Medical Conditions

Recognizing Signs of Bone Tumors in Children

Medically reviewed by Dr. Michael Okonkwo, MD, FAAP · Board-Certified Neonatologist

Content reviewed against published NIH, AAP, Mayo Clinic guidelines

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If your baby has been diagnosed with or you suspect recognizing signs of bone tumors in children, here is what the evidence says.

The short answer

Bone tumors in children are rare, especially before age 5. Signs include persistent bone pain (particularly at night or waking the child), a firm lump or swelling near a bone, limping without injury, and decreased use of a limb. Bone pain that worsens over time, occurs at rest, or wakes a child from sleep is different from normal growing pains and should be evaluated. Common benign bone conditions are far more likely than cancer.

Key takeaways

  • Bone tumors in children are rare, especially before age 5. Signs include persistent bone pain (particularly at night or waking the child), a firm lump or swelling near a bone, limping without injury, and decreased use of a limb. Bone pain that worsens over time, occurs at rest, or wakes a child from sleep is different from normal growing pains and should be evaluated. Common benign bone conditions are far more likely than cancer.
  • Usually normal when: Growing pains that occur in both legs in the evening and are gone by morning
  • Call your doctor if: Severe bone pain with a visible mass, especially with fever (possible osteomyelitis or tumor)
  • Varies by age — see the age-by-age breakdown below
“Fever itself is not an illness — rather, it is a sign or symptom that the body is fighting an infection. Fever stimulates certain defenses, such as the white blood cells, which attack and destroy invading bacteria.”
— Fever and Your Child, American Academy of Pediatrics (AAP)

Parents everywhere have the same worry. You are doing the right thing by looking into it.

What Parents Should Know

According to NIH, AAP, Mayo Clinic guidelines, bone tumors in children are rare, especially before age 5. Signs include persistent bone pain (particularly at night or waking the child), a firm lump or swelling near a bone, limping without injury, and decreased use of a limb. Bone pain that worsens over time, occurs at rest, or wakes a child from sleep is different from normal growing pains and should be evaluated. Common benign bone conditions are far more likely than cancer. At 0-12 months, bone tumors are extremely rare in infants. A bone-related lump or swelling in a baby is more likely a birth-related injury (clavicle fracture callus), infection (osteomyelitis), or benign bone cyst. Any unexplained bone swelling should be evaluated by your pediatrician. It is generally considered normal when growing pains that occur in both legs in the evening and are gone by morning. However, you should contact your pediatrician promptly if severe bone pain with a visible mass, especially with fever (possible osteomyelitis or tumor).

Sources: [1], [2], [3]

Normal vs. Concerning

Usually Normal
Worth Discussing
Growing pains that occur in both legs in the evening and are gone by morning
Severe bone pain with a visible mass, especially with fever (possible osteomyelitis or tumor)
Pain from an identifiable injury that improves with rest and healing
Bone pain that wakes your child from sleep repeatedly, or a pathological fracture (breaking a bone with minimal force)
A small bony bump that has been stable and evaluated by your pediatrician
Your child has persistent bone pain in one location lasting more than 2 weeks

By Age

What to expect by age

0-12 months

Bone tumors are extremely rare in infants. A bone-related lump or swelling in a baby is more likely a birth-related injury (clavicle fracture callus), infection (osteomyelitis), or benign bone cyst. Any unexplained bone swelling should be evaluated by your pediatrician.

12-24 months

Still very rare at this age. Persistent limping or refusal to bear weight that does not improve warrants X-ray evaluation. Most causes at this age are infections, fractures (including toddler fractures), or benign conditions.

2-3 years

Bone tumors remain uncommon. Persistent bone pain, especially at night, and unexplained limb swelling should be evaluated with imaging. Growing pains typically occur in both legs in the evening and resolve by morning, while bone tumor pain is usually in one location and progressive.

3-5 years

The risk of bone tumors increases slightly with age. Ewing sarcoma can occur in young children. Persistent, localized bone pain that worsens, a palpable mass near a bone, and limping that does not resolve should prompt evaluation including X-ray.

5+ years

Bone tumors become more common in the adolescent growth spurt but can occur at any age. Osteosarcoma and Ewing sarcoma are the most common malignant bone tumors in children. Early diagnosis and treatment by a pediatric orthopedic oncologist lead to the best outcomes.

