severe pain, neurovascular compromise or ill appearance should be evaluated more emergently Patients should have a temperature and pain severity documented Analgesics should be administered early, as indicated With concern of septic arthritis, the child should be made NPO Initial Assessment/H&P The history should focus on the location of joint pain, its duration, and relation to movement Pain due to septic arthritis is typically constant or increasing over time The clinician should inquire about local injuries that may identify a traumatic cause for the symptoms or penetrating injuries that may predispose to joint infection A prior history of rheumatoid disorders, sickle cell disease, or joint surgery should be obtained Sexually active teenagers are at risk for gonococcal arthritis The presence of rash may suggest juvenile idiopathic arthritis (JIA) or a viral etiology for the joint pain Both recent antibiotic use and immunization status may influence diagnostic testing and antibiotic selection Range of motion around the affected joint is dramatically reduced Any degree of movement causes great distress and is vigorously resisted Many clinicians rely on this aspect of the evaluation more than any other in differentiating infection from alternative causes of joint pain Clinical signs are more subtle in the neonate or young infant with a septic joint Nonspecific findings such as septic appearance, irritability, and pseudoparalysis of a limb are common presenting findings in these ages Parents may note excessive irritability associated with diaper changes in the infant with a septic hip The child with a septic hip will typically hold the hip flexed with the lower extremity in abduction and external rotation in order to decrease intracapsular pressure ( Fig 121.3 ) Close observation, and isolated manipulation of each joint will help identify the particular area of involvement