Department of Pediatrics
University Hospital
Hadassah Ein Kerem, Jerusalem
Parent Information Sheet
Acute Osteomyelitis
Welcome to the Children’s Ward!
Your child was admitted to our department for osteomyelitis, which is an infection
and inflammation of the bone, we understand the physical and emotional difficulties
that occur when a child is hospitalized and will try to ease you to stay as best as we
can.
Inflammation is a very severe contamination that may affect any bone but generally
affects the long bones, so it is more common in the limbs. The most common
incidence of this disease is in children 12 years or younger.
What are signs of osteomyelitis?
The most common signs:
* Lameness - is the most common complaint (in 30% of cases there are no other
complaints).
* Tenderness or pain of the inflamed area, limitation of movement or inability to
move the limb.
* Swelling, redness and local heat around the area of inflammation.
* Increased body temperature.
What are the causes of the infection?
In most cases bacteria cause the infection.
1. Source - the infection can be elsewhere in the body (such as diarrhea or strep
throat) and can pass around the body through the blood to the bones.
2. Entering the bone - Infection can occur through the wound or through a break in
the bone so that the bacterium can enter it can sit in bone causing an infection.
How to diagnose Osteomyelitis?
Check with a doctor, who will examine and measure the child's condition. The
doctor will ask also consult an orthopedic doctor whose specialty is treating bone.
Blood tests:
1. Blood count: This test can indicate inflammation in the body. Using the number of
white blood cells (leukocytes) whose job is to "fight" infection.
2. ESR (Erythrocyte Sedimentation Rate) - This test checks the sink rate of red blood
cells in vitro, and measures the distance between migrated cells for an hour. The
normal rate is between 5-20 mm. High values may indicate a direction of infectious
and inflammatory diseases.
Hadassah Medical Center, POB 12000, Jerusalem 91120
Phone. 02-6776465 Fax. 02-6434579
Department of Pediatrics
University Hospital
Hadassah Ein Kerem, Jerusalem
3. CRP: This test measures the proteins causing inflammation (there is overlap
between this test and ESR so they are both not always performed). There is usually
no such protein in the blood, so it indicates an infectious process going on in the
body.
4. Blood culture: This is a test done to determine if there is growth of bacteria from
the blood.
Bone scans
What is the test?
This is a noninvasive imaging test and is not painful. The purpose of the test is to
find areas of skeletal bone injury as a result of infection, injury, etc. The test is
performed by injecting a radioactive material directly into a vein. The material
specifically concentrates exclusively in organs and tissues of the body that undergo
a process of inflammation. It is possible to identify the location of the material in the
body using a camera called a gamma nuclear camera. A Gamma camera projects the
subject, but receives the minimum radiation emitted from the body.
How is the test performed?
The test is usually divided into two parts:
Part One: The radioactive material is injected through the IV.
Then wait two to three hours for the material to be absorbed by tissues. At this time
you should encourage your child to drink plenty of fluids in order to have a good
dispersion of the material in the body.
The second part: photographing the body, which is used in order to discover
whether, where, and how deep inflammation occurs. There is no extra radiation
given off by repeating this because these photos use the radiation emitted from the
body.
Duration of the photography: from 30 to 90 minutes depending on the medical
question and the child's age. Some of the tests extended and therefore you should
bring a toy or game to calm the child.
When is the test performed?
It should be performed as soon as possible. Usually in the second or third day of
hospitalization. Examination is urgent but testing is not performed on weekends.
Extended and applied antibiotic therapy does not affect results.
Where is the test performed?
The test is performed in the hospital – at the main area or the second floor.
Hadassah Medical Center, POB 12000, Jerusalem 91120
Phone. 02-6776465 Fax. 02-6434579
Department of Pediatrics
University Hospital
Hadassah Ein Kerem, Jerusalem
Who can be with the child during the examination?
A parent may stay with the child during the test.
In principle there is no prohibition to pregnant women and mothers to spend time
with the patient. However it is advisable to avoid it and find someone else to
accompany your child. (The hospital cannot worry about an alternative custodian).
Pregnant women who stay with their children are asked to keep a distance of 5 feet
from their children, during the test and for the first three hours after it. Most of the
radiation is fed into the kidneys and is excreted through the urine. Therefore it is
important that a pregnant woman will not be changing diapers during these hours.
Clarification – If the appropriate distance of 5 feet is kept between the mother and
her child their no danger of radiation exposure.
What is important after the test?
The child should drink a lot in order to expedite the removal of radiation from the
body, if the child does not drink enough the doctor and nurse may consider giving
liquids intravenously.
Be sure and throw the diaper in the trash room during the three hours after the test.
So far we discussed the tests.
What is actually the recommended treatment of inflammation?
The treatment of Osteomyelitis is prolonged antibiotic therapy. The treatment lasts
about six weeks, including 2-3 weeks inpatient intravenous therapy and other
treatment of oral treatment at home. Antibiotic treatment depends on the type of
pathogen bacteria, and duration of treatment depends on the rate of improvement
and will be determined on an individual basis.
Is it possible to give the child the antibiotic treatment at home?
It is possible to go home with intravenous antibiotics given by parents, only with the
consent of HMO, and the following of a number of conditions:
• After clinical improvement of the child's condition (temperature dropped, the
child returned to normal activity, and a decrease of inflammation shown in blood
tests)
• If the parents are willing and ready to take responsibility for the treatment of
intravenous antibiotics
• A child who weighs over 15 kg.
• A child with large vein access
• Lower weight children should consider continuing their treatment with a home
care team, depending on the circumstances.
Hadassah Medical Center, POB 12000, Jerusalem 91120
Phone. 02-6776465 Fax. 02-6434579
Department of Pediatrics
University Hospital
Hadassah Ein Kerem, Jerusalem
• If more then 5 days of home care remain
If your child fits into those conditions then the nurse will give you detailed
instructions of everything you need to know to provide healthcare at home.
Are there complications?
At the end of the treatment period the child is expected to have a complete recovery
and without complications in the majority of cases. Very rarely when complications
arise surgical intervention may be needed to clean the bone.
The department staff is at your disposal; they are ready to answer any questions or
requests you may have.
Wishing you a speedy recovery
Staff Department of Pediatrics
Hadassah Ein Kerem
Hadassah Medical Center, POB 12000, Jerusalem 91120
Phone. 02-6776465 Fax. 02-6434579