Hip Pain Children Irritable Hip

Overview

Irritable hip — also called transient synovitis (sin-oh-VY-tis) — is a common, short-term cause of hip pain in young children. The lining of the hip joint becomes inflamed, which means it is swollen and irritated. This makes the hip sore, so your child may limp, complain of pain in the hip, thigh or knee, or refuse to walk. It is not a joint infection and it is not a long-term arthritis. It usually settles completely within one to two weeks with rest and simple pain relief.

Yes. Irritable hip is the most common cause of hip pain in young children. Many children have one episode, and a small number have another one later.

It mostly affects children between about 3 and 10 years old, and it is slightly more common in boys than girls. It is rare before the age of 2 and unusual in teenagers. Hip pain in older children and teenagers needs to be checked carefully, because other conditions become more likely with age.

Symptoms

Common symptoms

• Pain in the hip, groin, thigh or knee — young children often feel hip problems as knee pain
• Limping, or walking on tiptoes on the affected side
• Refusing to walk or wanting to be carried
• Pain that is worse with movement and better with rest
• Sometimes a low temperature, or a recent cold or sore throat
• The leg may look slightly turned outward

Symptoms in children

• Crying or becoming upset when the nappy is changed or when the legs are moved
• Not wanting to stand, crawl or bear weight on one leg
• Being clingy, tired or off their food while in pain
• Pain that comes and goes in the first day or two

Symptoms in older adults

• Irritable hip is a childhood condition and does not affect older adults.
• Hip pain in adults usually has different causes, such as wear and tear (osteoarthritis), muscle strain or inflammation of the soft tissues.
• An adult with new hip pain should see a doctor for an assessment rather than assume it is irritable hip.

Causes

Main causes

• Most often, it follows a viral illness such as a cold, cough, sore throat or stomach bug. The body's immune response is thought to make the hip lining inflamed.
• Sometimes it follows a minor knock, trip or fall, or a lot of running and jumping.
• In many cases no clear trigger is found, and the exact cause is not known.
• It is important to know that it is not caused by anything the child or parent did wrong.

Risk factors

• Being between about 3 and 10 years old
• A recent cold, flu-like illness or other viral infection
• Being a boy (slightly more common)
• Recent physical activity or a minor injury
• Having had an episode of irritable hip before

When to see a doctor

See a doctor urgently if:

• Hip pain with any fever, or a child who looks unwell
• A child who cannot walk or refuses to put any weight on the leg
• Pain that is severe, sudden, or getting worse quickly
• Pain after a fall or accident
• A baby or toddler with hip or leg pain that lasts more than a day
• A leg that looks twisted, shortened, or is held in an odd position

Book a routine appointment if:

• Limping or mild hip pain that lasts longer than 2 or 3 days
• Pain that keeps coming back, or a second episode later on
• Hip pain in a child over 10 years old or in a teenager
• Any concern you have as a parent — it is always reasonable to get your child checked

Diagnosis

A doctor will start by asking about your child's symptoms, recent illnesses, any injuries, and how well they are eating, drinking and playing. They will watch your child walk if possible, feel the hip and leg, and gently move the joint to see how much pain and movement there is. They will also check the temperature and general wellbeing. Often this examination is enough to make the diagnosis, especially when the child is well in themselves and the pain is mild.

Tests that may be done

• Ultrasound scan of the hip — a quick, painless scan that shows whether there is fluid around the joint
• Blood tests — to look for signs of infection or inflammation if the doctor is concerned
• X-ray — not always needed, but sometimes used to rule out other problems in the bone
• Urine test — to check for a urine infection, which can occasionally cause hip or leg pain in children
• Sometimes a joint fluid sample or a longer stay in hospital, but only if a joint infection is suspected

What to expect at your appointment

Your child will usually be examined in a paediatric or emergency assessment setting if they are very young or unable to walk. If the doctor is confident it is irritable hip and your child is well, you will normally be sent home with advice on rest and pain relief, and given clear instructions about when to come back. If there is any doubt, your child may be kept for observation or referred to a children's unit for further checks. Follow-up is often arranged so someone can check that the pain has settled.

