Hip pain in children
A child gets up in the morning limping, and there was nothing wrong the day before. Or complains that a leg hurts and points sometimes at the groin…
On this page
- What an irritable hip is
- What must not be missed
- When the knee hurts and the hip is to blame
- A limp nobody can explain
- What else causes hip pain in a child
- How a doctor works out the cause
- Care at home once the doctor has agreed
- When to go back sooner than planned
- If it is an adult whose hip hurts
- Online consultation
Medicines commonly prescribed for Hip pain in children
For informational purposes only. Always consult a doctor before taking any medication.
Dosage form: EFFERVESCENT TABLET, 1000 mgActive substance: paracetamolManufacturer: Laboratorio Stada S.L.Prescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 600 mgActive substance: ibuprofenManufacturer: Tarbis Farma S.L.Prescription requiredDosage form: TABLET, 1000 mgActive substance: paracetamolManufacturer: Sandoz Farmaceutica S.A.Prescription not required
A child gets up in the morning limping, and there was nothing wrong the day before. Or complains that a leg hurts and points sometimes at the groin, sometimes at the knee. Most often the cause is a passing inflammation of the hip joint, known as irritable hip or transient synovitis, and it settles by itself within a few days. But that diagnosis is made last, not first: before it can be made, a doctor has to rule out several conditions in which waiting is expensive. So the main point of this page is not how to look after a synovitis at home, but how not to mistake something else for one.
What an irritable hip is
Transient synovitis is a brief swelling of the lining inside the joint. A little fluid collects, the capsule stretches, and every movement of the hip becomes painful. It happens mostly in children roughly between three and ten, more often in boys, and frequently a week or two after an ordinary cold or a tummy bug. There is usually no injury behind it: parents remember that the child had not been doing anything out of the ordinary.
The picture is recognisable. The child limps or favours one leg, dislikes having the hip taken outwards or turned inwards, and prefers to lie with the leg slightly bent and rolled out. Yet the child is still themselves: playing, talking, interested in what is going on, with no fever or only a slight one, and eating normally. The pain responds to an ordinary children's painkiller. From the outside the joint does not look hot or red.
A synovitis like this passes in a few days, occasionally stretches to two weeks, and leaves nothing behind. But only a doctor can make that diagnosis after examining the child, and almost always after tests. It is not a diagnosis to make at home.
What must not be missed
Septic arthritis is a pus-forming infection inside the joint. It is an emergency and the clock runs in hours: pus destroys the cartilage of the femoral head quickly, and the damage lasts a lifetime. It is treated in hospital by washing out the joint and giving antibiotics into a vein, and the sooner that happens, the more of the joint survives.
Get emergency help that same hour, call an ambulance on the single European number 112, or take the child to hospital if:
- the child will not let anyone touch the leg at all and screams at any attempt to move it;
- the child will not put the foot down and cannot take a single step — not limping, but refusing to bear weight;
- there is a fever, especially a high one, or shivering;
- the child is listless, pale, drowsy, refusing food and drink — looking ill rather than simply lame;
- the hip or groin is hot and swollen and the skin over it has turned red;
- the leg is held in a fixed position and the child will not let it be straightened;
- a rash appears that does not fade when pressed.
Telling synovitis and septic arthritis apart by eye is unreliable, and in any doubtful case you act as though it were an infection. It is worth remembering separately that a child who has been given something for fever can look better than they are. Judge how they are once the temperature has come down, and take them in anyway if any of the above has happened.
See a doctor the same day, not tomorrow, in calmer situations too: if the child is under three, if the pain started at night or wakes them, if the limp is getting worse day by day, if there has been a recent fracture or operation, or if the child is having chemotherapy, is on medicines that suppress the immune system, or has sickle cell disease.
When the knee hurts and the hip is to blame
This is the commonest trap in the whole subject, and people fall into it regularly. A child with a diseased hip very often complains about the knee or the middle of the thigh rather than the hip. The reason is anatomical: sensory branches of the same nerves supply both the joint and the skin over the knee, and a child's brain cannot pin down the source any more precisely.
From that comes a rule worth remembering, for parents and doctors alike: a child with knee pain always has the hip examined too, even if the knee itself looks normal, is not swollen and moves freely. If the knee is clear on examination and the child is still limping, look higher up.
The adolescent version deserves its own warning. A slipped capital femoral epiphysis, where the head of the thigh bone slides at its growth plate, begins with exactly this: a dull ache in the knee or groin and a limp, with a perfectly normal knee. Teenagers with that picture are treated for weeks for a "knee sprain" while the femoral head slips further. If a teenager has knee or hip pain with no injury, drags the leg and turns the foot outwards, that calls for examination and an X-ray of both hips, not for rest and a rub-on gel.
A limp nobody can explain
A limp in a child with no clear cause is always a reason to have them seen, never a reason to wait. Children do not limp out of stubbornness and hardly ever act out pain. If there was no fall and the way they walk has changed, there is an explanation and it has to be found. "It will sort itself out" works against the child here: some causes are harmless and do settle on their own, but it is precisely among limping children that bone infection, tumours and diseases are found in which a few lost weeks change the outcome.
