Knee pain in children: what are the warning signs?

You may associate knee pain with elderley people but did you know that it occurs quite commonly in children? We speak to leading paediatric consultant orthopaedic surgeon Mr Nigel Kiely about knee pain in children, including causes, “red flags” and treatment.

What are some common causes of knee pain in children?

There are lots of different causes of knee pain in children and the causes can depend on the age of the child.

For example, we see different diagnoses in teenagers compared to younger children. The most common cause of knee pains is usually related to sports and activities. We often see conditions called tractus posterolateralis, which is where tendons pull on growing bones around the knee and cause some irritation and pain. These are very common and will settle on their own with time and sometimes with physiotherapy, painkillers and reassurance.

There are also several other causes of knee pain. We sometimes see problems with the cartilage in the knee, a condition known as osteochondritis dissecans. This condition can cause pain and often needs some intervention scans. Occasionally it will require operations.

If a child has a sporting injury to the knee, they may have damaged some of the ligaments in the knee as well.

Then there are rarer things we see, such as a grosser bone around the knee and other changes in the cartilage. Additionally, when treating a child with knee painm we always think about referred pain from the hip.We always examine the hip and check that it’s not the cause of the pain.

How can parents or caregivers determine if their child's knee pain requires medical attention?

There are a few red flags for knee pain in children. If a child has pain that makes them limp or if the pain is severe, keeping them awake at night, those are big concerns.

Furthermore, if the parents or caregivers notice anything in the knee, such as if the knee is swollen, stiff, red or if there are other joints involved and particularly if one knee is more affected than the other, these are signs that they should be concerned.

Additionally, if the child is acutely unwell; if they’re feeling sick, looking unwell, they have a temperature or fever, then that may be a sign of infection, which requires urgent attention.  

How can these conditions be treated?

There’s a range of treatments available for children. Things such as reassurance is required, as well as lot of activity moderation, painkillers and physiotherapy really help for more common problems such as like tractus posterolateralis, which I previously mentioned.

Some conditions may need surgery, depending on the nature of what the condition is. If a child has experienced a ruptured cruciate ligament, they may need surgery to reconstruct the ligament. If they are suffering from cartilage damage, that may need to be repaired as well.

With the other conditions, treatment really depends on what they are. So for example for a boney growth, surgery may be required to remove that. If it’s infection, urgent treatment with admission to hospital is essential.

Are there any exercises or stretches that can help prevent knee pain in children who are active in sports or other physical activities?

When discussing children who have tractus posterolateralis problems which cause pain during sports, exercises or stretches to treat these depend on where the pain is located.

There are a few different locations for pain but what we normally recommend is that the child modifies their activity, particularly children who take part in high impact activity such as football. They may be playing football multiple times a week and they may be overloading their knees. In this case, we would recommend changing the activity level and maybe suggest swapping out a high-impact activity for low-impact activities, such as swimming or gym work.

If the child does have tight hamstrings muscles, they can sometimes work on stretching those as well.  They have to alter the duration of sport they’re doing, for example, playing half a match rather than a full match.

Are there any warning signs that parents should be aware of when it comes to knee pain in children?

There are a few key warning signs that parents should be aware of regarding knee pain in children. These are as follows;

• If the pain is severe and sudden.
• If the child is limping.
• If they notice anything in the knees such as stiffness, swelling or redness.

If you are concerned about your child’s knee pain and would like to arrange an appointment with Mr Kiely, do not hesitate to do so by visiting his Top Doctors profile today.