Coxitis and When to Be Alert if a Child Avoids Walking
When a small child suddenly starts avoiding stepping on one foot, limps, or complains of pain in the hip or groin, parents naturally become alert. One of the common causes of these issues, especially in children between the ages of 3 and 10, is the so-called coxitis of the hip joint, also known as parainfectious coxitis. Although its name may sound frightening, in most cases, it is a temporary and non-serious inflammation that resolves on its own without lasting consequences. The key, however, is proper recognition and sufficient bed rest.
What is coxitis and why does it affect children?
Coxitis is a general term for inflammatory involvement of the hip joint. It can have various causes—from infections to autoimmune diseases. The child's body, which is still developing immune responses and is growing intensively, is more susceptible to a specific type of coxitis, namely, parainfectious coxitis.
This form most commonly appears as a reaction of the body to a recently experienced viral infection—typically of the upper respiratory tract, such as a cold, cough, or mild viral infection. It is not caused by direct invasion of the joint by an infectious agent but rather by an exaggerated immune response of the body, which reacts with inflammation in the hip. For this reason, it is referred to as "parainfectious," meaning accompanying the infection.
A peculiarity is that coxitis in children almost exclusively occurs on one side and usually resolves within a few days to weeks. Nevertheless, it can still cause significant discomfort for the child.
How to recognize parainfectious coxitis?
Symptoms can appear suddenly and often occur about a week after a common viral infection. The child starts complaining of pain in the hip, groin, or even knee area, even though the real problem lies elsewhere. Sometimes, a mild fever may also occur. However, the main symptoms are limping or stiff walking and possibly refusal to walk at all. Some children may even refuse to sit on the potty or be carried due to the pain.
Unlike the more serious septic arthritis, which requires immediate antibiotic treatment and often surgical intervention, parainfectious coxitis does not significantly alter the child's overall condition. The child is usually not apathetic, has a normal appetite, and apart from limping, appears relatively healthy.
A doctor may recommend an ultrasound of the hip joint to confirm the diagnosis, which will show a typical finding—effusion in the joint cavity. Blood tests are usually normal or show only slightly elevated inflammatory markers (e.g., CRP or sedimentation).
Practical example: The mother of five-year-old Eliška noticed that after a weekend with a cold, her daughter suddenly does not want to walk and favors her left leg. The general practitioner referred her to orthopedics, where an ultrasound confirmed a mild effusion in the left hip—a typical sign of parainfectious coxitis. After the recommended rest and a few days of relaxation, Eliška returned to her usual running around with friends.
What is the treatment and what can parents do?
The most important element of treatment is bed rest and limiting physical activity until the pain and limping subside. Usually, no antibiotic treatment is necessary because it is not a bacterial infection. A doctor may recommend non-steroidal anti-inflammatory drugs, such as ibuprofen, to relieve pain and inflammation.
Parents should ensure that the child really rests—which is not easy with active children. Generally, a few days of rest are sufficient, but in some cases, recovery can take up to two weeks. If symptoms worsen or persist longer, it is necessary to consult the doctor again.
It is also important to reassure both the child and themselves—the words "inflammation" and "joint" may trigger fears of permanent damage, but parainfectious coxitis leaves no consequences if the rest regime is followed.
When to be alert and what could indicate something more serious?
When a child starts limping, the first explanation often suggested is parainfectious coxitis. It is the most common cause of limping in young patients. However, caution is advised—behind similar symptoms, there could be much more serious diagnoses that need to be taken seriously right from the start.
One such problem is septic arthritis—a bacterial infection of the joint. This condition does not wait and develops quickly. If treatment is delayed, it can cause permanent joint damage. Therefore, it is crucial to detect it as soon as possible and administer the correct antibiotics.
Another possibility worth mentioning is Perthes disease, a condition where the blood supply to the femoral head is disrupted. It can die and deform as a result. This condition often affects children between the ages of 4 and 10. Diagnosis is more challenging, and treatment requires patience—from rest to orthopedic procedures.
Autoimmune disorders, such as rheumatoid arthritis, which can cause long-term joint pain and swelling, also occur. This is not just a one-time episode of limping but a chronic process that requires long-term care by a rheumatologist.
In the most serious cases, bone tumors or the presence of bone cysts cannot be ruled out, which, while sounding frightening, can also be well managed with early detection. It is important to listen to the body and not underestimate anything.
In short—limping in a child can be a trivial matter, but also a warning sign. If it lasts longer or is accompanied by pain, swelling, or fever, it is certainly advisable to seek expert help. More information about parainfectious coxitis can be found, for example, here.
Parents should pay attention in cases where:
- the child has a high fever
- the pain worsens and does not subside even at rest
- limping lasts longer than two weeks
- the child is apathetic and has difficulty moving even at rest
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In these cases, it is necessary to visit a pediatric orthopedic specialist or the outpatient department of a children's hospital.
Why is the hip joint so sensitive in children?
The hip is one of the largest and most burdened joints in the body. In children, it is still developing and is supplied by a rich network of blood vessels. Any disruption of balance—whether by inflammation, injury, or immune reaction—can manifest here more quickly than elsewhere. Moreover, children often cannot precisely locate pain, so they complain about the knee, calf, or just "I don't want to walk," which can lead to late recognition of the problem.
The sensitivity of the child's musculoskeletal system is confirmed by MUDr. Kateřina Veselá, a pediatric orthopedic specialist from FN Motol: “For children, every limping deserves attention. Even a seemingly trivial cause can hide a more serious problem."
Coxitis and returning to normal activity
After symptoms subside, the child does not need to be restricted—they can return to kindergarten, the playground, and sports. However, it is not advisable to immediately burden them with intensive activities like trampolining or football training. A gradual return to movement is recommended, ideally starting with normal walking and then gradually adding more demanding activities.
In some cases, a follow-up visit to the orthopedist may be recommended in a few weeks, especially if the child has experienced coxitis repeatedly or if limping lasted longer.
Although parainfectious coxitis can be unpleasant for children and stressful for parents, there is no need to panic. In most cases, it is a well-managed condition with an excellent prognosis. It is important to listen to your child, notice changes in walking or behavior, and not hesitate to consult a doctor if unsure.
Children are not small adults—and their bodies sometimes react to common stimuli in unusual ways. Limping after a viral infection is one of those signals that should not be overlooked, but at the same time, there is no reason for excessive concern. Careful observation, rest, and a possible medical check-up are usually enough to have the little patient running towards new adventures in no time.
