Paging Dr. Hive for my 10 month old - Update in 1st post

[lexi]

Ok, yesterday my daughter was cranky. If you put her down she shrieked as if in pain. She acts like her legs hurt. I've been trying to carry her as much as possible.

Last night she started refusing to bear weight on her legs. She will crawl and pull up on her knees but not stand. (She's been cruising the furniture and trying to walk for a few weeks now). So this is odd.

She woke up this morning in a better mood but still will not stand. If you try to put her on her feet she will go limp and melt to the floor to crawl instead.

I cannot think of a time that she fell over and hit anything or any other injury. No falls. No accidents. Nothing I'm aware of.

Her appetite is normal and she has no fever or any other symptoms. I feel like she acts like her ankle hurts. Last night one ankle might have been slightly swollen (it's hard to tell with the baby chub). So I iced it and gave her Motrin.

I'm going to call my ped as soon as he opens. But I'm so stressed. What could be wrong and what should I do? We leave town tomorrow so I'm feeling completely overwhelmed.

 

Update: So I'm back from the dr. My daughter had a slight fever when they checked her at the ped. She has also had a stuffy/runny nose today. My dr thinks she has some type of infection. He believes that she might have a virus that is causing her to have pain. 

At the dr they put her on her back and rotated her hips. They said her hips look great. She didn't fuss at all when they did it - she was actually giggling. They checked her knees and legs and she was fine. She was only cranky when they messed with her feet - her left food specifically. 

The dr was able to rotate and flex her feet and she didn't have a lot of pain. She was just irritable. He doesn't believe she has a fracture or break but does think the problem has to do with her feet/ankles and not her hips or upper legs. 

When I tried to put her on the floor to stand she stood on her right leg and kept her left leg in the air, refusing to let that foot touch the ground. 

So the dr thinks it's a virus that is causing pain and might also cause sores to break out on her feet (maybe like hand, foot, and mouth....I don't know). He did give me orders for X-rays. I'm supposed to watch her tonight and see how she is in the morning. Then I'm supposed to call him with an update to decide if I need to do anything further. 

She has seemed like her pain is less today and is not screaming like she was last night. So I guess that's good. But I don't feel great that I have no definite answers. 

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Edited February 2, 2017 by lexi

[ashfern]

If you're open to chiropractic, I'd take her in for an adjustment.

[lexi]

If you're open to chiropractic, I'd take her in for an adjustment.

I am and I can call my chiro. I just got an appt with our dr for 2 pm. So I'll see how she does while we wait. And I'll see if I can get in at the chiro today.

[Jan in SC]

My guess- she has a virus in her hip. All of my children had this. It resolved itself fairly quickly and left no issues. I would get it checked though because it can be an infection in the joint which require intervention.

 

Google transient synovitis

 

It's a side effect of a virus.

 

ETA- there are other hip issues that can show up at that age, so I would see my doctor, not a chiro, but that's me.

Edited February 2, 2017 by Jan in SC

[magnificent_baby]

I would not see a chiro for this.

 

I would get into your pede today, if that's not possible I would go to an urgent care, a pediatric one if available. Fracture comes to my mind first.

[lexi]

I would not see a chiro for this.

 

I would get into your pede today, if that's not possible I would go to an urgent care, a pediatric one if available. Fracture comes to my mind first.

I got an appt so I'm just waiting until we go in.

 

I called a friend who works for an orthopedic dr and she could work me into the schedule this afternoon. I don't know if that type of dr would be helpful. He's not pediatric.

 

I feel like my brain has shut off. I think it's the stress of trying to leave town and the fact that my kids were under the weather earlier this week. I feel completely brain dead.

[TCB]

I, also, would see a dr first. The hip problem mentioned above is quite common I think. Also, my dd had hip dysplasia as a baby, so definitely worth getting her checked out to make sure she does not have an undiagnosed hip problem.

[magnificent_baby]

I got an appt so I'm just waiting until we go in.

 

I called a friend who works for an orthopedic dr and she could work me into the schedule this afternoon. I don't know if that type of dr would be helpful. He's not pediatric.

