Pediatric Bone and Joint Infections

Bone infections, or osteomyelitis, involve inflammation of the bone, usually caused by a bacterial infection. In children, the bacteria are most often Staphylococcus aureus (staph infection) and is primarily carried through the blood.

Preschool-aged children account for about half of bone infection cases because of the rich blood supply in their growing bones. In both children and adolescents, bone infections happen most often in long bones of the legs and arms. If untreated, bone infection can cause severe complications, including:

• Bone destruction
• Abscesses (pockets of infected pus)
• Infected joints (septic arthritis)
• Deformities and disability resulting from ongoing infections

In addition to staph, other types of bacteria that can cause bone infections include:

• Group A streptococci (pneumoniae and pyogenes), usually found in the upper respiratory tract
• Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA), spread by skin-to-skin contact
• Salmonella, which usually causes gastrointestinal infections
• Group B streptococci in newborns (passed from mothers during childbirth)

The most common symptoms of a bone infection are severe pain and swelling around the infected area. Other symptoms include:

• Fever and/or chills
• Soreness, warmth and redness in the infected area
• General fatigue
• Inability to support weight on and move the affected limbs (usually the most noticeable signs in newborns and infants)

If your child has any of these symptoms, your pediatrician may suspect a bone infection. In older children and adolescents, bone infections can occur after an injury such as a broken bone. Your physician will examine your child and ask about any recent injuries. Other tests that help diagnose bone infection include:

• Blood tests to check for signs of infection throughout the body
• X-rays to check for fractures and other problems with bones
• Diagnostic imaging, especially MRI scans to evaluate bone marrow for inflammation, or CT or bone scans
• Needle aspiration (sampling bone marrow) or bone biopsy (sampling bone) to determine the type of bone infection

Once your physician has determined the type of bacteria that is causing your child’s bone infection, he or she can choose the appropriate treatment for it. Some options include:

• Antibiotics that target specific infections, delivered either intravenously (IV) or orally (by mouth)
• Surgery for severe bone infections, to drain abscesses or remove segments of dead or infected bone
• Bone graft to replace dead or infected bone

Learn more about Orthopaedics and Sports Medicine at Children’s National Hospital.