Medical Conditions

Bone Infection (Osteomyelitis) in Children

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

Content reviewed against published AAP, OrthoInfo, NIH guidelines

Editorial policy

Last reviewed:

If your baby has been diagnosed with or you suspect bone infection (osteomyelitis) in children, here is what the evidence says.

The short answer

Osteomyelitis is a bacterial infection of the bone, most commonly caused by Staphylococcus aureus. In children, it typically affects the long bones (femur, tibia, humerus) and presents with localized bone pain, swelling, warmth, fever, and refusal to use the affected limb. Diagnosis involves blood tests, X-rays, and MRI (the most sensitive imaging test). Treatment requires prolonged intravenous antibiotics, typically for several weeks, and sometimes surgical drainage. Early treatment leads to excellent outcomes.

Key takeaways

  • Osteomyelitis is a bacterial infection of the bone, most commonly caused by Staphylococcus aureus. In children, it typically affects the long bones (femur, tibia, humerus) and presents with localized bone pain, swelling, warmth, fever, and refusal to use the affected limb. Diagnosis involves blood tests, X-rays, and MRI (the most sensitive imaging test). Treatment requires prolonged intravenous antibiotics, typically for several weeks, and sometimes surgical drainage. Early treatment leads to excellent outcomes.
  • Usually normal when: Your child bumped a leg or arm and has mild tenderness and swelling at the injury site without fever, which is consistent with a soft tissue bruise
  • Call your doctor if: Your child has bone pain or limb swelling combined with high fever (over 101.3 F / 38.5 C), refusal to bear weight, or refusal to move the limb, which requires emergency evaluation to rule out bone or joint infection
  • 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)

This is one of the most common questions parents ask. Searching for answers means you care.

What Parents Should Know

According to AAP, OrthoInfo, NIH guidelines, osteomyelitis is a bacterial infection of the bone, most commonly caused by Staphylococcus aureus. In children, it typically affects the long bones (femur, tibia, humerus) and presents with localized bone pain, swelling, warmth, fever, and refusal to use the affected limb. Diagnosis involves blood tests, X-rays, and MRI (the most sensitive imaging test). Treatment requires prolonged intravenous antibiotics, typically for several weeks, and sometimes surgical drainage. Early treatment leads to excellent outcomes. At 0-3 months, neonatal osteomyelitis can be subtle and difficult to diagnose. Affected newborns may show irritability, poor feeding, decreased movement of the affected limb (pseudoparalysis), swelling near a joint, or low-grade fever. Newborns are at increased risk if they had a NICU stay, IV lines, or bloodstream infections. Group B Streptococcus, Staphylococcus aureus, and gram-negative organisms are common causes in this age group. Because neonatal bones have a rich blood supply connecting to growth plates and joints, osteomyelitis in newborns frequently involves the adjacent joint as well. It is generally considered normal when your child bumped a leg or arm and has mild tenderness and swelling at the injury site without fever, which is consistent with a soft tissue bruise. However, you should contact your pediatrician promptly if your child has bone pain or limb swelling combined with high fever (over 101.3 F / 38.5 C), refusal to bear weight, or refusal to move the limb, which requires emergency evaluation to rule out bone or joint infection.

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

Normal vs. Concerning

Usually Normal
Worth Discussing
Your child bumped a leg or arm and has mild tenderness and swelling at the injury site without fever, which is consistent with a soft tissue bruise
Your child has bone pain or limb swelling combined with high fever (over 101.3 F / 38.5 C), refusal to bear weight, or refusal to move the limb, which requires emergency evaluation to rule out bone or joint infection
Your child has growing pains at night in both legs without fever, swelling, or daytime limping
Your newborn or young infant suddenly stops moving one arm or leg, is irritable, and has a fever, which could indicate neonatal osteomyelitis or septic arthritis requiring urgent hospital evaluation
Your child had osteomyelitis that was treated and inflammatory markers have normalized with no residual symptoms
Your child has persistent bone pain in one location lasting more than a few days, especially if accompanied by low-grade fever
Your child has transient limb soreness after vigorous activity that resolves within a day and has no fever
Your child is limping or refusing to use one arm or leg without a clear injury, even if they do not have a fever

