Joint pain in children and when to see a rheumatologist

By: MaiLan Nguyen, MD, Rheumatology, 02/01/22

Joint pain in children is a common complaint and usually is not a sign of a serious condition. It can be difficult to distinguish between normal childhood aches and pains and when a child needs further evaluation by their pediatrician or a specialist. For some children, an evaluation by a pediatric rheumatologist may help clarify the cause of the joint pain and how to treat it.

What are some common causes of joint pain in children?

Growing pains

Growing pains are one of the most common causes of joint pain in children between the ages of three and 12. It typically affects the legs but can also affect the arms and can be crampy, episodic and severe. It commonly occurs in the evening or at night and may even wake the child up from sleep but usually resolves by the morning.

The symptoms improve with massage, heat or over the counter pain medications like acetaminophen or ibuprofen. Most importantly, the child will not have any joint swelling, joint stiffness, fever, weight loss or rash, and their growth and development is not affected.

Benign hypermobility syndrome

Children who are hypermobile are flexible and have joints that move beyond normal range of motion. Hypermobility is more common in girls but can occur in boys too. It can run in families, but the exact cause is unknown. Children with hypermobility are more likely to have joint dislocations or sprains.

Children with benign hypermobility syndrome have muscle or joint pain that is worse with activity or as the day goes on. They may even have transient joint swelling that lasts hours to a few days. Symptoms resolve with rest.

Children become less flexible as they get older, so symptoms often improve with time. However, some children with hypermobility develop chronic pain.

Children who are hypermobile may benefit from physical therapy and home exercise plans that focus on strengthening muscle to stabilize the loose joints.

Overuse injuries

Overuse injuries are a common cause of joint pain in athletes. Tenderness to the affected area and increased pain with physical activity, especially if it involves a repetitive motion, are common signs of overuse injuries. Your child’s pediatrician can evaluate for signs of an overuse injury, and some children may benefit from further evaluation from a Sports Medicine specialist.

When should my child see a doctor about the joint pain?

If the joint pain occurs after an injury, your child should see a doctor.

It is also recommended to see a doctor if at least one of these symptoms is present:

  • Fever
  • Redness or warmth of a joint
  • Rash
  • Joint swelling that has persisted for at least several days
  • Joint stiffness or decreased range of motion
  • Joint pain or stiffness that is worse in the morning
  • Joint pain or stiffness that is worse after a nap or periods of inactivity
  • Trouble using the joint
  • Limping
  • Weight loss

What are signs and symptoms of juvenile idiopathic arthritis?

Though juvenile idiopathic arthritis (JIA) is a less common cause of persistent joint pain in children, it is one of the most common conditions treated by a pediatric rheumatologist. Close to 300,000 children in the United States have been diagnosed with some form of JIA. JIA can occur at any age during childhood but is unlikely in children less than six months old. JIA is a form of chronic joint inflammation that lasts at least 6 weeks constantly. It can affect one joint or many joints and can even be associated with eye inflammation.

Symptoms of JIA include:

  • Joint swelling that has persisted for at least several days
  • Joint stiffness or decreased range of motion
  • Joint pain or stiffness that is worse in the morning, after a nap, or after periods of inactivity
  • Limping

There is no blood test that can diagnose JIA. Children with JIA often have normal laboratory studies. The diagnosis of JIA depends on the symptoms your child is experiencing, their physical examination and the exclusion of other conditions that can cause joint swelling and inflammation. Imaging may help in the diagnosis of JIA too.

Pediatric rheumatologists are specialists trained in evaluating children for JIA and other causes of chronic joint swelling, stiffness and pain. In our pediatric rheumatology clinics, we evaluate for and provide ongoing care and treatment for JIA. With treatment, most children with JIA live normal lives.

If your child is experiencing these symptoms, contact your pediatrician. An appointment with the pediatric rheumatologist may help figure out the underlying cause of your child’s joint pain and what the best treatment is.