What to Tell Your Pediatrician

  • Describe when you first noticed recognizing signs of bone tumors in children and how it has changed over time.
  • Note your baby's current age and which age-specific patterns you are seeing.
  • Mention if your child has persistent bone pain in one location lasting more than 2 weeks.
  • Mention if you notice a firm lump near a bone that is growing.
  • Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
  • Bring a list of any questions or observations you want to discuss at the appointment.

What Should You Do?

When to take action

Probably normal when...
  • Growing pains that occur in both legs in the evening and are gone by morning
  • Pain from an identifiable injury that improves with rest and healing
  • A small bony bump that has been stable and evaluated by your pediatrician
Mention at your next visit when...
  • Your child has persistent bone pain in one location lasting more than 2 weeks
  • You notice a firm lump near a bone that is growing
  • Your child is limping without a clear injury and it is not improving
Act now when...
  • Severe bone pain with a visible mass, especially with fever (possible osteomyelitis or tumor)
  • Bone pain that wakes your child from sleep repeatedly, or a pathological fracture (breaking a bone with minimal force)

What You Can Do at Home

  • Keep track of when you notice recognizing signs of bone tumors in children — noting the time of day, duration, and any triggers can help your pediatrician.
  • Remember that growing pains that occur in both legs in the evening and are gone by morning — this is generally within the range of normal.
  • At 0-12 months, focus on observation rather than intervention unless your pediatrician advises otherwise.
  • Follow any care instructions from your pediatrician. Keep a written log of symptoms to bring to appointments.
  • While monitoring at home, seek immediate care if severe bone pain with a visible mass, especially with fever (possible osteomyelitis or tumor).

Recognizing Signs of Soft Tissue Tumors in Children

Rhabdomyosarcoma is the most common soft tissue tumor in children, typically occurring before age 6. It can develop anywhere in the body but commonly in the head/neck, urinary/reproductive tract, or limbs. Signs depend on location: a visible or palpable growing mass, eye bulging (orbital tumor), nasal obstruction or bloody discharge (nasal tumor), or urinary problems (pelvic tumor). With modern treatment including chemotherapy, surgery, and radiation, cure rates are improving.

Recognizing Signs of Leukemia in Children

Leukemia is the most common childhood cancer, but it is still rare. Warning signs include persistent unexplained fever, unusual pallor or fatigue, easy bruising or bleeding, bone or joint pain, swollen lymph nodes, enlarged abdomen (liver/spleen), frequent infections, and petechiae (tiny red dots on the skin). These symptoms are far more commonly caused by other conditions, but persistent symptoms with no clear explanation should be evaluated with a complete blood count.

When Should My Baby See a Pediatric Orthopedist?

A pediatric orthopedist specializes in bone, joint, and muscle conditions in growing children. Common reasons for referral include hip dysplasia, clubfoot, limb length differences, bowed legs beyond normal range, fractures, scoliosis, limping, and bone or joint abnormalities detected on examination or imaging. These specialists understand how growing bones and joints behave differently from adults.

Milestone

Month-by-Month Development

Detailed monthly development guides from birth through 24 months.

Guide

When to Call the Doctor

General guide on when to call the pediatrician, visit urgent care, or go to the ER.