By Age

What to expect by age

0-3 months

Neonatal osteomyelitis can be subtle and difficult to diagnose. Affected newborns may show irritability, poor feeding, decreased movement of the affected limb (pseudoparalysis), swelling near a joint, or low-grade fever. Newborns are at increased risk if they had a NICU stay, IV lines, or bloodstream infections. Group B Streptococcus, Staphylococcus aureus, and gram-negative organisms are common causes in this age group. Because neonatal bones have a rich blood supply connecting to growth plates and joints, osteomyelitis in newborns frequently involves the adjacent joint as well.

3-12 months

Infants with osteomyelitis typically present with irritability, fever, swelling or tenderness over the affected bone, and refusal to move the affected limb. A baby who suddenly stops using one arm or leg (pseudoparalysis) without a clear injury should be evaluated promptly. Staphylococcus aureus is the most common causative organism. Blood cultures, inflammatory markers (CRP, ESR, white blood cell count), and MRI are the key diagnostic tools. X-ray changes may not be visible for 10-14 days after infection onset.

1-3 years

Toddlers with osteomyelitis may present with a limp, refusal to walk or bear weight, localized pain over a bone, fever, and sometimes redness or swelling. The most commonly affected bones are the femur and tibia. Children in this age group may not be able to articulate where the pain is, so a careful physical exam is important. MRI is the gold-standard imaging study. Treatment typically involves initial IV antibiotics (often nafcillin or cefazolin) with a transition to oral antibiotics for a total course of 4-6 weeks, guided by clinical improvement and declining inflammatory markers.

3-5 years

Older children can usually point to where it hurts, which helps localize the infection. Signs include refusal to bear weight, limping, bone tenderness, fever, and malaise. If an abscess has formed in the bone, surgical drainage may be necessary in addition to antibiotics. Kingella kingae is an increasingly recognized cause of bone and joint infections in children under age 5. With appropriate antibiotic treatment, most children recover fully without long-term bone damage, though follow-up imaging may be recommended to ensure the growth plate was not affected.

What to Tell Your Pediatrician

  • Describe when you first noticed bone infection (osteomyelitis) 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 a few days, especially if accompanied by low-grade fever.
  • Mention if your child is limping or refusing to use one arm or leg without a clear injury, even if they do not have a fever.
  • 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...
  • Your child bumped a leg or arm and has mild tenderness and swelling at the injury site without fever, which is consistent with a soft tissue bruise
  • Your child has growing pains at night in both legs without fever, swelling, or daytime limping
  • Your child had osteomyelitis that was treated and inflammatory markers have normalized with no residual symptoms
  • Your child has transient limb soreness after vigorous activity that resolves within a day and has no fever
Mention at your next visit when...
  • Your child has persistent bone pain in one location lasting more than a few days, especially if accompanied by low-grade fever
  • Your child is limping or refusing to use one arm or leg without a clear injury, even if they do not have a fever
  • You notice localized swelling, warmth, or redness over a bone in your child
Act now when...
  • Your child has bone pain or limb swelling combined with high fever (over 101.3 F / 38.5 C), refusal to bear weight, or refusal to move the limb, which requires emergency evaluation to rule out bone or joint infection
  • Your newborn or young infant suddenly stops moving one arm or leg, is irritable, and has a fever, which could indicate neonatal osteomyelitis or septic arthritis requiring urgent hospital evaluation

What You Can Do at Home

  • Keep track of when you notice bone infection (osteomyelitis) in children — noting the time of day, duration, and any triggers can help your pediatrician.
  • Remember that your child bumped a leg or arm and has mild tenderness and swelling at the injury site without fever, which is consistent with a soft tissue bruise — this is generally within the range of normal.
  • At 0-3 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 your child has bone pain or limb swelling combined with high fever (over 101.3 F / 38.5 C), refusal to bear weight, or refusal to move the limb, which requires emergency evaluation to rule out bone or joint infection.

