Q) Dear Dr. Gwenn:

My 3 yr old had an injury to her left foot. It is still has some swelling and she limps pretty bad in the morning, when it’s cold, or she has to run. We have taken her to her pediatrician 2 times. The first time and X-ray was done and no fracture could be detected. The second time was because 6 weeks had passed and no improvement. I would say it is getting worse now and we are on the 9th week.

What do you suggest? I’m a very tired mom from having her beg to be carried all the time. We have it wrapped and on Motrin (i.e. generic ibuprofen), but it’s just not improving.

Thank you for your help.
LK

A) Dear LK:

Thank you for asking this very important question.

At any age, whenever a medical situation doesn’t resolve as expected or is getting worse, that situation needs to be re-evaluated by your original physician, in this case your child’s pediatrician. The re-evaluation is essential to not only see what may have changed from the initial visit but look for new diagnoses that may not have been able to be diagnosed at the original visit. This visit is also an important touch point to help decide if it’s time to consult a specialist at one of the major medical centers.

You are most definitely at the point of needing a full re-evaluation but likely the input of a specialist. Call your pediatrician to arrange an in-office evaluation with a repeat examination. During that visit, discuss what labs and x-rays have been done in the past and whether those should be repeated. Also discuss whether a pediatric rheumatologist or orthopedist would be helpful to see at this stage as both specialize in swollen joints. Your pediatrician can guide you best as to which specialist would be best for your child based on your child’s actual exam and lab test results.

In the mean time, keep doing what you are doing. It may not look as if the Motrin is working but very likely your daughter would feel a lot worse if you stopped it.

I hope your daughter feels better soon.

Dr. Gwenn