In most cases, knee pain in children can be due to growing pain, and there is no need for medical attention since it may resolve quickly without complications. However, it is always necessary to identify the exact causes of knee pain in children. Dr. Mark Halstead, MD, Sports Medicine Specialist at St. Louis Children’s Hospital, says, “knee pain can result from because of overuse, imbalance in muscle strength and flexibility or from Osgood-Schlatter disease (1).” Knee pain with other symptoms, such as redness and swelling, may require prompt medical care.
Read on to know more about the causes and treatment of knee pain in children and when to see a doctor.
Causes Of Knee Pain In Children
There could be various causes for knee pain in children. Here we list some of them.
Normal Causes For Knee Pain In Children
According to a research article published in the British Medical Journal, Growing pain normally occurs in children between the ages three-twelve, usually during the evening or night. If the pain is felt in both legs, in the front of the thighs or calves or behind the knees, without any external swelling or injury, then it might be growing pain. These pains are not usually associated with limping and may not have any signs of local trauma and infection (2).
Growing pains usually don’t require any medical intervention, and they tend to fade away after a certain age. If you are unsure that the knee pain is a growing pain, then it is best to consult your pediatrician (3). Also, the use of aspirin as a pain reliever is not recommended for children below the age of 16 years, as it can cause Reye’s Syndrome (4).
Causes For Knee Pain In Children Which Could Raise A Concern
Apart from these, here are a few causes of knee pain, which could be an indication of an underlying condition. The below causes include both an underlying medical condition as well as the wear and tear of the knee when a child is active in sports.
1. Knee injuries:
Your child can also have knee pain because of an injury. If your child’s knee shows the below symptoms, then it is best to seek professional advice.
- If the knee is not able to support the weight of the body
- The kneecap feels out of place, and cannot have a full-motion
- There is a painful popping or crackling sound
- There is swelling, and the knee is locking (5)
2. Infection in the knee
Bacterial infection in the knee may result in conditions such as osteomyelitis and septic arthritis.
In neonates and infants, the symptoms are nonspecific, which may include irritability, refusal to walk, or limited spontaneous movements of limbs.
Whereas in older children, symptoms such as swollen and painful joints associated with effusion, functional impairment, tenderness, and local warmth (6).
3. Juvenile arthritis
If the child is showing signs such as pain, inflammation, stiffness of joints, and fatigue, it could indicate the onset of an autoimmune disease known as juvenile arthritis. The most common type of arthritis in children is called juvenile idiopathic arthritis (7) Usually more than one joints, such as like knee, ankle, elbow, wrist and finger joints, are involved in juvenile arthritis.
4. Osgood-Schlatter disease
Osgood-Schlatter disease is an inflammation of the region where the shinbone attaches to the kneecap, causing knee pain in adolescents. This usually occurs during puberty, when the child goes through growth spurts. It could be common in children who actively participate in athletics and sports (8).
5. Jumper’s knee
Jumper’s knee is a painful knee condition, where accumulated stress on the patellar tendon causes tears in the region.
This mainly occurs in children who are involved in jumping sports. The common symptoms of this include pain due to prolonged sitting, squatting, and stair climbing. Also, sudden tendon pain occurs when there is a loading impact on the knee and stops immediately when the load is removed. It is rarely experienced while resting (9).
6. Soft tissue knee injuries
A soft tissue injury is the damage of ligaments, tendons, and muscles in a region of the body. Soft tissue knee injury refers to the trauma caused due to excessive pressure or overuse of the ligaments, tendons, and muscles (10).
7. Patellofemoral syndrome (PFS)
Patellofemoral pain syndrome is a pain in the anterior part of the knee. This is a common condition among teenagers and athletes. Overuse, injury, displaced kneecap, or excess weight or pressure applied on the kneecap result in roughening, softening, or wearing down of the cartilage below the kneecap (11).
Kids with Patellofemoral syndrome experience pain when they squat, jump or bend the knee.
8. Quadricep’s tendinitis
Teenagers who play sports such as soccer and football, which involve a lot of running, tend to overuse their knee structures, resulting in strain or injury of the quadriceps muscle. This leads to pain, swelling, and weakness in the knee. Pain is usually felt in the lower thigh region, above the patella, when the person tries to move the knee (12).
