Many children have musculoskeletal pain. These symptoms are relatively common, occurring in 4–30% of children in a non-clinic setting,1 whereas Allen found that 1.6% of children attending the children’s emergency/ambulatory department at the Royal Children’s Hospital in Melbourne presented with a non-traumatic muscle or joint problem.2 The British Paediatric Rheumatology Group (BPRG) has reported that of 4948 cases on their register, 40% of children had a diagnosis of juvenile chronic arthritis, 24% had mechanical/orthopaedic disorders, and 29% a diagnosis of ‘other’, which would include many with pain syndromes.3 It has been reported that the three most common recurrent pains in childhood are head pain (15–20% of children),4 5 abdominal pain (10–15%),4 6 and limb pain (15%).7 These figures therefore put musculoskeletal pain as among the most common forms of pain in childhood8 and this frequency (15 000/100 000 children) contrasts with the incidence of juvenile chronic arthritis of 14–16 per 100 000 children under 16 (0.015%).

Rosenberg, in his review from his clinic over a seven year period, noted over 100 different disorders presenting with musculoskeletal symptoms.9 Thus the high incidence of such symptoms in the general paediatric population is reflected in the BPRG figures, which show that paediatricians and rheumatologists with an interest in rheumatological disorders of childhood have a significant number of referrals that are not due to truly inflammatory rheumatological disorders.