Management of knee pain in children

Management of knee pain in children depends on the underlying cause. For Osgood-Schlatter disease, advice includes explaining the diagnosis and prognosis, with symptoms usually resolving over time, often within months ¹. Pain relief options include paracetamol or NSAIDs if no contraindications exist, intermittent ice packs (10-15 minutes up to three times daily), and protective knee pads for kneeling ¹. Exercise modification is key; children can continue activity below the pain threshold, reducing duration, frequency, or intensity, or switching to low-impact activities like swimming or cycling ¹. Stretching exercises for the quadriceps and hamstrings, along with cross-training, are recommended as preventative strategies ¹. If symptoms persist or worsen despite appropriate management, reassess for alternative causes and consider referral to a physiotherapist for advice on stretching, strengthening, and reducing muscle imbalance ¹. Referral to a paediatrician or orthopaedic surgeon may be necessary if diagnostic uncertainty exists ¹.

For Baker's cysts, reassurance is given if asymptomatic and diagnosed via ultrasound, as they typically resolve without treatment ². If symptoms are troublesome, simple analgesia (paracetamol or ibuprofen) and physiotherapy can be considered ². Direct aspiration in primary care is not recommended ². Referral to a paediatric orthopaedic surgeon or paediatrician is advised if the diagnosis is unclear, symptoms are troublesome despite conservative measures, the cyst is very large, or if specialist treatment of an underlying knee joint condition is required ². Red flags indicating a serious alternative diagnosis, such as deep vein thrombosis, warrant urgent assessment in paediatrics or accident and emergency ².

In children with cerebral palsy, pain is common and can stem from musculoskeletal problems, increased muscle tone, fatigue, immobility, or other general causes ³. Assessment should involve parents or carers, recognizing that pain can be challenging to identify, especially with communication difficulties ³. Non-pharmacological interventions like environmental adjustments, music, physical contact, massage, and local hot or cold applications can be considered for pain management ⁴. A stepwise approach to analgesia is recommended, starting with paracetamol or ibuprofen for mild pain, and considering opioids for moderate to severe pain ⁴. Physical therapy, including stretching and strengthening exercises, should be tailored to the individual, considering their views and potential barriers ⁵.