Bone Infections in Toddlers, or How My Son Learned to Love Doctors

If you find yourself in the unenviable position of having a child with a bone infection, otherwise known as “osteomyelitis,” our story might help you. It’s frightening whenever your little one is sick, and something as ominous-sounding as a bone infection is certainly enough to keep you on edge.

A few points to start:

  • Noodle was 2 years and 3 months when he got his bone infection.
  • It’s not your fault. The bone infection is a staph infection that gets into the blood and settles in a bone. Kids’ immune systems aren’t up to scratch to fight these kinds of infections, so it’s more common in kids than adults. Basically, if your kid got a bone infection, you won the germ lottery. Lucky you.
  • The treatment is long because, as one doctor put it to us: as hard as it is for an infection to settle into a bone, it’s just as hard for anti-biotics to get in there and clear it out. It takes a while. Be patient.
  • As long as you’ve gotten treatment within a reasonable amount of time, there will not likely be any long-term problems associated with the infection.
  • Though they usually appear around joints or where there is rapid bone growth, they can appear in strange places, as they did for Noodle. His infection was in a couple of bones on the top of his left foot.
  • If you have further questions, please ask.
Our story:

May 2012

Auckland Domain

Noodle played happily with his friends, running around in the bushes, chasing ducks, climbing trees. His mom thought that she noticed him walking a bit funny. But sometimes he skips when he runs because he’s so darned happy all the time. I thought little of it.

Café in Bayswater

By mid-morning, after playing at the coffee shop with some friends — it’s common in New Zealand to have separate play areas for kids in cafés — Noodle was noticeably limping. This was alarming, but it seemed reasonable enough that he might have twisted his ankle or something; he had been playing hard with his friends the previous day, right? (And so the rationalizing begins!)

At this point, it’s important to know your child’s limits and reactions to pain. Noodle is a Stoic. He rarely ever complains if something hurts, unless he’s sick. At this point, he was not complaining, but we knew that there might be something more afoot, so we decided to watch him carefully.


Noodle usually wakes up and comes into our room. He did. But he crawled. Still no complaint from him, but he wouldn’t put weight on his left foot. This is cause for alarm. We felt the foot and it was a bit swollen and warm. To me, this = sprain. But, come to find out, it’s rare for a toddler to sprain anything, as their tendons are so malleable at this age.

We decide to take him to the doctor.

The doctor examines him, pushes on his foot, moves it around. No complaints. Noodle sits and plays with the toys in the office while the doctor talks to us about what might be going on. He determines that we should “wait and see,” because sometimes, in his experience, strange things crop up in kids and just sort of go away. Noodle’s temperature is normal. The doctor points out that our main concern is infection, but there is no wound on the surface of the skin, so it doesn’t appear, superficially, that he has an infection.

I’m not wholly satisfied with this, but OK. (At this point I had no idea what a bone infection was, so it didn’t even occur to me to insist on anything else.)

Emergency Room, Starship Children’s Hospital

Noodle’s Mom took him back to the doctor on Wednesday afternoon, because there had been no improvement. This time, we saw a different doctor, and she was more alarmed than the previous doctor. She recommended that we take him to Starship Children’s Hospital — the kids’ emergency room part of it.

I’m starting to think: are you even sure what you’re looking at? First it seems normal and that kids swell up from time to time, now there’s a genuine fear of infection and “sepsis” of the joints. Internet research reveals that such things cause agonizing pain, so I think — really?

We arrived at the ER at about 7 PM. To make a very long story short, after a blood test and several communication breakdowns between us and the staff, we were told that the test was normal, but that she is going to talk to someone else …. I drifted off. What?? Everything is normal? Are you even serious?? I fade back into the conversation and hear something about keeping him overnight. What?? You can’t tell us what even might be wrong and you think I’m going to leave him with you?? Nope.

We left. They were not happy with this result, but we had talked it over and we decided that we would take him to a private practice the next day and deal with it out of pocket.

Emergency Room, Starship Children’s Hospital

On Thursday, we had called back to the regular doctor. We asked her for a reference to a private pediatrician so that we could have a proper blood test done and get some real answers. She gave us some phone numbers and said she would track down the results of Noodle’s ER test to get some more details of what they found.

There were no private pediatrician appointments until Friday, and Noodle’s condition hadn’t gotten any worse, so we figured we would wait the one more day.

On Friday morning, I got a phone call from the supervising doctor at the Emergency Room. She gave me the results of the test, saying there were not in fact normal — we had been misinformed — and suggested that we come back for a follow up so that she could make a better determination of what’s going on. That sounded reasonable.

We returned and it was a completely different place. Everyone was helpful, told us what was happening, what they were looking for with the tests. Long story short, the second test came back with an elevated inflammation level (I forget what the official name for it is.) The attending pediatrician sent for the orthopedist.

Dr. Bob, a study in medical competence, explained exactly what he would look for, what he would do if it were his kid, what he recommended doing — an x-ray to see if there’s a sign of infection — and he put our minds at ease. “Bone infections are common.” We would hear this often in the next couple of weeks.

The x-ray indicated that there was indeed something amiss in a bone, and the next step was a bone scan. They admitted us to Starship, which is an absolutely spectacular hospital, let me add. Noodle got a room, shared with a few other kids, and they called in a technician to do the bone scan after hours; they were, shall we say, concerned about Noodle.

