Bone Infections

Dear Lisa,

My son was diagnosed with a bone infection at 17 months old. What are the chances of reoccurrences and is it normal for his body temp has been slightly warmer since the infection?

“Concerned Mom”

Dear “Concerned Mom”,

A bone infection or Osteomyelitis occurs in 1 in 10,000 healthy children per year.(1) The femur and tibia (leg bones) are the most affected bones. (2) Osteomyelitis in children usually occurs as the result of an infection elsewhere in their body that deposits in the bone. The offending microorganism travels to the blood and then the blood carries the infection to the metaphysis or area of the bone that grows. Because children's bones are always growing this is a susceptible place for the infection to settle.(2)

Signs of Osteomyelitis include fever, pain, limp or refusing to walk. Younger children may present with poor feeding, irritability, or sepsis (overwhelming infection). The treatment for Osteomyelitis is intravenous antibiotics. The recommended duration of intravenous antibiotics is from 7 to 21 days. Following this period, oral antibiotics typically are administered for 3 to 6 weeks.(2) In some cases children develop chronic Osteomyelitis which requires much longer courses of antibiotic therapy.

Since different organisms (germs) can cause Osteomyelitis the type of antibiotic and course of treatment may vary. Also, children may respond to treatment differently, therefore, the time frame of recovery may vary from child to child. Signs that a child is improving include alleviation of pain, improvement in the ability to move the affected area and decrease in temperature. Usually a child is not discharged from the hospital until there is decreased pain, improved movement and at least 24 hours without fever. (3)

In regards to your question about your son’s temperature, there should have been a decrease in temperature after treatment. A sign of prolonged temperature is usually a sign of continuing infection. As mentioned above, it does take weeks of antibiotics to treat Osteomyelitis and therefore total resolution may take a while. Your doctor should tell you what temperature range he expects your son to have in relation to the point of therapy he is in. Most doctors agree that a rectal temperature greater than or equal to 100.4 degrees Fahrenheit is considered to be a fever in a child. If this is the case in your son, it would be important to report this to the doctor treating him for his bone infection so that he can monitor your son’s treatment.

There are a few factors that may cause a change in a child’s temperature. Therefore, what you perceive as a change in his temperature may be a normal variation. Depending on the amount of clothes a young child has on and the temperature of the environment the temperature may vary. Sometimes after exercising or eating the body temperature can elevate temporarily. The temperature may also vary depending upon the amount of time that a thermometer is in place and the type of thermometer used. In the course of a normal day a child’s temperature can vary 1 to 1.5 degrees. The lowest reading usually occurs early in the morning before rising and the highest temperature occurs between 5 to 7 pm in the early evening. (4)

The route that you use to take your son’s temperature also may affect the reading. A normal temperature is expected to be 98.6 degrees Fahrenheit if taken orally. If a temperature is taken rectally, it is expected to be one degree higher; therefore a normal rectal temperature is 99.6 degrees. If a temperature is taken axillary, it is expected to be one degree lower; therefore a normal axillary temperature is expected to be 97.6 degrees.

Taking an oral temperature on a 17 month old child is not an option because he is not able to hold the thermometer in his mouth properly. Performing an axillary temperature is also very difficult. You need direct skin to skin contact to get an accurate reading, which is very hard to do on 17 month old child who is moving. The only way to take an accurate temperature on a 17 month old child is rectally. Since the temperature may change due to the amount of time a thermometer is in place correctly, many times rectal temperatures are incorrect due to improper technique due to the child’s movement. I suggest purchasing an electronic rectal thermometer that takes only 30 to 60 seconds to take the reading. Having to hold a toddler still for any longer than this will most likely result in the incorrect reading.

Children at risk for developing Osteomyelitis include those with diabetes, chronic renal disease, rheumatoid arthritis, a compromised immune system or blood disorders ( such as sickle cell anemia). If your child has any of these disorders he would be at increased risk for developing Osteomyelitis. In general the long term complications of Osteomyelitis may include recurrent infection and gait abnormality.(3) Therefore in regards to your question about the probability of developing another bone infection, the chances are higher if he has any of these underlying problems.

Although it can be quite worrisome thinking about the possibility that your child may develop another bone infection, you are in a much better position now that you have experience with the problem. Your familiarity with Osteomyelitis will help you identify symptoms early which will result in proper diagnosis and early treatment. Addressing symptoms such as pain, limp, refusal to walk, fever and limited movement and bringing them to your Doctor’s attention will help your son get the care he needs to recover quickly.

(1) Wilson S, Leonard K, Luchs J, Sena V. Acute Osteomyelitis: Radiographs vs. MRI. Consultant for Pediatrics. 2006;May: 283-284.
(2)Green NE, Edwards K. Bone and joint infections in children. Orthop Clin North Am. 1987;18(4):555-576.
(3)Osteomyelitis. Pediatric Annals. 2006;35(2):113-122.
(4)Bellack J, Bamford P. Nursing Assessment, A Multidimensional Approach. 1984. Belmont California: Wadsforth Inc:283-285.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Answers to Questions about Childhood Illnesses