My Baby or Toddler Is Limping

A limp in a baby or toddler always deserves medical attention, as young children cannot reliably tell you where it hurts. The most common cause in toddlers is a minor injury such as a 'toddler's fracture' (a subtle shin bone crack) or muscle strain. However, limping can also indicate infection in a joint or bone, hip problems, or other conditions that need prompt evaluation.

Baby Not Using One Arm or Hand

If your baby consistently avoids using one arm or hand, it deserves evaluation. Before 18 months, babies should use both hands roughly equally - strong hand preference before this age can indicate a concern with the less-used side. Possible causes include brachial plexus injury (Erb's palsy) from birth, nursemaid's elbow, fracture, or neurological differences. Early identification leads to better outcomes with therapy.

Triage

Fever Decision Tree

Step-by-step guidance for evaluating your baby's fever by age and temperature.

Milestone

Month-by-Month Development

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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 bone infection (osteomyelitis) in children normal?
Osteomyelitis is a bacterial infection of the bone, most commonly caused by Staphylococcus aureus. In children, it typically affects the long bones (femur, tibia, humerus) and presents with localized bone pain, swelling, warmth, fever, and refusal to use the affected limb. Diagnosis involves blood tests, X-rays, and MRI (the most sensitive imaging test). Treatment requires prolonged intravenous antibiotics, typically for several weeks, and sometimes surgical drainage. Early treatment leads to excellent outcomes.
When should I call the doctor about bone infection (osteomyelitis) in children?
Your child has bone pain or limb swelling combined with high fever (over 101.3 F / 38.5 C), refusal to bear weight, or refusal to move the limb, which requires emergency evaluation to rule out bone or joint infection Your newborn or young infant suddenly stops moving one arm or leg, is irritable, and has a fever, which could indicate neonatal osteomyelitis or septic arthritis requiring urgent hospital evaluation
When is bone infection (osteomyelitis) in children normal?
Your child bumped a leg or arm and has mild tenderness and swelling at the injury site without fever, which is consistent with a soft tissue bruise Your child has growing pains at night in both legs without fever, swelling, or daytime limping Your child had osteomyelitis that was treated and inflammatory markers have normalized with no residual symptoms
What causes bone infection (osteomyelitis) in children?
Osteomyelitis is a bacterial infection of the bone, most commonly caused by Staphylococcus aureus. In children, it typically affects the long bones (femur, tibia, humerus) and presents with localized bone pain, swelling, warmth, fever, and refusal to use the affected limb. Diagnosis involves blood tests, X-rays, and MRI (the most sensitive imaging test). Treatment requires prolonged intravenous antibiotics, typically for several weeks, and sometimes surgical drainage. Early treatment leads to excellent outcomes. Common explanations include: Your child bumped a leg or arm and has mild tenderness and swelling at the injury site without fever, which is consistent with a soft tissue bruise. Your child has growing pains at night in both legs without fever, swelling, or daytime limping.
What should I mention to my pediatrician about bone infection (osteomyelitis) in children?
You should mention bone infection (osteomyelitis) in children at your next visit if: Your child has persistent bone pain in one location lasting more than a few days, especially if accompanied by low-grade fever. Your child is limping or refusing to use one arm or leg without a clear injury, even if they do not have a fever. You notice localized swelling, warmth, or redness over a bone in your child.
Is bone infection (osteomyelitis) in children normal at 0-3 months?
Neonatal osteomyelitis can be subtle and difficult to diagnose. Affected newborns may show irritability, poor feeding, decreased movement of the affected limb (pseudoparalysis), swelling near a joint, or low-grade fever. Newborns are at increased risk if they had a NICU stay, IV lines, or bloodstream infections. Group B Streptococcus, Staphylococcus aureus, and gram-negative organisms are common causes in this age group. Because neonatal bones have a rich blood supply connecting to growth plates and joints, osteomyelitis in newborns frequently involves the adjacent joint as well.
Is bone infection (osteomyelitis) in children normal at 3-12 months?
Infants with osteomyelitis typically present with irritability, fever, swelling or tenderness over the affected bone, and refusal to move the affected limb. A baby who suddenly stops using one arm or leg (pseudoparalysis) without a clear injury should be evaluated promptly. Staphylococcus aureus is the most common causative organism. Blood cultures, inflammatory markers (CRP, ESR, white blood cell count), and MRI are the key diagnostic tools. X-ray changes may not be visible for 10-14 days after infection onset.
Should I go to the ER for bone infection (osteomyelitis) in children?
Seek emergency care if your child has bone pain or limb swelling combined with high fever (over 101.3 F / 38.5 C), refusal to bear weight, or refusal to move the limb, which requires emergency evaluation to rule out bone or joint infection, or if your newborn or young infant suddenly stops moving one arm or leg, is irritable, and has a fever, which could indicate neonatal osteomyelitis or septic arthritis requiring urgent hospital evaluation. When in doubt, call your pediatrician's after-hours line for guidance.
Does bone infection (osteomyelitis) in children go away on its own?
In many cases, bone infection (osteomyelitis) in children resolves on its own, especially when your child bumped a leg or arm and has mild tenderness and swelling at the injury site without fever, which is consistent with a soft tissue bruise. By 3-5 years, older children can usually point to where it hurts, which helps localize the infection. Signs include refusal to bear weight, limping, bone tenderness, fever, and malaise. If an abscess has formed in the bone, surgical drainage may be necessary in addition to antibiotics. Kingella kingae is an increasingly recognized cause of bone and joint infections in children under age 5. With appropriate antibiotic treatment, most children recover fully without long-term bone damage, though follow-up imaging may be recommended to ensure the growth plate was not affected.
AAPORTHOINFONIH

