
I am shocked to learn that children have arthritis! How can it be? My son is 3.5 years and thinks he is superman. He”s jumping from table/chairs and anything he can find and i am so worried that he is going to break some bone. What is your view on children taking supplements? Thanks for sharing a great article.

HSS on the Move says:

Hello Pete, Thanks for your question! Maureen Suhr, pediatric physical therapist, says “A child needs plenty of exercise to keep bones and muscles strong. It sounds like this isn’t a problem for your child. In addition to exercise, however, a child needs a healthy, balanced diet with protein for strong muscles and calcium for strong bones. For calcium to be absorbed properly, he also needs an adequate supply of vitamin D. Children naturally absorb vitamin D from the sun but these days and especially in winter, outdoor playtime and drinking milk might not be enough. Dr. Shevaun Doyle, pediatric orthopedist at Hospital for special surgery recommends a children’s gummy vitamin with at least 600 IU of Vit D 3, to allow children to grow and maintain a healthy body.” Before starting a new supplement regimen, it is best for you to consult with your child’s treating physician or pediatrician.

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