Difficulty of Changing Diapers in a Toddler

Abstract

A 19-month-old boy presented with a two-week history of arching of the back while walking, which progressed to the inability to bear weight followed by the inability to sit. His mother noticed he was screaming in pain whenever she changed his diaper. He had no history of fever, chronic cough, travel, animal exposure, drinking unpasteurized milk, or sick contacts. His immunization was up to date. He had been sitting and walking since seven and 11 months old, respectively. On physical examination, he was afebrile, and all his vital signs were within normal limits. He was keeping his leg flexed and externally rotated bilaterally. He had a normal tone and reflexes in all his extremities. There was no apparent erythema, swelling, or tenderness in his lower limbs. No restriction of movement of both the knee and hip joints. He was refusing to bear weight on his lower limbs. The spine examination showed no skin changes, swelling, or spinal deformity. He had tenderness of the lumbosacral area on palpation. His white cell count was 12.9 × 10^9/L, C-reactive protein was 12 mg/L, and the X-ray of his lower limbs was reported to be normal.

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