Q) Dear Dr. Gwenn:

My 3 year old boy has been limping for a little over 6 months. At first we saw an orthopedic doctor who thought it was growing pains and put him on naproxen twice a day. That did help as long as he took it but he still had a slight limp. If we missed a dose, the pain came back horribly.

Over the past month, his limp and pain worsened. We were sent to a rheumatologist and an ophthalmologist to be tested for arthritis. The tests came back negative. The rheumatologist put him on prednisolone with the naproxen. I was just wondering what the next step should be. I do not want to keep giving my 3 year old medicine unless it is necessary. What else could be causing this limp?

Thanks.

A

A) Dear A:

Limp in a small child is always a challenge to sort out partly because the child is too young to accurately explain how he feels. Since your son has had limp for son long, referals to specialists such as orthopedists and rheumatologists are the next steps once your pediatrician has done the first stage of the office work up.

Since your son’s limp and pain are getting worse, it is necessary that something be done for him to be more comfortable. As much as we would love to give every child a diagnosis for their specific symptoms, that just isn’t always possible. Sometimes the best we can do is rule out the big diagnoses and then treat the symptoms, in this case the pain. In my mind, that is always necessary when it comes to a child with naming the diagnosis very much secondary.

For you to feel more comfortable about treating your son, ask your rheumatologist for a consult session to review the work up and the reasoning behind the prednisolone with the naproxen. Ask about what the working diagnosis seems to be and what the next steps will be if your son is not better in a reasonable amount of time. One important issue you need to consider is that this has been going on for a very long period of time and will likely take some time to calm down.

In addition to traditional medication treatments, ask your rheumatologist about physical therapy and even treatment modalities like accupuncture. Sometimes with chronic pain, these “nonmedical” therapies go a long way in helping people of all ages feel better.

Dr. Gwenn

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