The differential diagnoses for this case scenario should include the possibility of a bone tumour, infection, a seronegative arthropathy, an injury or nonspecific leg pains.
Jessie is a 3-year-old girl who is usually well and happy. Over the past three months, she has been waking up almost every night crying and telling her parents that she has a sore leg. She identifies the area of pain in the same calf all the time and is very reluctant to let her parents touch it. Jessie resists any attempt to allow her calf to be massaged, or even handled to see if she in fact has a cramp. She can be in pain for up to an hour, but eventually settles back to sleep after warm milk and paracetamol. During the day, she is active and does not limp, the leg looks totally normal and she is quite happy to allow her leg to be examined.
What is the most likely cause of Jessie’s pain, and how should it be managed?