What is Osteomyelitis in Children

Bone infections (osteomyelitis) occur when bacteria or other germs get inside a bone. This can happen if your child has an infection in another part of his or her body that spreads through the blood.

Germs from the child’s skin or from outside of the child’s body can cause this type of infection if the child has a wound or a broken bone (fracture) that breaks the skin.

In children, the arms and legs are the bones that are most often affected. Bone infections need to be treated quickly to prevent damage to the child’s developing bones.

These infections can cause the child’s bones to develop an abnormal shape (deformity) or not work the way that they should (disability).

What are the causes?

Most bone infections in children are caused by bacteria, especially a type that is often found on children’s skin (staphylococcus). They can also be caused by other germs, such as viruses and funguses.

What increases the risk?

This condition is more likely to develop in children who:

• Recently had surgery, especially bone or joint surgery.
• Have certain diseases, such as:
  • HIV (human immunodeficiency virus).
  • Diabetes.
  • Rheumatoid arthritis.
  • Sickle cell anemia.
  • Kidney disease that requires dialysis.
• Are 3 years old or younger. Young children do not have a completely developed body defense system (immune system) to fight infections. They are also more likely to fall and cut or scrape their skin.
• Have a condition or take medicines that block or weaken the body’s defense system (immune system).
• Have had a joint or bone repaired with plates or screws (surgical hardware).
• Have had trauma, such as stepping on a nail or a broken bone that came through the skin.
• Have a central line for IV access.

What are the signs or symptoms?

Symptoms vary depending on the type and location of the child’s infection. Symptoms of bone infections may include:

• Fever and chills.
• Redness and warmth near the infection.
• Swelling.
• Pain and stiffness.
• Drainage of fluid or pus near the infection.
• A limp arm or leg.
• Refusing to walk or to use an arm.
• Irritability.
• Loss of appetite.
• Vomiting.

How is this diagnosed?

This condition may be diagnosed based on:

• Your child’s symptoms and medical history.
• A physical exam.
• Tests such as:
  • A sample of tissue, fluid, or blood taken to be examined under a microscope.
  • Pus or discharge swabbed from a wound for testing to identify germs and to determine what type of medicine will kill the germs (culture and sensitivity).
  • Blood tests.
• Imaging studies. These may include:
  • X-rays.
  • CT scan.
  • MRI.
  • Bone scan.
  • Ultrasound.

How is this treated?

Treatment depends on the cause and type of infection. Antibiotic medicines are usually the first treatment for a bone infection. This may be done in a hospital at first. Your child may have to continue IV antibiotics at home or take antibiotics by mouth for several weeks after that.

Other treatments may include surgery to remove:

• Dead or dying tissue from a bone or joint.
• Infected plates or screws that were used to repair a broken bone.

Follow these instructions at home:

Medicines

• Give over-the-counter and prescription medicines only as told by your child’s health care provider.
• Give the antibiotic medicine as told by your child’s health care provider. Do not stop giving the antibiotic even if your child starts to feel better.
• Follow instructions from your child’s health care provider about how to give IV antibiotics at home. You may need to have a nurse come to your home to give your child the IV antibiotics.

General instructions

• Ask your child’s health care provider if there are any restrictions on your child’s activities.
• If directed, put ice on the affected area:
  • Put ice in a plastic bag.
  • Place a towel between your child’s skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Have your child wash his or her hands with soap and water often. If soap and water are not available, have your child use alcohol-based hand sanitizer.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if:

• Your child has redness, warmth, pain, or swelling that returns after treatment.
• Your child’s symptoms get worse, or your child develops any of the following symptoms:
  • A fever or chills.
  • A limp.
  • Refusing to walk.
  • Will not use an arm or a leg.
  • Refusing to eat.
  • Seems to have no energy (lethargic).
  • Is very irritable.

Get help right away if:

• Your child has rapid breathing or has trouble breathing.
• Your child cannot drink fluids or make urine.
• The affected arm or leg swells, changes color, or turns blue.

Summary

• Bone infections (osteomyelitis) develop when bacteria or other germs get inside a bone.
• Most bone infections in children are caused by bacteria, especially a type that is often found on children’s skin (staphylococcus).
• Antibiotic medicines are usually the first treatment for a bone infection. Any further treatment will depend on the cause and type of infection.