Now, as a parent, do you think to yourself, hey this is amazing medical service, or do you think, holy shit they’re calling someone in on his day off! I tend to be more alarmed than assuaged by such things, so I was alarmed.

First Noodle had to get a radioactive injection so that his bones would show up on the scan. The technician who saw us was amazing. He explained all the science to me, answered every question I had, and described exactly what Noodle would be up against if it proved to be a bone infection — which was looking increasingly likely.

The bone scan was a bit of a nightmare. They took six angles, and each required Noodle to stay still for five minutes. He’s a wiggler. This was not easy. And it was heartbreaking to hear him crying “Daddy! Help me!!” while he was strapped to the machine. But what is a daddy to do? Whisk him home and cuddle him and hope the infection takes its course — or take the chance that it’s not an infection? No way. I had already read about bone infections and the long term effects they can have on kids, and I was not going to take that kind of risk with Noodle. He’d have to ride out the scan. (He now remembers the bone scan machine fondly.)

The scan indicated what we all expected: osteomyelitis. So a course of antibiotics was agreed upon. He was to stay in the hospital at least through the weekend, and until the blood indicators started moving in the other direction. That is, he would stay until it was clear that the antibiotics were doing their job. And we’re talking IV antibiotics here. This ain’t no joke. Every six hours, he was to have an infusion.

Bone infection treatment takes weeks, and having an IV in one’s hand for weeks is untenable. They suggested a PICC line, which is a small tube that goes up the arm and dumps out right near the heart. In order to put this in the little guy, they would need to put him under. Eeeek!! But at the same time, they would like to do an MRI to get the clearest possible look at the bones. And, they wanted to look for pus in the joint, which would indicate that the infection had spread, which means they would want to drain it. Also, they would get a sample and try to grow it to determine exactly which bacteria we were up against.

That’s a lot to take in all at once. But there’s no rest once this process is in motion. Off we went.

The Next 12 Days
Starship Children’s Hospital

Let me say first that the nurses at Starship are amazing. They see lots of bone infections, since it is, by all accounts, “common,” and so they knew just what we were going through and just what to say and do. The weekend was somewhat uneventful, since Noodle felt OK, but just had to be there every six hours for his infusion.

Monday was his MRI and PICC line. Again, all the processes were explained clearly, and all went well.

Dr. Bob was always willing to stop and chit chat, and his ability to put things in plain language is second to none that I have met in medicine — except Noodle’s Great Uncle Ed. Day to day we usually saw Dr. Bob; only occasionally did Mr Field pop over to remind the bacteria that it had no chance against the battle he was orchestrating against it. Given this, when Noodle thinks of doctors now, he thinks of “Dr. Bobs! Dr. Bobs!” In fact, to this day he talks about Dr. Bob. If he bangs his knee and cries, I ask him if we need to go to the hospital. “Yes, and see Dr. Bobs.”

The week dragged along slowly. The PICC line helped because now they could infuse the antibiotics quickly. The MRI gave a clearer picture and confirmed what we all suspected. The samples from his foot failed to grow bacteria in the lab, but my understanding is that only about half the samples ever do.

We started talking to the researchers. There are debates about whether you need to stay on IV antibiotics for 4 – 6 weeks, or whether orals work just as well. The researchers were conducting a trial to see; there have been successful trials elsewhere, but this was the first in New Zealand. We elected to get involved in the trial, because we couldn’t imagine Noodle wiggling constantly with a PICC line and bag of antibiotics strapped to him for a month. We ended up in the oral arm of the trial rather than the control arm — lucky us. Orals would start once blood tests indicated that the infection was under control with the IV. Then a few days of monitoring on orals and we could go home.

During the week, Noodle started spiking high fevers. This was not unexpected, but scary nonetheless. Also, at his age, he was not doing well in a shared room with older kids. The afternoon nap was rarely successful, and his early bed time and generally screamy nature at this point wasn’t helping the other kids heal any quicker either. The nurses — did I mention how awesome they are — got him into a private room, and things started looking up.

Again, this whole process takes patience. The attending physicians see you once a day. You get antibiotics every six hours. In between, what do you do?

I imagine that in the US, we would have been confined to the ward, which would have driven Noodle out of his tree. Instead, as Dr. Bob put it, they only need to see us at certain times, so if we want to go out on little adventures, go ahead. So we did. A few times we took the boy back home to play with his familiar toys. We went to the Domain, to MOTAT (a local museum with trains!!), visited his friends. New Zealand is a pretty laid back place, and this attitude extends to Starship as well.

Eventually, Noodle’s blood numbers looked good. We got a release date. All went smoothly. The oral antibiotics were working well. Off we went.

Back Home

After such a grueling 12 days, we were glad to be back home. But there was more to be done. We had to administer the antibiotics at exactly the right intervals, keep a record of it, get regular blood tests, and lots and lots of follow up visits — with the researchers and with the osteopaths separately. We continue to be impressed at how conscientious Kiwi doctors are with follow up and with making absolutely certain that you are healed. Good on them.

Noodle had two follow up x-rays. One after about a month. All looked good. Another after 3 months. At our last visit, Mr Field, the head of the pediatric osteopathic department, saw us and he took all the time I wanted to show me the x-rays, explain what we were looking at, what he was looking for, and to assure me that the little guy should have no long-term problems. There have been none. Infection cured.


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