References

  1. [1]American Academy of Pediatrics. Osteomyelitis. Red Book: Report of the Committee on Infectious Diseases, 2021. AAP
  2. [2]American Academy of Orthopaedic Surgeons. Osteomyelitis. OrthoInfo, 2022. OrthoInfo
  3. [3]National Institutes of Health. Osteomyelitis. MedlinePlus, 2023. NIH

Doctor Visit Checklist

Bring this checklist to your next pediatrician visit to discuss Bone Infection (Osteomyelitis) in Children.

Things to mention

  • Describe when you first noticed bone infection (osteomyelitis) 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 a few days, especially if accompanied by low-grade fever.
  • Mention if your child is limping or refusing to use one arm or leg without a clear injury, even if they do not have a fever.
  • 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 a few days, especially if accompanied by low-grade fever
  • Your child is limping or refusing to use one arm or leg without a clear injury, even if they do not have a fever
  • You notice localized swelling, warmth, or redness over a bone in your child

Urgent signs to report immediately

  • Your child has bone pain or limb swelling combined with high fever (over 101.3 F / 38.5 C), refusal to bear weight, or refusal to move the limb, which requires emergency evaluation to rule out bone or joint infection
  • Your newborn or young infant suddenly stops moving one arm or leg, is irritable, and has a fever, which could indicate neonatal osteomyelitis or septic arthritis requiring urgent hospital evaluation

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

Related Resources

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Bottom line

Most cases of bone infection (osteomyelitis) in children are normal. Talk to your pediatrician if your child has bone pain or limb swelling combined with high fever (over 101.3 f / 38.5 c), refusal to bear weight, or refusal to move the limb, which requires emergency evaluation to rule out bone or joint infection.

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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Baby Not Using One Arm or Hand

If your baby consistently avoids using one arm or hand, it deserves evaluation. Before 18 months, babies should use both hands roughly equally - strong hand preference before this age can indicate a concern with the less-used side. Possible causes include brachial plexus injury (Erb's palsy) from birth, nursemaid's elbow, fracture, or neurological differences. Early identification leads to better outcomes with therapy.

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