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Six-Year-Old Complains of Thigh Pain

Pediatrics Expert Advice from Henry Bernstein, M.D.

Q: My six-year-old daughter just started complaining of right thigh pain. She did not bang it and was not out playing. Earlier in the day, she had a short bout with vomiting. There are no bruises or swelling and no pain to delicate touch. It only seems to bother her when she bends her leg at the hip. She even woke up crying because while moving in her sleep the pain woke her up.

A: Thigh pain is an unusual complaint for a six-year-old, so I am not sure what is wrong with your daughter. The thigh is not the area of the leg where muscles ache from lots of exercise, so called "growing pains". Besides this is only one leg, while "growing pains" tends to be both. Your thought that injury to your daughter's thigh could be the problem is a good one. However, since you related that she has not had any injury, there is neither any obvious bruising nor any swelling in that area, I would look for other possibilities.

Pain of any extremity in a child often is confusing and can involve anywhere from the top to the bottom of it. There can be limp, fever, swelling, tenderness, rash, a break in the skin, or other systemic signs and symptoms. The vomiting you mention may just be your daughter's response to her discomfort, her anxiety related to the pain, or maybe the beginning of a more serious infection in the body. It is often helpful to consider what is just above, below, or around the spot, whenever there is pain somewhere. It could be the bone inside, the muscles and nerves involving that limb, or even the groin.

In this case, the hip is probably the first place to consider, particularly if your daughter has had any recent fever. We would not want to miss any infection involving the hip joint, as it could also have long-term consequences in the future. Involvement of the hip joint is not clearly identified on exam the way swelling of an ankle or knee can be seen. A good physical exam can usually localize where the problem is coming from, although sometimes X-rays and/or laboratory studies are needed. Check in with your daughter's doctor if this pain continues, she has fever, or just will not use her leg right.

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Henry Bernstein, M.D., is currently the associate chief of the Division of General Pediatrics and director of Primary Care at Children's Hospital, Boston. He also has an academic appointment at Harvard Medical School.

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