 

I feel like my brain has shut off. I think it's the stress of trying to leave town and the fact that my kids were under the weather earlier this week. I feel completely brain dead.

 

I think that's a great plan.

 

If fracture is ruled out, you can go from there, but definitely concerning symptoms.

 

Poor girl and poor Mom! :(

[ealp2009]

My 10 month old has a fracture and these were/ are his symptoms. The hospital missed it the first time because the fracture was around his knee not his hips. And he saw a NP. His MD knew it was he knee as soon as he saw him because he wouldn't straighten his less. He won't pull up and it has been two weeks at this point. He is crawling around though and is in much less pain now. We saw the ortho after getting the X-ray. Probably good to see them for a baby. We didn't need a cast. The doc gave me an option and said I could be really careful or we could do a cast. She would have recommended a cast if he was in daycare.

 

 

Sent from my iPhone using Tapatalk

Edited February 2, 2017 by ealp2009

[bzymom]

Another thought:  My daughter had similar symptoms twice.  Both times the diagnosis was Synovitis.  

 

I hope your little feels better quickly!

[lexi]

Well today she's in a better mood and is crawling like crazy. She's cruising the furniture but on her knees. She won't stand. She will lift up her left leg like she's going to try to pull up but she won't put weight on the right leg. She will keep that leg with her knee on the ground. So weird!

I leave for our appt in one hour.

[ktgrok]

Praying for an easy answer

[LMV]

Ok, yesterday my daughter was cranky. If you put her down she shrieked as if in pain. She acts like her legs hurt. I've been trying to carry her as much as possible.

 

Last night she started refusing to bear weight on her legs. She will crawl and pull up on her knees but not stand. (She's been cruising the furniture and trying to walk for a few weeks now). So this is odd.

 

She woke up this morning in a better mood but still will not stand. If you try to put her on her feet she will go limp and melt to the floor to crawl instead.

 

I cannot think of a time that she fell over and hit anything or any other injury. No falls. No accidents. Nothing I'm aware of.

 

Her appetite is normal and she has no fever or any other symptoms. I feel like she acts like her ankle hurts. Last night one ankle might have been slightly swollen (it's hard to tell with the baby chub). So I iced it and gave her Motrin.

 

I'm going to call my ped as soon as he opens. But I'm so stressed. What could be wrong and what should I do? We leave town tomorrow so I'm feeling completely overwhelmed.

Is she lying on her back comfortably and seeming to move both legs well? Or is she holding one leg in flexion and external rotation? Has she had any preceding URI symptoms?

 

I would not see a chiro for this.

 

I would get into your pede today, if that's not possible I would go to an urgent care, a pediatric one if available. Fracture comes to my mind first.

 

I completely agree with no chiro please! Fracture is in the differential although without a history of trauma and with the presentation shared it would not be at the top of my list. A septic joint or a toxic synovitis would be higher on my list (although a three or five year old little boy would fit the demographics of this better than a 10 month old little girl). With these concerns I would probably push more in the direction of ED/Pediatric ED over urgent care. 

 

I got an appt so I'm just waiting until we go in.

 

I called a friend who works for an orthopedic dr and she could work me into the schedule this afternoon. I don't know if that type of dr would be helpful. He's not pediatric.

 

I feel like my brain has shut off. I think it's the stress of trying to leave town and the fact that my kids were under the weather earlier this week. I feel completely brain dead.

Some of this depends on how the differential settles out. If there is concern for a septic joint then you need to aspirate the joint both to make or exclude the diagnosis and for therapeutic reasons. [Delay in joint aspiration can lead to joint destruction.] If you need a joint aspiration many pediatricians do not do this procedure and some EM physicians do not do all joints. I'm the only physician in our group who will aspirate hips in kids. So that may be where orthopedics comes in if that is needed.

 

Good Luck! I'm praying you get answers and it all works out. 

[lexi]

Is she lying on her back comfortably and seeming to move both legs well? Or is she holding one leg in flexion and external rotation? Has she had any preceding URI symptoms?

