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Should Your Child See a Doctor?

Leg Pain

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Definition

  • Pain in the legs
  • The pain is not due to a known injury
  • Minor muscle strain and overuse injury are covered in this topic

Causes

  • Main Causes: Muscle spasms (cramps) and strained muscles from overuse injury (e.g., excessive running or jumping). Up to 50% of all injuries seen in pediatric sports medicine are related to overuse.
  • Muscle Cramps: Brief pains (1 to 15 minutes) are usually due to muscle spasms (cramps). Foot or calf muscles are especially prone to cramps that occur during exercise or that awaken your child from sleep. Muscle cramps that occur during exercise are also called heat cramps. They often respond to extra water and salt.
  • Strained Muscles: Continuous acute pains (hours to 3 days) are usually due to overstrenuous activities or forgotten muscle injuries during the preceding day. Can occur in arms or legs.
  • Growing Pains: 10% of healthy children have intermittent, harmless pains that are often referred to as growing pains (although they have nothing to do with growth)
  • Viral Infections: Muscle aches are common with viral illness, especially influenza.
  • Serious Causes: Fractures, swollen joints (arthritis), deep vein thrombosis, neuritis

When to Call Your Doctor for Leg Pain

Call 911 If…

  • Your child is not moving or too weak to stand

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick
  • Swollen joint
  • Calf pain on 1 side lasts over 12 hours
  • Bright red area on skin
  • Muscle weakness or can't stand or walk
  • Numbness (loss of sensation) present over 1 hour
  • Severe pain or cries when leg touched or moved

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs to be seen
  • Fever is present
  • Pain makes child walk abnormally (has limp)
  • Painful joint and can't move it normally

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns
  • Cause of leg pain is uncertain
  • Leg pain present over 7 days
  • Leg pains or muscle cramps are a recurrent chronic problem

Parent Care at Home If

  • Caused by muscle cramps in the calf or foot
  • Caused by overuse injury (strained muscles)
  • Cause is obvious and harmless (e.g., tight new shoes, a recent shot)

Home Care Advice for Muscle Cramps or Strained Muscles

 

  1. Treatment For Muscle Cramps:
    • Muscle cramps in the feet or calf muscles occur in a third of children.
    • During attacks, stretch the painful muscle by pulling the foot and toes upward as far as they will go to break the spasm.
    • Stretch the muscle in the direction opposite to how it is being pulled by the cramp or spasm.
    • Apply a cold pack or ice bag wrapped in a wet cloth to the painful muscle for 20 minutes.
    • If these are heat cramps (occurring during exercise on a hot day), give lots of water and sports drink in addition to stretching the muscle and a cold pack.
    • Future attacks may be prevented by daily stretching exercises of the heel cords (stand with the knees straight and stretch the ankles by leaning forward against a wall). Also give the feet more room to move at night by placing a pillow under the covers at the foot of the bed. Also be sure your child gets enough calcium in the diet.
  2. Treatment For Strained Muscles From Excessive Use (Overuse Injury):
    • Apply a cold pack or ice bag wrapped in a wet cloth to the sore muscles for 20 minutes several times on the first 2 days.
    • Give acetaminophen (e.g., Tylenol) or ibuprofen for pain relief.
    • If stiffness persists over 48 hours, have your child relax in a hot bath for 20 minutes twice a day, and gently exercise the involved part under water.
  3. Expected Course: Muscle cramps usually last 5 to 30 minutes. Once they resolve, the muscle returns to normal quickly. A strained muscle hurts for 2 to 7 days. The pain often peaks on day 2. Following severe overuse, the pain may last a week.
  4. Call Your Doctor If:
    • Muscle cramps occur more frequently
    • Child develops a limp, a swollen joint, or a fever
    • Pain caused by work or exercise persists over 7 days
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

References

  1. Abu-Arafeh I and Russell G. Recurrent leg pain in school children. Arch Dis Child. 1996;74:336-339.
  2. Brenner JS and the Council on Sports Medicine and Fitness. Overuse injuries, overtraining, and burnout in child and adolescent athletes. Pediatrics. 2007;119(6):1242-1246.
  3. Engelbert RHH, Bank RA, Sakkers RJB et al. Pediatric generalized joint hypermobility with and without musculoskeletal complaints: a localized or systemic disorder? Pediatrics. 2003;111:e248-254.
  4. Feiste JE, et al. After the flu: Acute viral myositis. Contemp Pediatr. 1995;12(3):29-52.
  5. Inocencio JD. Musculoskeletal pain in primary pediatric care: Analysis of 1000 consecutive general pediatric clinic visits. Pediatrics. 1998;102(6). URL: http://www.pediatrics.org/cgi/content/full/102/6/e63
  6. Leung AKC, et al. Leg cramps in children. Clin Pediatr. 1997; 36:69-73.
  7. Metzl JD, Metzl JA. Shin pain in an adolescent soccer player: a case-based look at "shin splints". Contemp Pediatr. 2004;21(9):36-47.
  8. Renshaw T. The child who has a limp. Pediatr Rev. 1995;16:458-465.
  9. Tse S, Laxer R. Approach to acute limb pain in childhood. Pediatr Rev. 2006;27(5):170-180.

Disclaimer

This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 1/4/2010

Last Revised: 7/15/2008 5:52:29 PM

Copyright 1994-2010 Barton D. Schmitt, M.D.


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