Knee pain

Template

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LateralityChoose oneFirst line

Likely causeChoose one

Red flagsChoose one

Findings presentChoose any

Findings absentChoose any

Hip examChoose one

ImagingChoose one

PlanChoose any

Additional planChoose any

ReferralChoose any

DispositionChoose one

Follow-upChoose one

Counseling

Most knee pain in active children improves with a few weeks of activity changes and strengthening. Recommended supportive care with ice and tylenol or motrin as needed for pain, with an emphasis on avoiding activities that cause pain, home strengthening exercises, and a gradual return to sports. Return precautions given including swelling, locking or giving way, fever, limping, night pain, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

CounselingNot in the note with these choices

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

Note when inserted as is

Knee pain
• No fever, night pain, weight loss, or bruising
• No effusion, locking, or instability
• Hip exam normal
• No x-ray needed given a typical history and exam
• Activity modification, limiting running, jumping, and squatting that cause pain
• Home hip and thigh strengthening and stretching
• Follow up if worsening or not improving

Most knee pain in active children improves with a few weeks of activity changes and strengthening. Recommended supportive care with ice and tylenol or motrin as needed for pain, with an emphasis on avoiding activities that cause pain, home strengthening exercises, and a gradual return to sports. Return precautions given including swelling, locking or giving way, fever, limping, night pain, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Laterality; likely cause (PFPS, patellar tendinopathy, SLJ, collateral sprain, contusion)
Effusion, locking, instability present or absent
Hip exam (SCFE)
Ottawa knee rules; x-ray
Activity modification; strengthening
Topical diclofenac, cross-training, patellar strap
Septic joint

Return precautions in the template

swellinglocking or giving wayfeverlimpingnight pain

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.