Zero to Finals

Migratory large-joint inflammation, carditis, erythema marginatum, subcutaneous nodules or Sydenham chorea may appear two to four weeks after streptococcal pharyngitis. Diagnosis combines evidence of recent infection with the Jones criteria, followed by anti-inflammatory treatment, penicillin and long-term recurrence prevention.

Persistent fever for more than five days with rash, non-purulent conjunctivitis, oral changes, cervical lymphadenopathy or red swollen hands and feet should prompt assessment for Kawasaki disease. Coronary artery risk drives echocardiography, intravenous immunoglobulin, high-dose aspirin and repeated cardiac follow-up.

Palpable non-blanching purpura over the legs and buttocks, joint pain and abdominal symptoms suggest immunoglobulin A vasculitis in a child. Immediate assessment must still exclude dangerous alternatives, while urine testing, blood pressure monitoring and prolonged follow-up identify renal disease that may otherwise remain clinically silent.

Joint hypermobility becomes clinically important when it accompanies pain, recurrent dislocation, bruising, abnormal wound healing, autonomic symptoms or vascular warning signs. Beighton scoring, subtype recognition and multi-system assessment guide differentiation, while management centres on strengthening, function, pacing and treatment of associated postural orthostatic tachycardia syndrome.

Persistent joint pain, swelling and stiffness in a child should prompt assessment for inflammatory arthritis, with joint count, symmetry and systemic features helping define subtype. Systemic juvenile idiopathic arthritis, macrophage activation syndrome, enthesitis and silent anterior uveitis carry distinct implications for escalation and multidisciplinary care.

Paediatric and trauma-and-orthopaedic clinicians get a focused review of recurrent fractures after minimal trauma. Blue-grey sclera, joint hypermobility, short stature, dental fragility, bone deformity and hearing loss support recognition of a type 1 collagen disorder requiring coordinated multidisciplinary care.

Paediatric, adolescent-health and orthopaedic clinicians get a focused review of activity-related anterior knee pain. A tender tibial tuberosity lump and pain with resisted knee extension support the diagnosis, while activity modification, ice, anti-inflammatory analgesia and later physiotherapy guide management.

Paediatric, orthopaedic and genetics teams get a focused review of FGFR3-related achondroplasia. Disproportionate short stature, proximal limb shortening and characteristic craniofacial features are connected to surveillance for foramen magnum stenosis, hydrocephalus, obstructive sleep apnoea, recurrent middle-ear disease and spinal complications.

Paediatric, endocrine and orthopaedic clinicians get a focused review of defective growth-plate mineralisation. Delayed walking, poor growth, wrist swelling, bowed legs, bone pain and pathological fractures are linked to vitamin D, calcium and phosphate assessment, wrist or knee imaging, supplementation and specialist referral.

Paediatric and orthopaedic clinicians get a focused review of newborn hip screening, acetabular underdevelopment and femoral-head instability. Defined breech presentation or first-degree family history can require ultrasound despite a normal examination, while a true clunk, restricted abduction, asymmetry, limp or delayed walking should prompt imaging and specialist assessment.