Frequently asked questions

Is recognizing signs of bone tumors in children normal?
Bone tumors in children are rare, especially before age 5. Signs include persistent bone pain (particularly at night or waking the child), a firm lump or swelling near a bone, limping without injury, and decreased use of a limb. Bone pain that worsens over time, occurs at rest, or wakes a child from sleep is different from normal growing pains and should be evaluated. Common benign bone conditions are far more likely than cancer.
When should I call the doctor about recognizing signs of bone tumors in children?
Severe bone pain with a visible mass, especially with fever (possible osteomyelitis or tumor) Bone pain that wakes your child from sleep repeatedly, or a pathological fracture (breaking a bone with minimal force)
When is recognizing signs of bone tumors in children normal?
Growing pains that occur in both legs in the evening and are gone by morning Pain from an identifiable injury that improves with rest and healing A small bony bump that has been stable and evaluated by your pediatrician
What causes recognizing signs of bone tumors in children?
Bone tumors in children are rare, especially before age 5. Signs include persistent bone pain (particularly at night or waking the child), a firm lump or swelling near a bone, limping without injury, and decreased use of a limb. Bone pain that worsens over time, occurs at rest, or wakes a child from sleep is different from normal growing pains and should be evaluated. Common benign bone conditions are far more likely than cancer. Common explanations include: Growing pains that occur in both legs in the evening and are gone by morning. Pain from an identifiable injury that improves with rest and healing.
What should I mention to my pediatrician about recognizing signs of bone tumors in children?
You should mention recognizing signs of bone tumors in children at your next visit if: Your child has persistent bone pain in one location lasting more than 2 weeks. You notice a firm lump near a bone that is growing. Your child is limping without a clear injury and it is not improving.
Is recognizing signs of bone tumors in children normal at 0-12 months?
Bone tumors are extremely rare in infants. A bone-related lump or swelling in a baby is more likely a birth-related injury (clavicle fracture callus), infection (osteomyelitis), or benign bone cyst. Any unexplained bone swelling should be evaluated by your pediatrician.
Is recognizing signs of bone tumors in children normal at 12-24 months?
Still very rare at this age. Persistent limping or refusal to bear weight that does not improve warrants X-ray evaluation. Most causes at this age are infections, fractures (including toddler fractures), or benign conditions.
Should I go to the ER for recognizing signs of bone tumors in children?
Seek emergency care if severe bone pain with a visible mass, especially with fever (possible osteomyelitis or tumor), or if bone pain that wakes your child from sleep repeatedly, or a pathological fracture (breaking a bone with minimal force). When in doubt, call your pediatrician's after-hours line for guidance.
Does recognizing signs of bone tumors in children go away on its own?
In many cases, recognizing signs of bone tumors in children resolves on its own, especially when growing pains that occur in both legs in the evening and are gone by morning. By 5+ years, bone tumors become more common in the adolescent growth spurt but can occur at any age. Osteosarcoma and Ewing sarcoma are the most common malignant bone tumors in children. Early diagnosis and treatment by a pediatric orthopedic oncologist lead to the best outcomes.
NIHAAPMAYO CLINIC

References

  1. [1]National Cancer Institute. Osteosarcoma and Ewing Sarcoma Treatment. NIH
  2. [2]American Academy of Pediatrics. Bone Tumors. HealthyChildren.org. AAP
  3. [3]Mayo Clinic. Bone cancer in children. Mayo Clinic

Doctor Visit Checklist

Bring this checklist to your next pediatrician visit to discuss Recognizing Signs of Bone Tumors in Children.

Things to mention

  • Describe when you first noticed recognizing signs of bone tumors in children and how it has changed over time.
  • Note your baby's current age and which age-specific patterns you are seeing.
  • Mention if your child has persistent bone pain in one location lasting more than 2 weeks.
  • Mention if you notice a firm lump near a bone that is growing.
  • Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
  • Bring a list of any questions or observations you want to discuss at the appointment.

Observations to share

  • Your child has persistent bone pain in one location lasting more than 2 weeks
  • You notice a firm lump near a bone that is growing
  • Your child is limping without a clear injury and it is not improving

Urgent signs to report immediately

  • Severe bone pain with a visible mass, especially with fever (possible osteomyelitis or tumor)
  • Bone pain that wakes your child from sleep repeatedly, or a pathological fracture (breaking a bone with minimal force)

My notes

From ismybabyalright.com — free, evidence-based baby health guides

All content follows our editorial policy and is reviewed against published clinical guidelines.

2,705 evidence-based guides6 authoritative medical sources5 medical advisory board members

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Bottom line

Most cases of recognizing signs of bone tumors in children are normal. Talk to your pediatrician if severe bone pain with a visible mass, especially with fever (possible osteomyelitis or tumor).

Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.

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Rhabdomyosarcoma is the most common soft tissue tumor in children, typically occurring before age 6. It can develop anywhere in the body but commonly in the head/neck, urinary/reproductive tract, or limbs. Signs depend on location: a visible or palpable growing mass, eye bulging (orbital tumor), nasal obstruction or bloody discharge (nasal tumor), or urinary problems (pelvic tumor). With modern treatment including chemotherapy, surgery, and radiation, cure rates are improving.

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When Should My Baby See a Pediatric Orthopedist?

A pediatric orthopedist specializes in bone, joint, and muscle conditions in growing children. Common reasons for referral include hip dysplasia, clubfoot, limb length differences, bowed legs beyond normal range, fractures, scoliosis, limping, and bone or joint abnormalities detected on examination or imaging. These specialists understand how growing bones and joints behave differently from adults.

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