Pain

Musculoskeletal infections in children include osteomyelitis, septic arthritis, and pyomyositis. Most of these infections are bacterial. Staphylococcus aureus is the most common organism in children in all age cat-egories. Others include group A Streptococcus, Neisseria meningitidis in purpura fulminans, Streptococcus pneumoniae, Neisseria gonorrhoeae, Mycobacterium tuberculosis, and Borrelia burgdorferi.

Infants and toddlers will put just about anything into their mouths. Each year in this country, between 100,000 and 200,000 incidents of foreign-body ingestions are reported to poison control centers.1,2 The large majority of ingestions are accidental. (In adolescents, ingestions are usually intentional.)

A 17-year-old boy with no history of foot problems decided to try some new moves with his skateboard on a steep ramp. Midway down the ramp, he tumbled head over heels and landed with most of his weight on his plantar-flexed right foot.

A 9-year-old girl was hospitalized because of a painful, vesicular rash on her genitals, groin, and buttocks. There was also concern about possible genital herpes infection in a minor.

A 12-year-old girl complains of left knee pain and swelling that resulted from a collision with another player while she was playing kickball the day before. Her left foot was planted as she tried to catch a ball, and she was hit on the outside of the left knee. She fell to the ground and was unable to walk on the injured leg; overnight, the knee became more swollen and painful.

"Headaches" is the chief complaint. Acne was the problem last year for 17-year-old Michelle. Otherwise her history is unremarkable. What's causing these daily headaches?