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In the United States, some children spend years in pain before anyone figures out what is actually wrong. Pediatric orthopedic specialists are in short supply, and in more complex areas like hip preservation, they are even harder to find. That gap in care means conditions that could be treated early often go unnoticed until they become much harder to fix.
Dr. Sivashanmugam Raju sees the impact of that delay every day. As a pediatric orthopedic surgeon who focuses on hip preservation, he works with children from across multiple states who are still searching for answers long after their symptoms first appeared. Many arrive after a long stretch of uncertainty, when what started as something subtle has already changed how they move and live.
“One of the cases that stayed with me early in my practice involved a child who presented with what seemed like a simple issue—unilateral toe walking,” he said. “However, on closer evaluation, the child was found to have a unilateral hip dislocation that had gone undiagnosed.”
Kids do not always describe pain clearly, and early signs can look like something parents and providers see all the time. A limp that comes and goes. Knee pain that does not seem connected to the hip. Or discomfort that gets written off as growing pains. But the cost of missing those early signs can build over time.
“A delayed diagnosis is not just a clinical issue; it is a lived experience for families,” Dr. Raju said. That experience often means repeated visits to different providers, time off work for appointments, and the stress of not knowing why a child is struggling. For the child, it can mean pain that limits activity such as missed time on the field or playground.
Conditions like developmental dysplasia of the hip can sometimes be treated early with relatively simple measures. When they are missed, treatment may require complex reconstruction. Other conditions can show up in ways that are easy to misread, like knee pain that actually stems from the hip. By the time the correct diagnosis is made, the underlying issue may have progressed significantly.
Part of the challenge is how quickly symptoms are dismissed. Growing pains are often used as an explanation, but that label should come with caution and more serious options should be ruled out first. “‘Growing pains’ are real, but they are a diagnosis of exclusion,” Dr. Raju said. Persistent pain, limping, or uneven movement are all signs that deserve a closer look. When those signals are missed, the window for simpler treatment can close.
At the pediatric hip preservation clinic Dr. Raju established at a major Midwest research university, families are finally getting that closer look. The clinic brings together expertise across pediatric orthopedics, sports medicine, and joint reconstruction to evaluate the full picture of a child’s condition. That kind of comprehensive approach is not widely available, which is why families often travel significant distances to be seen.
For some children, getting the right diagnosis in time can prevent long-term damage, including early arthritis and repeat surgeries. For others who arrive later, the goal shifts to managing a more complex situation.
When kids cannot move the way their peers do, they often start to pull back. Sports and social activities are no longer fun and their confidence takes a hit. Over time, that can shape how they see themselves and what they believe they are capable of doing.
The cases Dr. Raju sees are not isolated and reflect a broader issue in how pediatric care is accessed and delivered. Too few specialists, combined with administrative hurdles and fragmented care pathways, can delay the kind of evaluation that changes outcomes.
Dr. Raju’s work focuses on early recognition and targeted treatment, and his approach helps reduce long-term complications and the need for more invasive care later in life. His research, published in leading orthopedic journals, also contributes to how other physicians approach similar conditions, extending that impact beyond a single clinic.
When care comes together at the right moment, it can change the trajectory of a child’s life. And if that kind of approach becomes more widely available, it has the potential to reshape how pediatric orthopedic conditions are treated across the country, one diagnosis at a time.
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