 

 

I completely agree with no chiro please! Fracture is in the differential although without a history of trauma and with the presentation shared it would not be at the top of my list. A septic joint or a toxic synovitis would be higher on my list (although a three or five year old little boy would fit the demographics of this better than a 10 month old little girl). With these concerns I would probably push more in the direction of ED/Pediatric ED over urgent care. 

 

Some of this depends on how the differential settles out. If there is concern for a septic joint then you need to aspirate the joint both to make or exclude the diagnosis and for therapeutic reasons. [Delay in joint aspiration can lead to joint destruction.] If you need a joint aspiration many pediatricians do not do this procedure and some EM physicians do not do all joints. I'm the only physician in our group who will aspirate hips in kids. So that may be where orthopedics comes in if that is needed.

 

Good Luck! I'm praying you get answers and it all works out. 

 

Ok.....she can lie on her back comfortably but I do feel like she holds her right leg straight out and stiff at times. She's not kicking like she normally would. And my older kids have had respiratory infection stuff that she seems to have gotten. She's had a bit of a runny nose. So she does have some symptoms of what my kids have. 

 

I posted an update in the first post. Does it sound like my dr is on the right track or should I try to get another opinion or go to a different dr? 

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[LMV]

Ok.....she can lie on her back comfortably but I do feel like she holds her right leg straight out and stiff at times. She's not kicking like she normally would. And my older kids have had respiratory infection stuff that she seems to have gotten. She's had a bit of a runny nose. So she does have some symptoms of what my kids have. 

 

I posted an update in the first post. Does it sound like my dr is on the right track or should I try to get another opinion or go to a different dr? 

Schedule

Is the left leg flexed and somewhat rotated? Is she moving the left leg normally?

 

To be fair your daughter's pediatrician did an exam and if he/she is really comfortable that this could not possibly be a septic joint then I hesitate to question any of that because I haven't examined her. I think in EM we do sometimes have a pretty low threshold to proceed to joint aspiration especially in kids because the consequences of missing this can be significant for the patient. If you have a really low but not completely absent suspicion then sometimes proceeding with blood work (Blood Cx, CBC, and CRP) and imaging (ultrasound is often more sensitive for septic arthritis than plain x-ray but can be tech dependent---our department does use ultrasound with a joint protocol and that can be helpful) and if everything looks great then, although you can't 100% exclude the septic joint without an aspiration, it might be reasonable to watch.

 

Does this help? If she gets worse over night or if you have further concerns now going to the ED for this would not be unreasonable or an inappropriate use of health care resources.

[Selkie]

Well, this is interesting because our family is currently in the throes of a yucky virus and one of the symptoms we've all experienced is achy legs and feet for the first couple of days. My right foot hurt so badly that it almost felt like I had twisted my ankle, and my 18 y.o. son made the comment that he hadn't had such achy joints since he had lyme disease several years ago. Once the fever breaks, the achiness goes away and then it is just like any other respiratory virus (sore throat, runny nose, cough).

 

Hope she is feeling better soon!

[lovinmyboys]

That is interesting that she had a fever. I took ds6 to the dr today because he has had a few headaches this week (he has never had them before). When they took his temp it was 100.4, so the dr said right now she was thinking probably a virus. I had no clue he had a fever and he wasn't acting feverish at all (not that 100.4 is super high).

 

Anyway, we were out of town a few years ago and then ds4 would absolutely not walk on one of his legs. I would ask him where it hurt and he would look at it and say "I can't find it" (like he was looking for a scrape). I didn't really know where to take him and he was generally happy, so I never took him in. After about 4 days he started walking again. (I was going to find somewhere to take him that day but he started acting fine). All that to say, sometimes I think kids do just get pains and they go away on their own. Hopefully that is true for your baby. Enjoy your trip!

[MistyMountain]

One time my youngest daughter was crying about her leg hurting when she had a fever. It scared me a little because it seemed a strange symptom to have with a fever. We took her to the doctor and they said she looked fine. She had the fever and complained and cried about leg pain for a few days and then it got better.

Edited February 3, 2017 by MistyMountain