Synopsis
Recognise blood-borne bone infection early, distinguish a stable child from sepsis or a drainable focus, obtain meaningful cultures, and coordinate antibiotics, imaging, source control and growth-aware follow-up.
- A limping, non-weight-bearing or pseudoparalysed child with focal bone tenderness and fever has osteomyelitis until a safer explanation is established; early skin and radiographs may look normal.
- Admit all children with suspected acute musculoskeletal infection for combined paediatric and orthopaedic care and examine the whole child, spine and adjacent joints.
- Initial investigations are FBC, CRP, blood cultures and ESR in the BOASt sequence, plus plain radiographs of the relevant bone and joint; no single result excludes disease.
Key red flags
Shock, altered behaviour, mottling, oliguria, rising lactate or rapidly worsening limb pain indicates systemic danger and requires parallel sepsis treatment and orthopaedic source-control planning.
Investigation priorities
Assess inflammation, cytopenia and a baseline for response.
Map marrow, cortex, physis, joint and soft-tissue extension.
Management branches
High-risk sepsis, organ dysfunction or rapid clinical decline accompanies suspected bone infection.
- Call paediatrics, orthopaedics, anaesthesia and microbiology and apply the current sepsis pathway without waiting for imaging.
- Take blood cultures and essential tests immediately, then give empirical intravenous antibiotics with no avoidable delay.
The child is physiologically stable and definitive sampling or surgery can occur promptly.
Key medicines
Empirical intravenous therapy for paediatric bone infectionUse the trust's current paediatric bone-and-joint infection regimen at the full weight-based dose immediately after blood cultures in high-risk sepsis; in a stable child, start immediately after planned deep sampling and record dose, interval and review time.
Culture-directed oral continuationWhen the child is clinically improving, inflammatory trends are favourable, oral absorption is reliable and an active formulation is available, prescribe the exact weight-based oral agent and frequency agreed with microbiology for the documented remaining course and review date.