Hip pain

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LateralityChoose oneFirst line

Red flags presentChoose any

Red flags absentChoose any

ExamChoose one

Likely causeChoose one

ImagingChoose one

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CrutchesChoose one

Physical therapyChoose any

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Discussed the need for emergency evaluation today. Caregiver expressed understanding and agreement with plan. Answered all questions.

Note when inserted as is

Hip pain
• No fever, refusal to bear weight, limited internal rotation, night pain, or weight loss
• Full, painless hip range of motion; walking without a limp; knee exam normal
• Likely muscle strain or overuse
• Exam reassuring; x-ray deferred after shared decision making
• Relative rest from running and jumping that cause pain, then a gradual return
• Home hip stretching and strengthening
• Physical therapy referral
• Follow up if worsening or not improving

Most hip pain in active children comes from muscle strain or overuse and improves over a few weeks with rest from painful activities and stretching. Recommended supportive care with ice and tylenol or motrin as needed, with an emphasis on avoiding activities that cause pain and a gradual return to sports. Return precautions given including fever, limping or refusing to walk, night pain, knee or thigh pain with a limp, pain that keeps getting worse, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Red flags present or absent (fever, refusal to bear weight, limited internal rotation, night pain, weight loss)
Hip exam, knee exam
Likely cause: strain, hip flexor, hip pointer, pelvic apophysitis, transient synovitis, avulsion, SCFE, Perthes
Rest, gradual return; stretching
Crutches; non-weight bearing for SCFE
Septic hip; unstable SCFE

Return precautions in the template

feverlimping or refusing to walknight painknee or thigh pain with a limppain that keeps getting worse

Sources

Sport-Related Concussion in Children and Adolescents. Clinical Report. Pediatrics 2018;142(6):e20183074. (newest AAP concussion CR found; also Early Childhood…
Overuse Injuries, Overtraining, and Burnout in Young Athletes. Clinical Report. Pediatrics 2024;153(2):e2023065129. (replaces earlier report)
Early Childhood Concussion. State-of-the-art review. Pediatrics 2024;154(5):e2023065484 (not an AAP policy)
The Cribsiders #86: , #94 Overuse Injuries

Few formal guidelines cover this topic, so the template also leans on expert opinion.