Key points about osteomyelitis in children
- osteomyelitis is an infection in the bone
- it usually happens when bacteria spread to the bone through the blood
- osteomyelitis can affect any bone, but it often affects the bones in the arms or legs
- common symptoms include bone pain, fever, swelling and not wanting to use the affected arm or leg
- tamariki need blood tests and scans to help diagnose osteomyelitis
- treatment usually involves antibiotics, often through a drip at first
- some tamariki need an operation to treat the infection
What is osteomyelitis?
Osteomyelitis is an infection in the bone. It can happen in any bone in the body. In tamariki, it often affects the long bones in the arms or legs.
Osteomyelitis can happen at any age. It can make tamariki feel very unwell. A child with osteomyelitis needs medical care, usually in hospital.
An illustration showing a normal bone compared with osteomyelitis, an infection in the bone.
Source: KidsHealth
transcribeTranscript
The illustration shows a child sitting with one leg bent. Part of the lower leg is shown beneath the skin to show the bones and muscles.
Two circles show a close up of the child’s lower leg.
- The top circle is labelled ‘Normal’ and shows the normal bones and muscles of the lower leg and foot.
- The bottom circle is labelled ‘Osteomyelitis – An infection in the bone’. It shows a red area in the lower leg bone labelled ‘Infection’.
At the top right is the KidsHealth logo with the website kidshealth.org.nz.
Causes of osteomyelitis in children
Bacteria usually cause osteomyelitis. The most common bacteria that causes osteomyelitis is Staphylococcus aureus. This is sometimes called staph.
Many bacteria live on the skin, in the nose and throat, and in other parts of the body. Most of the time they do not cause harm. Osteomyelitis can happen if bacteria get into the bloodstream and travel to a bone.
Osteomyelitis can also happen when bacteria:
- spread from an infection near the bone
- enter the body through a deep cut, wound or broken bone
Sometimes, health professionals cannot find exactly where the infection started.
Bone and joint infections can happen together
Sometimes, a child can have osteomyelitis and an infection in a nearby joint at the same time. This is called a joint infection or septic arthritis. A bone infection can spread into a nearby joint.
Your child’s healthcare team will check for signs of a joint infection. They may arrange further scans or tests.
Symptoms of osteomyelitis in children
Symptoms can develop quickly. They can also come on slowly over several days.
Symptoms of osteomyelitis can include:
- pain in a bone or limb
- swelling, redness or warmth over the sore area
- fever
- feeling generally unwell
- not wanting to walk, stand or use an arm or leg
- limping
- pain when moving the affected area
Pēpi (babies) and young tamariki may not be able to say where they have pain. They may:
- cry more than usual
- seem unsettled or irritable
- feed less than usual
- cry when you move or hold part of their body
- stop using an arm or leg normally
See a health professional urgently if you think your child has an infection or you are worried.
Diagnosing osteomyelitis in children
A health professional will ask about your child’s symptoms and examine your child. They may check the sore area for swelling, warmth and movement.
Your child may need tests, such as:
- blood tests to look for signs of infection
- blood cultures to check which bacteria may be causing the infection
- an x-ray
- an MRI scan
- an ultrasound scan
- a CT scan
An x-ray may look normal early in the infection. Your child may still have osteomyelitis even if the first x-ray does not show a problem.
An MRI scan can show infection in the bone and nearby tissues. It can also help health professionals look for pus or infection in a nearby joint.
Sometimes, health professionals take a small sample from the infected area. This can help them find out which bacteria caused the infection and which antibiotics will work best.
Managing osteomyelitis in children
Tamariki with osteomyelitis usually need treatment in hospital. The healthcare team will give treatment to help clear the infection, manage pain and support your child’s recovery.
Antibiotics
Treatment usually includes antibiotics. Your child may need antibiotics through a cannula into a vein at first. This is called intravenous antibiotics, or IV antibiotics.
Once your child starts to improve, they may be able to change to antibiotics by mouth. Your child may need to keep taking antibiotics for several weeks.
Pain relief medicine
Your child may need pain relief medicine while the infection improves. The healthcare team will talk with you about what pain relief your child needs and how often to give it.
Hospital stay
While your child is in hospital, they may need:
- fluids through a drip if they are not drinking well
- support to move safely, which can involve things such as crutches and other walking aids
- physiotherapy to help movement and strength as they recover
Surgery
Some tamariki need surgery. Surgery may help if there is pus, an abscess, infected tissue, or pressure around the bone.
The surgeon may drain the pus or clean out the infected area. Sometimes, tamariki need more than one surgery, to properly clear out an infection.
Looking after your child at home
After your child has gone home from hospital, they may still need time to recover.
Antibiotics
Your child may need to keep taking antibiotics at home for several weeks.
Give the antibiotics exactly as the health professional explains. Keep giving the antibiotics until the course is finished, unless your child’s health professional tells you to stop.
Antibiotic Advice For Children
Rest
Your child may need extra rest while they recover. Let your child slowly return to their usual activities as they start to feel better.
The health team will let you know when your child can return to childcare, school, sport or other activities.
Pain relief
Your child may still need pain relief medicine at home. Follow the instructions from the healthcare team or the medicine label.
Go back to a health professional
Go back to a health professional if your child:
- has pain that's getting worse
- does not improve with pain relief medicine
- stops using the affected arm or leg again
See a health professional urgently if you are worried or your child:
- gets worse
- has a fever again
- has increasing pain or swelling
- cannot take their antibiotics
Acknowledgements
Illustrations by Dr Greta File. Property of KidsHealth