The same applies to a child too young to talk. In an under-three, leg pain shows itself as refusing to stand, crying during nappy changes when the legs are parted, objecting to being picked up under the arms, or suddenly crawling lopsidedly. In the youngest children the cause is less often trivial, so they are examined with particular care.
What else causes hip pain in a child
Besides synovitis and septic arthritis, at these ages you also see:
- Perthes' disease, a disturbance of the blood supply to the femoral head in which part of the bone dies and then rebuilds. It is commonest between four and eight and in boys. The pain is quiet, but the limp lasts months and does not settle with rest;
- slipped capital femoral epiphysis, a slip at the growth plate in a teenager, usually during a growth spurt and more often where there is excess weight. It can also come on suddenly after a trivial movement, and then the child stops weight-bearing altogether;
- injury: a fracture, a crack, a torn muscle or an avulsion where a muscle attaches to the pelvis, which is not unusual in sporty teenagers after a sudden effort;
- osteomyelitis, infection of the bone itself. It comes with fever and constant pain, including at rest, and needs the same urgency as septic arthritis;
- juvenile idiopathic arthritis, joint inflammation lasting weeks. Morning stiffness that eases with movement, other joints joining in, and a duration of more than six weeks all point towards it;
- tumours, both bone tumours and leukaemia. Pain at rest and at night that wakes the child, pain in several bones at once, weight loss, night sweats, unexplained pallor, bruising and enlarged lymph nodes all force the question. It is rare, which is exactly why it has to be said out loud;
- hip dysplasia picked up late, in a child who walked late, waddles, or dips noticeably to one side.
How a doctor works out the cause
The examination starts with watching: how the child walks, gets up from a chair, lies down on the couch. Then the doctor checks the range of movement in both hips, always comparing sides, assesses internal rotation separately, feels the knee, the lower leg and the foot, takes the temperature, and looks at the skin and lymph nodes. They will ask what illnesses the child has had in the past two or three weeks, whether there have been any falls, whether anything similar runs in the family, and whether immunisations are up to date.
After that, if the picture is not completely clear, blood tests including inflammatory markers are usually taken and an ultrasound of the hip is done, since that shows fluid in the joint best. X-rays of both hips are taken when Perthes' disease, a slipped epiphysis or an injury is suspected, and in two views: an early slip does not show on every view. Where the doubt lies between synovitis and infection, the joint is aspirated and the fluid examined, and that is the decisive test. Sometimes an MRI is added.
Care at home once the doctor has agreed
Home care only comes in once the child has been examined and the dangerous causes have been excluded. From then on it comes down to rest and pain relief.
- Let the leg rest: a few days without running, jumping, sports clubs or PE. There is no need for bed rest — the child will limit themselves as much as it hurts.
- For pain, use children's preparations of paracetamol or ibuprofen and measure the dose by the child's weight, following the leaflet. Do not exceed the number of doses in a day and do not combine two products containing the same active ingredient.
- Return to normal life gradually, guided by how the child feels rather than by the calendar: walking first, then play, then running and sport.
- Do not apply heat to the joint, do not rub in warming ointments and do not massage it. If an infection is behind the pain, heat makes matters worse.
- Do not push a child to "walk it off" and do not make them stand on the leg if they cannot.
- Attend the follow-up appointment if one has been arranged, even if things have improved: in Perthes' disease and in a slipped epiphysis a temporary improvement is deceptive.
When to go back sooner than planned
Contact the doctor without waiting for the appointment if a fever appears, if the pain worsens or stops responding to painkillers, if the child is bearing less weight on the leg, if the pain went and has come back, or if after two weeks the limp is unchanged. A limp that drags on beyond a couple of weeks is no longer synovitis, and the diagnosis needs revisiting.
If it is an adult whose hip hurts
In adults the same area hurts for entirely different reasons, and the paediatric logic does not carry over: there the leading causes are osteoarthritis, inflammation of the bursa on the outer side of the hip and pain referred from the lower back, while the urgent one is a fracture of the top of the thigh bone in an older person after a fall. There is a separate page on this site about hip pain in adults. The reverse holds too: if the person limping or complaining of the hip is a child or a teenager, this is the page to read rather than the adult one, because the list of causes and the level of urgency are not the same.
Online consultation
A child's hip cannot be fully assessed through a screen: it needs examining, and often scanning. But an online consultation answers a different and equally important question — how urgently that examination is needed. An Oladoctor doctor will go through with you exactly how the child is limping, whether they will bear weight, what happened in the preceding weeks, whether there is a fever and how the child looks overall, and will explain which signs call for an ambulance right now and which allow a calm trip to a clinic. They will help you make sense of any tests and images already done and advise which specialist to see. If what you describe sounds like an infected joint, you will be told straight away and sent to hospital.
This material is for information only and does not replace medical advice.
Consult with a doctor about Hip pain in children
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Hip pain in children
Discuss your symptoms and possible next steps for Hip pain in children with a doctor online.
