Reflex sympathetic dystrophy (RSD), an unusual diagnosis in general paediatrics, is well recognised by paediatric rheumatologists. This study reports the presentation and the clinical course of 46 patients (35 female, age range 8-15.2) with RSD. The patients saw professionals from an average of 2.3 specialties (range 1-5). Twenty five (54%) had a history of trauma. Median time to diagnosis was 12 weeks (range 1-130). Many children had multiple investigations and treatments. Once diagnosis was made, treatment followed with physiotherapy and analgesics. Median time to recovery was seven weeks (range 1-140), with 27.5% relapsing. Nine children required assessment by the child and adolescent psychiatry team. This disease, though rare, has significant morbidity and it is therefore important to raise clinicians' awareness of RSD in childhood. Children with the condition may then be recognised and referred for appropriate management earlier, and spared unnecessary investigations and treatments which may exacerbate the condition. (Arch Dis Child 2000;82:231-233) Keywords: reflex sympathetic dystrophy; complex regional pain syndrome Reflex sympathetic dystrophy, a disorder characterised by severe and continuous pain in an extremity associated with vasomotor instability, was first described by Mitchell in 1864 during the American Civil War.1 It is a well recognised diagnosis in adults but, although it occurs in children, is rarely mentioned in paediatric textbooks. Before 1978 only eight cases had been reported. [2][3][4][5][6] It is still probably underrecognised and underdiagnosed in children.Since it was first described there has been much disagreement about the condition. It has been given a number of diVerent titles, such as algodystrophy, Sudek's atrophy, causalgia, sympathetic maintained pain syndrome, and hand-shoulder syndrome.7 More recently, a revised taxonomic system for these disorders has been developed, and what we shall refer to in this paper as reflex sympathetic dystrophy (RSD) is now known as chronic regional pain syndrome type 1 (CRPS 1). 8Since it was first described in paediatric patients, it has been realised that there are differences in presentation and treatment responses between adults and children. Generally, there is less often an antecedent history of trauma or surgery in children who develop RSD, and the outlook for recovery is better than in adults.9 Children rarely appear to develop trophic changes. 10 11 Psychological factors are thought to have a major role in the cause of this syndrome. 12The diverse symptomatology of RSD leads it to cross a wide spectrum of clinical disciplines. The resulting varied modes and routes of presentation may lead to a delay in diagnosis. Failure to recognise the condition may lead to unnecessary investigations and treatment, which may even exacerbate the condition.We report the clinical course and treatment response of 46 children with RSD, presenting to a large children's hospital in the north west of England. This study aimed at determining the ...

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