A hip problem can be hard to deal with, both for the child who has the problem and to the parent or caregiver. A child who has a hip problem may feel pain in the hip, groin, thigh, or knee. A child in pain may limp or be unable or unwilling to stand, walk, or move the affected leg. A baby in pain may cry, be fussy, and have other signs of pain. Hip problems may be present at birth (congenital) or may develop from injury, overuse, inflammation, infection, or tumour growth.
To better understand hip problems, it may be helpful to know how the hip works. It is the largest ball-and-socket joint in the body. The thigh bone (femur) fits tightly into a cup-shaped socket (acetabulum) in the pelvis. The hip joint is tighter and more stable than the shoulder joint but it does not move as freely. The hip joint is held together by muscles in the buttock, groin, and spine; tendons; ligaments; and a joint capsule. Several fluid-filled sacs (bursae) cushion and lubricate the hip joint and let the tendons and muscles glide and move smoothly. The largest nerve in the body (sciatic nerve) passes through the pelvis into the leg.
Hip problems may develop from overuse, infection, or a problem that was present from birth (congenital). Oddly enough, a child who has a hip problem often feels pain in the knee or thigh instead of the hip. Hip problems that affect children include:
- An inflammatory reaction, such as transient or toxic synovitis. This generally occurs after the child has had a cold or other upper respiratory infection. This is the most common cause of hip pain in children.
- A slipped capital femoral epiphysis. This occurs when the upper end of the thigh bone (head of the femur) slips at the growth plate (epiphysis) and does not fit in the hip socket correctly.
- Legg-Calve-Perthes disease. This condition is caused by decreased blood flow to the head of the femur which affects the bone as seen on the X-ray and an MRI of a child with this problem.
- An inward twisting of the thigh bone (femoral anteversion). This condition causes the knees and feet to turn inward. The child will have a "pigeon-toed" appearance and may have a clumsy walk.
- Developmental dysplasia of the hip (DDH). This condition is caused by a problem in the development of the hip joint. The top of the femur does not fit correctly into the hip socket (acetabulum) so the femur can partially or completely slip out of the socket.
- Juvenile idiopathic arthritis (JIA). This condition causes inflamed, swollen joints that are often stiff and painful.
- Infection in the joint (septic arthritis), the bursa (septic bursitis), or the hip or pelvic bone (osteomyelitis).
- In rare cases, cancer of the bone, such as osteosarcoma.
Treatment for a hip problem depends on the location, type, and severity of the problem as well as the child's age, general health, and activity level. Treatment may include first aid measures; application of a brace, cast, harness, or traction; physiotherapy; medicines; or surgery.
Check your child's symptoms to decide if and when your child should see a doctor.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or non-binary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, or natural health products can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
Pain in children 3 years and older
- Severe pain (8 to 10): The pain is so bad that the child can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain. No one can tolerate severe pain for more than a few hours.
- Moderate pain (5 to 7): The pain is bad enough to disrupt the child's normal activities and sleep, but the child can tolerate it for hours or days.
- Mild pain (1 to 4): The child notices and may complain of the pain, but it is not bad enough to disrupt his or her sleep or activities.
Pain in children under 3 years
It can be hard to tell how much pain a baby or toddler is in.
- Severe pain (8 to 10): The pain is so bad that the baby cannot sleep, cannot get comfortable, and cries constantly no matter what you do. The baby may kick, make fists, or grimace.
- Moderate pain (5 to 7): The baby is very fussy, clings to you a lot, and may have trouble sleeping but responds when you try to comfort him or her.
- Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds when you try to comfort him or her.
Symptoms of infection may include:
- Increased pain, swelling, warmth, or redness in or around the area.
- Red streaks leading from the area.
- Pus draining from the area.
- A fever.
Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in children are:
- Diseases such as diabetes, cystic fibrosis, sickle cell disease, and congenital heart disease.
- Steroid medicines, which are used to treat a variety of conditions.
- Medicines taken after organ transplant.
- Chemotherapy and radiation therapy for cancer.
- Not having a spleen.
If there is a difference between the child's hips, you may notice that:
- One leg looks shorter than the other.
- There are more folds of skin on the inside of one thigh than on the other.
- One hip joint seems to move differently than the other.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
Home treatment may help relieve your child's hip pain, swelling, and stiffness. If your child will co-operate, use the following tips. If your child becomes upset or will not co-operate, do not force your child.
- Rest. Have your child rest and protect the sore hip. Have your child stop, change, or take a break from any activity that may be causing pain or soreness.
- For sleep, put your child on the side that does not have a problem.
- Gently rub your child's hip to relieve pain and help blood flow.
- If the swelling is gone, heat can be put on the area. Your child can carefully begin normal activities. Moist heat with a hot water bottle or warm towel may feel good to your child.
Try a non-prescription medicine to help treat your child's fever or pain:
Talk to your child's doctor before switching back and forth between doses of acetaminophen and ibuprofen to treat a fever. When you switch between two medicines, there is a chance your child will get too much medicine.
Be sure to follow these safety tips when you use a non-prescription medicine:
Cast care tips
If your child has a cast, see cast care tips.
Symptoms to watch for during home treatment
Call your child's doctor if any of the following occur during home treatment:
- Pain develops.
- Signs of infection develop.
- Your child does not want to bear weight on the side of the hip injury.
- Symptoms do not get better with home treatment.
- Symptoms become more severe or more frequent.
Most of the problems that can affect a child's hips or cause a child to limp can't be prevented. The following tips can help keep your child's bones healthy and strong.
Keep bones strong
Preparing For Your Appointment
To prepare for your appointment, see the topic Making the Most of Your Appointment.
You can help your doctor diagnose and treat your child's condition by being prepared to answer the following questions:
- What are your child's main symptoms? How long has your child had symptoms?
- Has your child had this problem in the past? If so, do you know what caused the problem at that time? How was it treated?
- Does your child limp or complain about pain when he or she walks? Where is the pain felt? How far can your child walk without pain? Does the pain get better or worse as he or she continues to walk?
- Has your child had any recent illness or fever?
- What activities make your child's symptoms better or worse?
- What activities does your child do? Has your child recently started a new activity?
- What home treatment measures have you tried? Did they help?
- What prescription or non-prescription medicines has your child taken? Did they help?
- Does your child have any health risks that may increase the seriousness of his or her hip symptoms?
Current as of: February 26, 2020
Author: Healthwise Staff
Medical Review: William H. Blahd Jr. MD, FACEP - Emergency Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine
H. Michael O'Connor MD - Emergency Medicine
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