Hip Problems in Younger Children

A child who has a hip problem may feel pain in the hip, groin, thigh or knee. The type of hip pain they have may help your child’s doctor determine the cause of their pain. A child with hip pain may limp or be unable or unwilling to stand, walk, sleep on the side that hurts or move the affected leg. A baby in pain may cry, be fussy and have other signs of pain. A clicking or snapping feeling or sound around the hip joint (snapping hip) may be a cause for concern. But if their hip is not painful, in many cases the click or snap is nothing to worry about. Home treatment may be all that is needed for minor hip symptoms.

To better understand hip conditions in your child, it may be helpful to know how the hip works. The hip 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 buttocks, 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, bone changes with age, tumors, infection, changes in the blood supply or an issue that was present from birth (congenital).

Hip pain in younger children can have different causes, depending on the location or condition:

• An inflammatory reaction, such as transient or toxic synovitis, which generally occurs after the child has a cold or other upper respiratory infection. This is the most common cause of hip pain in children.
• A slipped capital femoral epiphysis, which occurs when the upper end of the thigh bone (head of the femur) slips at the growth plate (epiphysis) and does not fit into the hip socket correctly.
• Legg-Calve-Perthes disease, which is caused by decreased blood flow to the head of the femur, affecting the bone as can be seen on an X-ray or MRI of a child with this problem.
• An inward twisting of the thigh bone (femoral anteversion), which causes the knees and feet to turn inward. The child will have a pigeon-toed appearance and may have an ungainly walk.
• Developmental dysplasia of the hip (DDH), which is caused by a condition 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), which causes inflamed, swollen joints that are often stiff and painful.
• Infection in the joint (septic arthritis), bursa (septic bursitis), 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; physical therapy; medicine or surgery.

Check your child’s symptoms to decide if and when your child should see a doctor.