Osteosarcoma is a bone tumor that is usually found in adolescents and young adults and develops at the edges of long bones that form the knee. It has symptoms such as pain in the bone, stiffness, swelling, or tenderness in the bone, weak bones, fatigue, weight loss, and anemia.
The doctor will then diagnose the condition and prescribe multi-agent chemotherapy or surgical management (13).
When To See A Doctor?
Growing pains usually don’t require any medical intervention, as they tend to fade away after a certain age.
But it is time to call the doctor if the pain lasts for over two weeks and the child has:
- Pain for a long duration, sometimes throughout the day
- Joint pains
- Pain in the mornings
- Weakness in the knees and is limping
- Swollen, red, or tender joints
In general, if the pain is affecting the child’s performance, a doctor’s evaluation is imperative.
Diagnosis Of Knee Pain
The doctor may ask you questions about the nature of the pain, its longevity, and when the child experiences it the most.
The doctor may inquire about other visible symptoms such as fever and rashes that can indicate juvenile arthritis. Post physical examination, X-rays, MRI, CT Scan, or blood work may also be recommended.
Treating Knee Pain In Children
The treatment of knee pain in children depends on the cause. The standard treatment methods of knee pain are explained below.
Sometimes, all your child needs is a little rest to get relief from knee pain. According to Michigan Medicine, RICE – Rest, Ice, Compression, and Elevation could help in relieving knee pain. This method is recommended immediately after an injury or a sprain (14).
However, it is best to have a clear diagnosis of the knee pain to know the root cause, as these methods only help in treating the pain and not the underlying cause.
- Rest: If the pain is due to a strained muscle or ligament, resting the knee may help in minimizing the sprain and reduce the pain. Place a small pillow under the knee when resting for relief.
- Ice packs: If there is a swelling along with pain, it is believed that ice might help. Apply an ice pack immediately after the injury to minimize the chances of swelling. Avoid hot water, hot showers, or hot tubs that can aggravate swelling, for at least 48 hours after the injury.
- Compression: The swelling of the knee might be decreased by wrapping it tightly (not too tightly though) with an elastic bandage. However, it is advised to consult your child’s doctor, as compression may not be recommended if there is an injury or sprain.
- Elevate: Swelling could be minimized by stretching the swollen knee in an elevated position. When sitting, use soft pillows to prop up the knee above the heart’s level. When sleeping, just place one pillow to elevate the knee slightly.
- Massage: If there is no swelling, pain in the knee could be alleviated with a gentle massage.
This might work if the knee pain is because of normal sprain, but if there is an underlying cause, then these remedies might not be able to relieve the pain. If the pain and swelling do not come down even after trying these tips for a day, then it is best to schedule an appointment with your child’s doctor.
2. Physical therapy and exercises
Therefore, exercising the knee can help relieve and reduce the chances of its recurrence (15). Help your child in doing Hamstring, Quadriceps stretches and knee to chest, straight leg raises, and wall side with pillow or ball exercises.
These exercises are helpful when you do them properly. It is best to consult a physiotherapist before you get the child to try them.
3. Non-steroidal anti-inflammatory drugs
Medication is not usually prescribed for knee pain unless it is due to inflammation, and OTC medications such as ibuprofen can be used to reduce the pain. However, make sure you check with the doctor before giving them to the child.
4. Knee braces
Knee braces are often recommended for young athletes in training. There are different types of knee support braces for different uses (16).
As a reminder, do not use medication or knee braces for a child’s knee pain without consulting a doctor first.
5. Other treatments
Few herbal remedies may also ease knee pain in children.
- Oral consumption of highly purified Ginger extract could help reduce pain caused due to arthritis. However, it works well when taken alongside any prescription medications for arthritis, as the effect of ginger alone was found to be moderate (17).
- Apple cider vinegar has alkalizing properties that can alleviate knee pain. It is believed that adding apple cider vinegar to your child’s bathwater and drowning the knee for 20-25 minutes can help relieve pain. It can also be mixed with coconut oil and massaged on the knee.
