The site of infection could be anywhere in the body, but most commonly in the metaphysis of long bones. So osteomyelitis tends to occur near the joints of the limbs. The child presents with acute pain near a major joint of the limb , associated with high fever. The typical patient looks sick. Blood tests often show elevated white blood cell count as well as high sedimentation rate and C-reactive protein.
Blood culture is done to identify the responsible bacteria.
Local aspiration of the site is also sometimes useful to identify the bacteria involved. When a diagnosis of osteomyelitis is made, the child should be admitted to the hospital and started on intravenous antibiotics immediately. A response, indicated by settling of the spiking fever and decrease in local pain and tenderness, should be obtained in 24 to 48 hours. If there is no response after this time, serious consideration should be given to surgically explore and decompress the osteomyelitis. Intravenous antibiotics are given for about 3 weeks, followed by oral antibiotics for another 3 weeks.