Treatment

The main treatment for irritable hip is rest and gentle pain relief while the inflammation settles. Children usually improve within a few days and are back to normal within one to two weeks. Antibiotics are not needed, because this is not an infection. If the doctor is not sure whether there is a joint infection, your child may need to be checked in hospital first before being sent home.

Self-care at home

• Let your child rest and avoid running, jumping, sports and long walks until the pain has gone
• Encourage normal gentle walking around the house if your child is comfortable doing so
• Ask your pharmacist or doctor which over-the-counter pain medicine is suitable for your child's age and weight, and follow the instructions on the label
• Do not give aspirin to a child under 16
• Make sure your child drinks plenty of fluids and eats normally
• Keep them off school or nursery while they are sore and limping, then let them return gradually
• Wait until your child can walk normally and without pain before letting them go back to sports or rough play
• Note any changes in symptoms so you can tell the doctor if things do not improve

Medical treatments

Treatment is focused on comfort and rest. A doctor or pharmacist can advise on suitable pain relief for your child's age and weight, and will explain how long to use it. Your child may be reviewed after a few days, either in person or by phone, to check the pain is settling. If there is any concern about a joint infection or another bone condition, your child will be referred to a children's unit for closer observation and tests. Physiotherapy is not usually needed, because the joint recovers on its own.

When is surgery considered?

Surgery is not needed for irritable hip. If a different condition is found — such as a joint infection or a problem with the blood supply to the hip bone — the treatment plan will be explained by the specialist team.

Living with this condition

In the first few days, your child may be clingy, need more cuddles, and want to be carried or to sit quietly. Keep things calm and simple. Offer gentle play, like drawing, reading or watching a film, rather than running about. Most children are back to their usual selves within a week or two. If your child uses a nursery or school, let staff know what has happened so they can watch for any limping when your child returns.

Lifestyle tips

• Build in plenty of rest during the recovery days, and keep nap times and bedtime routines steady
• Return to activity slowly — short walks first, then normal play, then sports
• Keep up usual healthy routines such as hand washing, which helps reduce the viral infections that often come before irritable hip
• Make sure your child wears well-fitting shoes and has a safe play area to reduce trips and falls
• Notice if a particular activity seems to trigger pain, and pace it for a while

Diet and exercise

No special diet is needed. Offer normal, balanced meals and plenty of fluids. During the sore period, gentle movement around the house is fine if your child is comfortable — complete rest in bed is not necessary and can make children stiff and unhappy. Avoid sports, trampolining, running games and long walks until the pain has fully gone and your child is walking normally. Once recovered, normal active play is encouraged and helps build strong bones and muscles.

Mental health and emotional wellbeing

Hip pain can be upsetting for a child and worrying for parents. Children may become anxious about walking, fear falling, or get frustrated at missing play and school. This usually settles quickly once the pain eases. Be reassuring and calm, explain in simple words that the hip is sore but will get better, and praise small steps back to normal activity. Parents often feel guilty or anxious too — that is very common and understandable, and it is not your fault. If your child seems very distressed, or if worry is affecting sleep, school or family life, speak to your doctor or school health team about support.

Prevention

Irritable hip cannot always be prevented, because it often follows ordinary childhood viral infections. You can lower the chances of common infections with simple hand washing and by keeping your child's vaccinations up to date. Safe play areas, well-fitting shoes and watching for overly rough play can reduce minor injuries. If your child has had irritable hip before, easing back into sport gradually after an illness may help.

Screening programmes

There is no screening test for irritable hip. It is found by a doctor's examination when a child has hip pain or a limp.

Complications

If left untreated

• Most children recover fully without treatment beyond rest and pain relief.
• In a small number of children the pain lasts longer than expected, and a follow-up appointment is needed to check for other causes.
• Rarely, what looks like irritable hip turns out to be a joint infection, which needs urgent hospital treatment — this is why fever and being unable to walk are taken seriously.
• Rarely, other childhood hip conditions such as a problem with the blood supply to the hip bone, or a slipped growth plate in older children, can cause similar symptoms and need specialist care.

Long-term outlook

The outlook is very good. Nearly all children with irritable hip make a full recovery within one to two weeks and have no long-term hip problems. A small number of children have another episode later, which also usually settles with rest. Keep an eye on your child and see your doctor if the pain is not improving as expected, if fever develops, or if you are worried at any point.

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