- Mustard oil has been used in Ayurveda medicine for long, and is believed that the selenium present in the oil reduces the joint pains (18). Massaging the knees with mustard oil might reduce inflammation, improve blood circulation, in that part of the body and alleviate pain.
It is also believed that lemon (topically), turmeric (taken orally), and eucalyptus oil (topically) are other herbal ingredients that can be used to relieve or alleviate knee pain in children. These remedies work best when they are used to supplement the medical treatment prescribed by the doctor or the physical therapist.
Preventing Knee Pain
Unless your child is diagnosed with an autoimmune disease, normal knee pains can be treated with regular exercise. But with a few tips, you can teach your child to take care of their knees while engaging in sports and other physical activities.
These tips may help in reducing the risk of developing knee pain at a young age.
Other ways to prevent knee pain in children are:
- Losing weight if the child is overweight
- Doing warm-up exercises in the beginning and relaxing exercises at the end of a workout
- Regular exercise to strengthen the knee muscles and bones to reduce the chances of knee injury or damage
- Bending the knees during landing while jumping
- Training throughout the year to stay fit and reduce the likelihood of injury, especially if the teenager plays a sport such as soccer or football
- Using the right type of running or sport shoes
- Avoiding running down hills or steep terrains that require the child to put extra pressure on the knees.
Frequently Asked Questions
1. When does growing pain stop in children?
Growing pain in children generally stops by the time they are teenagers (19).
2. Can dehydration cause knee pain in children?
Yes. Since 70-80% of joint cartilage is water that has a lubricating effect, dehydration may cause knee pain (20).
Knee pain in children is generally a growing pain that does not require medical intervention. However, it is important to check with a doctor to know the reason for the condition because knee pains may also be due to injuries, bacterial infections, or juvenile arthritis. Get the condition medically reviewed if your child experiences joint pains, fever, or knee weakness. Most children get better with rest, ice packs, and massage. Other treatment options may include physical therapy, medications, and knee braces. Encourage your children to maintain an optimum weight, use the right shoes, and do warm-up exercises before a workout to prevent knee pain.
2. Felicity Goodyear-Smith; Growing pains-Parents and children need reassuring about this self-limiting condition of unknown cause; NCBI(2006)
3. How to tell if it’s growing pains – or something more; Akron Children’s Hospital
4. Jennifer Chapman; Justin K. Arnold; Reye Syndrome; NCBI
5. 8 Signs Your Child’s Knee Needs To Be Examined; Nationwide Children’s
6. A. Gigante, et al.; Acute osteomyelitis and septic arthritis in children: a systematic review of systematic reviews; European Review for Medical and Pharmacological Sciences
7. Juvenile Arthritis; National Institute of Arthritis and Musculoskeletal and Skin Disease
8. Raju Vaishya, Ahmad Tariq Azizi, Amit Kumar Agarwal, and Vipul Vijay; Apophysitis of the Tibial Tuberosity (Osgood-Schlatter Disease): A Review; NCBI(2016)
9. Javier A. Santana; Andrew l. Sherman; Jumpers Knee; NCBI
10. Soft tissue injuries; Sports Medicine Australia
11. Wolf Petersen; Patellofemoral pain syndrome; NCBI(2014)
12. Dominic King; Quadriceps tendinopathy: a review—part 1: epidemiology and diagnosis; NCBI(2019)
13. Osteosarcoma; American Childhood Cancer Organization
14. Rest, Ice, Compression, and Elevation (RICE); Michigan Medicine; University of Michigan
15. Exercise for stronger knees and hips; Harvard Health Publishing
16. Knee Pain: How to Choose the Right Knee Brace for Your Child; Healthychildren.org
17. Altman RD, Marcussen KC; Effects of a ginger extract on knee pain in patients with osteoarthritis; NCBI(2001)
18. To Study the Beneficial Effect of Mustard Oil and Salt Massaging With Oral Prophylaxis in Patients With Gum Diseases; Clinical trials; US National Library of Medicine
19. Growing Pains; Cleveland Clinic
20. Dehydration and Joint Pain: How Your Hydration is Affecting Joint Health; Orthopedic Associates
21. Anterior Knee Pain in Children and Teens; The Children’s Hospital of Philadelphia